Pentamidine
Mechanism :
It is an antiprotozoal drug that is mainly used in the treatment of protozoal infections, especially kala azar. It is also used in the treatment and prevention of pneumonia caused by Pneumocystis carinii.
Indication :
- Pneumonia due to pneumocystis carinii (PJP) in patients intolerable to sulfamethoxazole and trimethoprim
- African trypanosomiasis
- Visceral leishmaniasis caused by L. Donovani
Contraindications :
Congenital QT syndrome; Electrolyte abnormalities, uncorrected.
Dosing :
>4 months: 4 mg/kg IV/IM OD.
Give for 21 days for PJP treatment,for 10 days for African trypanosomiasis and for 2-4 weeks for visceral leishmaniasis.
PJP prophylaxis:
>5 years: 300 mg nebulization every 4 weeks.
Adverse Effect :
Extravasation/tissue damage, hypoglycemia, hyperglycemia, severe diabetes mellitus, pancreatitis, pancreatic islet cell necrosis, nephrotoxicity, renal failure, hypotension, ventricular tachycardia, QT prolongation, torsades de pointes, thrombocytopenia, leukopenia, pancytopenia, bronchospasm, anaphylaxis, Stevens-Johnson syndrome, hepatotoxicity, hallucinations.
Nebuliser: Cough, wheezing, fever, decreased appetite, bronchospasm, infection, fatigue.
Interaction :
Interaction Characteristics:
CYP2C19 substrate, hypoglycemia, nephrotoxicity, prolongs QT interval definite.
Contraindicated:
Cidofovir, cisapride, dronedarone, pimozide, streptozocin, thioridazine, toremifene, ziprasidone.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Depending on severity of infection: 4 mg/kg/day IV for 7–10 days, then on alternate days to complete minimum 14 doses, OR, 4 mg/kg on alternate days to complete minimum 14 doses |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in GFR<10 mL/min |
| HD | Not dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
No dose adjustment recommended.