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Antiprotozoal (PCP, leishmaniasis, trypanosomiasis)

Pentamidine isetionate

Brand names: Pentacarinat

Pentamidine isetionate is an antiprotozoal and antifungal agent used for Pneumocystis jirovecii pneumonia (treatment and prophylaxis), leishmaniasis and early-stage African trypanosomiasis, generally as a second-line option.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It interferes with protozoal and fungal nucleic acid and folate metabolism and disrupts mitochondrial function, although its precise mode of action is not fully defined.

Prescribing in practice

  • Parenteral use can cause severe hypotension, dysglycaemia (both hypoglycaemia and hyperglycaemia), QT prolongation and acute renal impairment, so administration with the patient lying down and close cardiovascular and metabolic monitoring is essential.
  • Nebulised administration is used for Pneumocystis prophylaxis and may provoke bronchospasm, which can be reduced by prior bronchodilator use.
  • Doses should be adjusted in renal impairment in line with the SPC and specialist advice.

Monitoring

Monitor blood pressure, blood glucose, renal and hepatic function, electrolytes including potassium and magnesium, full blood count and ECG during therapy.

Counselling the patient

  • Stay lying down during and after an infusion because of the risk of a sudden fall in blood pressure.
  • Report dizziness, palpitations, or symptoms of low or high blood sugar.
  • With the inhaled form, tell the team if you develop wheeze or chest tightness.

Evidence & guidelines

Pentamidine is an established alternative to co-trimoxazole for Pneumocystis jirovecii pneumonia where the first-line agent is unsuitable.

Reference: BHIVA OI guidelines; UKHSA imported infections guidance; WHO leishmaniasis; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways