Antiprotozoal (PCP, leishmaniasis, trypanosomiasis)

Pentamidine isetionate

Brand names: Pentacarinat

Adult dose

Dose: PCP treatment: 4mg/kg IV OD for 14–21 days; PCP prophylaxis: 300mg nebulised monthly

Route: IV / Nebulised

Frequency: OD (treatment) / Monthly (nebulised prophylaxis)

Clinical pearls

BHIVA OI guidelines: second-line for PCP after co-trimoxazole
Nebulised pentamidine for PCP prophylaxis when co-trimoxazole intolerant — use with appropriate environmental controls (negative pressure)
Visceral leishmaniasis: superseded by liposomal amphotericin per WHO/UKHSA

Contraindications

Severe hypersensitivity

Side effects

Hypoglycaemia (then hyperglycaemia — pancreatic toxicity)
Hypotension (especially rapid IV)
Renal impairment
Hepatotoxicity
Pancreatitis
QT prolongation / torsades
Bronchospasm (nebulised)
Nephrotoxicity

Interactions

QT-prolonging drugs
Aminoglycosides/amphotericin (nephrotoxicity)
Other pancreatotoxic drugs (didanosine)

Monitoring

Glucose (pre- and post-dose)
Renal function
LFTs
ECG
BP during infusion

Reference: BNF; BHIVA OI guidelines; UKHSA imported infections guidance; WHO leishmaniasis; SmPC; https://bnf.nice.org.uk/drugs/pentamidine-isetionate/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways