Pentamidine
PENTAM
Pronunciation: pen-TAM-i-deen
What it isMacromolecular-biosynthesis inhibitor used IV for Pneumocystis treatment or inhaled for prophylaxis when preferred drugs fail.
Why this oneInhalation offers non-sulfonamide prophylaxis with less systemic exposure, while IV treatment reaches established disease.
What limits itParenteral use can cause fatal hypotension, dysglycemia, pancreatitis, renal injury, and arrhythmia; inhaled drug misses extrapulmonary sites.
FDA-approved for
- PCP pneumonia (~1984)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Treatment of Pneumocystis pneumonia (P. carinii) | Adults | 4 mg/kg IV or deep IM QD | 4 mg/kg QD × 14–21 days | 4 mg/kg QD |
| Treatment of Pneumocystis pneumonia (P. carinii) | Peds >4 months | 4 mg/kg IV or deep IM QD | 4 mg/kg QD × 14–21 days | 4 mg/kg QD |
Renal Undefined
Hepatic Undefined
Use only when Pneumocystis has been demonstrated. Therapy >21 days has been used but may increase toxicity.
Instructions
- Do NOT use sodium chloride for initial reconstitution (precipitates).
- IM: dissolve 300 mg vial in 3 mL SWFI; give calculated dose by deep IM injection.
- IV: dissolve in 3–5 mL SWFI or D5W, dilute in 50–250 mL D5W, infuse over 60–120 min (rapid IV increases hypotension risk).
- Incompatible with fluconazole and foscarnet IV solutions.
Available strengths
- inj 300 mg
- sol 300 mg/vial
- inhaler 300 mg/300 mg
Cautions
- Fatal severe hypotension (esp. rapid IV)
- Fatal hypoglycemia
- Fatal acute pancreatitis
- Fatal cardiac arrhythmias
- Extravasation with ulceration/tissue necrosis
- Nephrotoxicity (common with parenteral use)
Adverse reactions
- Impaired renal function
- Elevated serum creatinine
- IM injection-site sterile abscess/necrosis/pain
- Leukopenia
- Elevated liver function tests
- Azotemia
- Elevated BUN
- Anorexia/nausea
- Hypoglycemia
- Hypotension
- Rash
- Thrombocytopenia
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 300 mg | inj | per unit | not offered |
Generic entry1992
⚠ BOXED WARNING
- Fatal severe hypotension, hypoglycemia, acute pancreatitis, and cardiac arrhythmias have occurred; reserve parenteral pentamidine for Pneumocystis pneumonia when safer therapy is unsuitable
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.