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Related to NebuPent: Pentamidine isethionate
NebuPent, Pentacarinat (UK), Pentam 300
Pharmacologic class: Antiprotozoal
Therapeutic class: Anti-infective
Pregnancy risk category C
Unknown. May interfere with nuclear metabolism and synthesis of DNA, RNA, and proteins.
Aerosol: 300 mg
Injection: 300 mg/vial
⊘Indications and dosages
➣Pneumocystis jiroveci pneumonia
Adults and children ages 5 and older: 4 mg/kg I.V. or deep I.M. daily for 14 days
➣ To prevent P. jiroveci pneumonia in high-risk patients with human immunodeficiency virus
Adults: 300 mg by inhalation once q 4 weeks using Respigard II nebulizer
• Visceral leishmaniasis
• History of anaphylaxis from pentamidine or diamidine compounds (inhalation only)
(Note: No absolute contraindications exist for patients with P. jiroveci.)
Use cautiously in:
• anemia, blood dyscrasias, hepatic or renal disease, hypoglycemia, diabetes mellitus, ventricular tachycardia, hypocalcemia, hypertension, hypotension
• pregnant or breastfeeding patients
• children (safety and efficacy of inhalation solution not established).
• For I.V. infusion, dilute 300 mg-vial with sterile water for injection. Withdraw prescribed dosage, then dilute further in 50 to 250 ml of dextrose 5% in water; infuse over 60 to
• For I.M. use, dilute 300 mg-vial with 3 ml of sterile water for injection. Withdraw prescribed dosage; administer deep I.M. using Z-track method.
• Keep patient supine during I.M. or I.V. administration to minimize hypotension.
• For inhalation, dilute in 6 ml of sterile water and administer through nebulizer at a flow rate of 6 L/minute from 50-psi compressed air source. Don't mix inhalation solution with other drugs.
CNS: headache, disorientation, hallucinations, dizziness, confusion, fatigue, neuralgia
CV: chest pain, ECG abnormalities, syncope, vasodilation, vasculitis, phlebitis, hypertension, palpitations, arrhythmias, severe hypotension
GI: nausea, vomiting, diarrhea, abdominal pain, anorexia, acute pancreatitis
Hematologic: anemia, leukopenia, thrombocytopenia
Metabolic: hypocalcemia, hypergly-cemia, hypoglycemia, hyperkalemia Musculoskeletal: myalgia
Respiratory: cough, dyspnea, congestion, pneumothorax, bronchospasm
Skin: rash, night sweats, urticaria, sterile abscess or induration at injection site
Other: metallic or bad taste, fever, chills, pain at injection site or elsewhere, edema, allergic reactions
Drug-diagnostic tests.Blood urea
nitrogen, creatinine, liver function tests,
potassium: increased values
Calcium, hemoglobin, hematocrit,
platelets, white blood cells: decreased levels
Glucose: increased or decreased level
☞ Closely monitor blood pressure and blood glucose. Watch for arrhythmias and evidence of pulmonary infection, blood dyscrasias, and pancreatitis during and after I.M. or I.V. administration, until patient is stable. (Severe, life-threatening reactions may occur.)
• Assess I.V. site closely during and after I.V. administration. Know that sterile abscess, pain, or induration may occur at injection site.
• Evaluate neurologic status.
• Monitor CBC (including platelet count), calcium and potassium levels, and kidney and liver function tests.
• Explain purpose of therapy. Stress importance of completing entire course of treatment.
☞ Teach patient to recognize and immediately report serious cardiovascular and neurologic reactions, abdominal pain, and easy bruising or bleeding.
• Teach patient how to use aerosol.
• Tell patient to notify prescriber if infection worsens.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.
Pentam 300(trade name)
ClassificationTherapeutic: anti infectives
Time/action profile (blood levels)
|IV||unknown||end of infusion||24 hr|
Adverse Reactions/Side EffectsFor parenteral form, unless otherwise indicated
Central nervous system
- anxiety (most frequent)
- headache (most frequent)
Ear, Eye, Nose, Throat
- burning in throat
- bronchospasm (most frequent)
- cough (most frequent)
- arrhythmias (life-threatening)
- chest pain
- pancreatitis (life-threatening)
- abdominal pain
- drug-induced hepatitis
- unpleasant metallic taste
- nephrotoxicity (most frequent)
Fluid and Electrolyte
- anemia (most frequent)
- leukopenia (most frequent)
- thrombocytopenia (most frequent)
- urticaria at IV site IM:
- sterile abscesses at IM sites
- allergic reactions including anaphylaxis (life-threatening)
- stevens-johnson syndrome (life-threatening)
- chills (most frequent)
InteractionsInteractions listed for parenteral administration
Drug-Drug interactionConcurrent use with erythromycin IV may ↑ risk of potentially fatal arrhythmias.Additive nephrotoxicity with other nephrotoxic agents, including aminoglycosides, amphotericin B, and vancomycin.Additive bone marrow depression with antineoplastics or previous radiation therapy.↑ risk of pancreatitis with didanosine.↑ risk of nephrotoxicity, hypocalcemia, and hypomagnesemia with foscarnet.
Renal ImpairmentIntravenous (Adults) CCr 10–30 mL/min- Administer normal dose q 24 hr; CCr <10 ml/min- Administer normal dose q 48 hr.
Availability (generic available)
- Assess patient for infection (vital signs, sputum, WBC) and monitor respiratory status (rate, character, lung sounds, dyspnea, sputum) at beginning of and throughout therapy.
- Obtain specimens for culture and sensitivity prior to initiating therapy. First dose may be given before receiving results.
- Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome or toxic epidermal necrolysis. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia.
- Intravenous: Intramuscular: Monitor BP frequently during and following IM or IV administration of pentamidine. Patient should be lying down during administration. Sudden, severe hypotension may occur following a single dose. Resuscitation equipment should be immediately available.
- Assess patient for signs of hypoglycemia (anxiety; chills; diaphoresis; cold, pale skin; headache; increased hunger; nausea; nervousness; shakiness) and hyperglycemia (drowsiness; flushed, dry skin; fruit-like breath odor; increased thirst; increased urination; loss of appetite), which may occur up to several months after therapy is discontinued.
- Pulse and ECG should be monitored prior to and periodically during therapy. Fatalities due to cardiac arrhythmias, tachycardia, and cardiotoxicity have been reported.
- Assess patient for signs of pancreatitis (nausea, vomiting, abdominal pain, increased serum lipase or amylase) periodically during therapy. May require discontinuation of therapy.
- Inhalation: A tuberculin skin test, chest x-ray, and sputum culture should be performed prior to administration to rule out tuberculosis.
- Lab Test Considerations: IM, IV—Monitor blood glucose concentrations prior to, daily during, and for several months following therapy. Severe hypoglycemia and permanent diabetes mellitus have occurred.
- Monitor BUN and serum creatinine prior to and daily during therapy to monitor for nephrotoxicity. Concentrations may be ↑.
- Monitor CBC and platelet count prior to and every 3 days during therapy. Pentamidine may cause leukopenia, anemia, and thrombocytopenia.
- May cause ↑ serum bilirubin, alkaline phosphatase, AST, and ALT concentrations. Monitor liver function tests prior to and every 3 days during therapy.
- Monitor serum calcium and magnesium concentrations prior to and every 3 days during therapy; may cause hypocalcemia and hypomagnesemia.
- May cause ↑ serum potassium concentrations.
Potential Nursing DiagnosesRisk for infection (Indications, Side Effects)
- Pentamidine must be given on a regular schedule for the full course of therapy. Administer missed doses as soon as remembered. If almost time for the next dose, skip the missed dose and return to the regular schedule. Do not double doses.
- Intramuscular: Dilute 300 mg of pentamidine with 3 mL of sterile water for injection for a concentration of 100 mg/mL. IM administration should be used only for patients with adequate muscle mass and given deep IM via Z-track technique. May cause sterile abscesses.
- pH: 4.3–5.4.
- Intermittent Infusion: Diluent: To reconstitute, add 3–5 mL of sterile water for injection or D5W to each 300-mg vial for a concentration of 100, 75, or 60 mg/mL, respectively. Withdraw dose and dilute further in 50–250 mL of D5W. Solution is stable for 48 hr at room temperature. Discard unused portions.Concentration: Not to exceed 6 mg/mL for administration.
- Rate: Administer slowly over 1–2 hr.
- Y-Site Compatibility: alemtuzumab, alfentanyl, aminocaproic acid, anidulafungin, argatroban, atracurium, atropine, benztropine, bleomycin, buprenorphine, calcium gluconate, carboplatin, caspofungin, chlorpromazine, cisplatin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexmedetomidine, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxacurium, doxycycline, enalaprilat, epinephrine, epirubicin, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fludarabine, gemcitabine, glycopyrrolate, granisetron, hetastarch, hydromorphone, idarubicin, ifosfamide, irinotecan, isoproterenol, labetalol, levofloxacin, lidocaine, lorazepam, mannitol, mechlorethamine, meperidine, metaraminol, methoxamine, metoclopramide, metoprolol, metronidazole, miconazole, midazolam, milrinone, mitoxantrone, multivitamins, naloxone, nesiritide, nitroglycerin, nitroprusside norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, pamidronate, pancuronium, papaverine, pentazocine, phentolamine, phytonadione, potassium acetate, procainamide, promethazine, propranolol, pyridoxime, quinupristin/dalfopristin, ranitidine, rituximab, rocuronium, sodium acetate, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, tigecycline, tolazoline, trastuzumab, trimetaphan, vancomycin, vasopressin, verapamil, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
- Y-Site Incompatibility: acyclovir, aldesleukin, amikacin, aminophylline, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin/sulbactam, ascorbic acid, azathioprine, aztreonam, bivalirudin, bumetanide, butorphanol, cefazolin, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, clindamycin, dantrolene, dexamethasone, diazepam, diazoxide, digoxin, doxorubicin, ephedrine, epoetin alfa, eptifibatide, ertapenem, fluorouracil, folic acid, foscarnet, furosemide, gentamicin, heparin, hydrocortisone, indomethacin, insulin, ketorolac, linezolid, magnesium sulfate, methotrexate, methyldopate, methylprednisolone, morphine, nafcillin, nalbuphine, oxacillin, palonosetron, pantoprazole, pemetrexed, penicillin G, pentobarbital, phenobarbital, phenylephrine, phenytoin, piperacillin/tazobactam, potassium chloride, prochlorperazine, protamine, sodium bicarbonate, streptokinase, ticarcillin/clavulanate, tobramycin, trimethoprim/sulfamethoxazole, vecuronium
- Inhalation: If using inhalation bronchodilator, administer bronchodilator 5–10 min prior to pentamidine administration.
- Administer in a well-ventilated area.
- Administration with patient in supine or recumbent position appears to provide a more uniform distribution of pentamidine.
- NebuPent Dilute 300 or 600 mg (for prophylaxis or treatment, respectively) in 6 mL of sterile water for injection. Place reconstituted solution into Respirgard II nebulizer. Do not dilute with 0.9% NaCl or admix with other medications, as solution will form a precipitate. Do not use Respirgard II nebulizer for other medications.
- Administer inhalation dose through nebulizer until chamber is empty, approximately 30–45 min.
- Administer with the flow rate of the nebulizer at the midflow mark (5–7 L/min) over approximately 15 min until the chamber is empty.
- Inform patient of the importance of completing the full course of pentamidine therapy, even if feeling better.
- Intravenous: Instruct patient to notify health care professional promptly if signs and symptoms of pancreatitis, rash, fever; sore throat; signs of infection; bleeding of gums; unusual bruising; petechiae; or blood in stool, urine, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Patient should not be given IM injections or rectal thermometers. Caution patient not to drink alcoholic beverages or take medication containing aspirin or NSAIDs, as these may precipitate gastric bleeding.
- Caution patient to make position changes slowly to minimize orthostatic hypotension.
- Inhalation: Advise patient that an unpleasant metallic taste may occur with pentamidine administration but is not significant.
- Inform patients who continue to smoke that bronchospasm and coughing during therapy are more likely.
- Prevention or resolution of the signs and symptoms of PJP in HIV-positive patients.