In the U.S.—

In Canada—

• Antiprotozoal

Pentamidine ( pen-TAM-i-deen) is used to treat Pneumocystis carinii (noo-moe-SISS-tis ) pneumonia (PCP), a very serious kind of pneumonia. This kind of pneumonia occurs commonly in patients whose immune system is not working normally, such as cancer patients, transplant patients, and patients with acquired immune deficiency syndrome (AIDS). In addition, your doctor may prescribe pentamidine for some other medical problems caused by protozoa. This medicine may also be used for other conditions as determined by your doctor.

Pentamidine may cause some serious side effects. Before you begin treatment with pentamidine, you and your doctor should talk about the good this medicine will do as well as the risks of using it.

Pentamidine is to be administered only by or under the immediate supervision of your doctor. It is available in the following dosage form:

Parenteral
• Injection (U.S. and Canada)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For pentamidine, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to pentamidine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Diet—Make certain your health care professional knows if you are on a low-sodium, low-sugar, or any other special diet. Since most medicines contain more than their active ingredient, some products may have to be avoided.

Pregnancy—Pentamidine has not been studied in pregnant women. However, studies in rabbits have shown an increase in miscarriages and bone defects in the fetus.

Breast-feeding—It is not known whether pentamidine passes into breast milk. However, because of the risk of side effects in the newborn, breast-feeding is not recommended during treatment with this medicine.

Children—Although pentamidine has not been widely used in children, this medicine is not expected to cause different side effects or problems in children than it does in adults.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of pentamidine in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving pentamidine, it is especially important that your health care professional know if you are taking any of the following:

• Amphotericin B by injection (e.g., Fungizone) or
• Antithyroid agents (medicine for overactive thyroid) or
• Azathioprine (e.g., Imuran) or
• Chloramphenicol (e.g., Chloromycetin) or
• Colchicine or
• Cyclophosphamide (e.g., Cytoxan) or
• Flucytosine (e.g., Ancobon) or
• Ganciclovir (e.g., Cytovene) or
• Interferon (e.g., Intron A, Roferon-A) or
• Mercaptopurine (e.g., Purinethol) or
• X-ray treatment or
• Zidovudine (e.g., AZT, Retrovir) or
• If you have ever been treated with x-rays or cancer medicine—When taken with pentamidine, these medicines may increase the chance of damage to your blood cells

• Carmustine (e.g., BiCNU) or
• Cisplatin (e.g., Platinol) or
• Combination pain medicine containing acetaminophen and aspirin (e.g., Excedrin) or other salicylates (with large amounts taken regularly) or
• Cyclosporine (e.g., Sandimmune) or
• Deferoxamine (e.g., Desferal) (with long-term use) or
• Foscarnet (e.g., Foscavir) or
• Gold salts (medicine for arthritis) or
• Inflammation or pain medicine (except narcotics) or
• Lithium (e.g., Lithane) or
• Other anti-infectives by mouth or by injection (medicine for infection) or
• Penicillamine (e.g., Cuprimine) or
• Streptozocin (e.g., Zanosar) or
• Tiopronin (e.g., Thiola)—When taken with pentamidine, these medicines may increase the chance of kidney damage

• Didanosine (e.g., ddI, Videx)—When taken with pentamidine, didanosine may increase the chance of pancreatitis (inflammation of the pancreas)

• Methotrexate (e.g., Mexate) or
• Plicamycin (e.g., Mithracin)—When taken with pentamidine, these medicines may increase the chance of damage to your blood cells and your kidneys

• Anemia or
• Bleeding disorders (history of) or
• Heart disease or
• Hypotension (low blood pressure) or
• Kidney disease or
• Liver disease—Pentamidine may make these conditions worse

• Diabetes mellitus (sugar diabetes) or
• Hypoglycemia (low blood sugar)—Pentamidine may increase or decrease blood sugar levels and may disturb control of sugar diabetes

To help clear up your infection completely, pentamidine must be given for the full time of treatment, even if you begin to feel better after a few days. Also, this medicine works best when there is a constant amount in the blood. To help keep the amount constant, pentamidine must be given on a regular schedule.

Dosing—

The dose of pentamidine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of pentamidine. If your dose is different, do not change it unless your doctor tells you to do so.

• For injection dosage form:
  • For Pneumocystis carinii pneumonia (PCP):
    • Adults and children—Dose is based on body weight and must be determined by your doctor. The usual dose is 4 milligrams (mg) per kilogram (kg) (1.8 mg per pound) of body weight given once a day for fourteen to twenty-one days. This dose is injected slowly into a vein over a one- to two-hour period of time.

Some patients may develop sudden, severe low blood pressure after a dose of pentamidine. Therefore, you should be lying down while you are receiving this medicine. Also, your doctor may want to check your blood pressure while you are receiving a pentamidine injection and several times after the dose has been given until your blood pressure is stable.

Pentamidine can lower the number of white blood cells in your blood, increasing the chance of your getting certain infections. It can also lower the number of platelets, which are necessary for proper blood clotting. If these problems occur, there are certain precautions you can take to reduce the risk of infection or bleeding:

• Check with your doctor immediately if you think you are getting a cold or any other infection.
• Check with your doctor immediately if you notice any unusual bleeding or bruising.
• Be careful when using regular toothbrushes, dental floss, or toothpicks. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your health care professional before having any dental work done.
• Avoid using a safety razor. Use an electric shaver instead. Also, be careful when using fingernail or toenail cutters.

Pentamidine may cause some serious side effects, including heart problems, low blood pressure, low or high blood sugar, and other blood problems. You and your doctor should discuss the good this medicine will do as well as the risks of receiving it.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your health care professional immediately if any of the following side effects occur:

• More common
  • Decrease in urination;  sore throat and fever;  unusual bleeding or bruising 
  
  

• Signs of diabetes mellitus or high blood sugar
  • Drowsiness;  flushed, dry skin;  fruit-like breath odor;  increased thirst ;  increased urination;  loss of appetite 
  
  

• Signs of low blood sugar
  • Anxiety;  chills;  cold sweats;  cool, pale skin;  headache;  increased hunger;  nausea;  nervousness;  shakiness  
  
  

• Signs of low blood pressure
  • Blurred vision;  confusion;  dizziness;  fainting or lightheadedness ;  unusual tiredness or weakness 
  
  

Signs of diabetes mellitus or high blood sugar, or signs of low blood sugar may also occur up to several months after you stop receiving this medicine.

• Less common
  • Fast or irregular pulse;  fever;  nausea and vomiting;  pain in upper abdomen ;  pain, redness, and/or hardness at place of injection ;  skin rash, redness, or itching 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Diarrhea;  loss of appetite;  nausea and vomiting 
  
  

Stomach problems, such as nausea and vomiting, or loss of appetite, are common minor side effects seen in pentamidine treatment. However, if you have these problems, and at the same time have sharp pain in the upper abdomen, or an unusual decrease in the amount of urine, check with your doctor immediately.

Pentamidine may also cause an unpleasant metallic taste. This side effect is to be expected and does not require medical attention.

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, pentamidine is used in certain patients with the following medical conditions:

• Leishmaniasis, cutaneous
• Leishmaniasis, visceral (kala-azar)
• Trypanosomiasis, African (African sleeping sickness)

If you are living in or will be traveling to an area where there is a chance of getting kala-azar or African sleeping sickness, the following measures will help to prevent reinfection with either disease:

• If possible, sleep under fine-mesh netting to avoid being bitten by sandflies (which carry kala-azar) or tsetse flies (which carry African sleeping sickness).
• Wear long-sleeved shirts or blouses and long trousers to protect your arms and legs, especially at dusk or during evening hours when sandflies are out. Since tsetse flies can bite through thin clothing, it is best to wear clothing made from fairly heavy material to protect arms and legs.
• Apply insect repellant to uncovered areas of the skin when sandflies or tsetse flies are out.

Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.