Pentamidine

General Information

Restricted formulary antimicrobial:

- Intravenous route is restricted to treatment and prophylaxis of pneumocystis carinii (jiroveci) pneumonia (PCP).
- All other indications must be recommended/prescribed by a Microbiology/ID consultant or registrar.

Use of IV for prophylaxis is unlicensed.
Intravenous pentamidine must be ordered via Baxter® as per OUH SOP for obtaining aseptically-prepared non-cancer medicines via Pharmacy.
Nebulised pentamidine must only be administered in a room with a scavenger unit. In the absence of this equipment nebulised pentamidine must not be used.

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Renal impairment

eGFR (mL/min/1.73m²)	Intravenous Treatment Dose
more than 10	Dose as in normal renal function
less than 10	For severe infection: 4mg/kg OD for 7-10 days and then on alternate days to complete a course of at least 14 doses. For less severe infection: 4mg/kg on alternate days for at least 14 doses.
HD/PD	Dose as in eGFR less than 10ml/min/1.73². Not dialysed
HDF/High Flux	Dose as in eGFR less than 10ml/min/1.73m². Unknown dialysability.

Hepatic impairment

Use in caution in patients with hepatic dysfunction.

Discuss with pharmacy.

The intramuscular route is not recommended by manufacturer for PCP.
IV prophylaxis (unlicensed): 4mg/kg over a minimum of 1 hour every 4 weeks.
Hypotension can occur with pentamidine, therefore baseline blood pressure should be established and patients must be lying down during administration. Blood pressure should be closely monitored during administration and at regular intervals until treatment is concluded.
QT prolongation can also occur with pentamidine, which is indicative of cardiac arrhythmia. Regular ECGs are recommended during IV therapy.
See local guidance for information on monitoring that should be carried out before, during and after IV pentamidine therapy.

Summary of Product Characteristics (SPC) for Pentacarinat 300mg. Accessed via www.medicines.org.uk 26/03/18. Last updated 23/05/14
The Renal Drug Database. Pentamidine Isetionate. Accessed via renaldrugdatabase.com 26/03/18. Last updated 21/11/17
BNF online accessed via www.medicinescomplete.com 7/1/19; last updated 11/12/18