Pentamidine isetionate

The SPC states these dosage recommendations apply to adults, adolescents, children and infants. OTHER REGIMENS FROM THE SAME SPC — Pneumocystis jirovecii pneumonia, PROPHYLAXIS: inhalation is recommended; the adult dosage for inhalation is 150 mg pentamidine isetionate every two weeks, or one dose of 300 mg once a month. Visceral leishmaniasis: 3-4 mg pentamidine isetionate per kg body weight, most conveniently administered by intramuscular injection every other day; the number of applications should not exceed 10, though a second treatment cycle is possible if necessary. Cutaneous leishmaniasis: 3-4 mg per kg body weight every other day for 3-4 doses, by intramuscular injection or intravenous infusion. Human African trypanosomiasis: 4 mg per kg body weight once a day or every other day, injected intramuscularly or infused intravenously, up to a total of 7-10 applications. ADMINISTRATION SAFETY: there may be a sudden and severe fall in blood pressure even after an injection, so the patient should be reclining; check blood pressure supine before administration and monitor continuously during and after the infusion/injection and regularly until the end of therapy. Regular monitoring required of blood urea nitrogen and serum creatinine daily, full blood count each day of therapy, fasting blood sugar each therapy day and at intervals after therapy ends, and liver function tests. Pentamidine isetionate may prolong the QT interval — monitor QTc in patients with known or suspected cardiac disease or on concomitant QT-prolonging medicines; take special care if QTc exceeds 500 ms and consider alternative therapy if QTc exceeds 550 ms. DOSAGE EQUIVALENCE: 4 mg of pentamidine isetionate contains 2.3 mg pentamidine base; 1 mg of pentamidine base is equivalent to 1.74 mg pentamidine isetionate. Displacement value: 300 mg pentamidine isetionate displaces approximately 0.15 ml of water. INHALATION: give a bronchodilator by metered dose inhaler 5-10 minutes before inhalation; use a nebuliser producing 1-5 micron particles in a vacated, well-ventilated room with staff in protective clothing; reconstitute in a fume cupboard. Hepatic impairment: no specific dosage recommendations. Elderly: no specific dosage recommendations. NOTE: the fetched SPC sections 4.4 and 4.8 were truncated at the source-fetch limit and section 4.5 (interactions) was not retrieved in full — the lists below are incomplete.

Figure shown is the SPC treatment dose for Pneumocystis jirovecii pneumonia (4 mg pentamidine isetionate per kg body weight once daily by slow IV infusion over 60 minutes; 14 days is generally sufficient). The SPC applies the adult figures to children: section 4.2 opens 'The following dosage recommendations apply to adults, adolescents, children and infants' and under Paediatric population states 'For infants, children and adolescents, the dosage recommendations given above apply.' No separate paediatric figure is given. Other indications in the same SPC use 3-4 mg/kg (leishmaniasis) or 4 mg/kg (trypanosomiasis) — see adultDose.notes. Verify against a children's formulary before prescribing.