Pentacarinat (Inhalational Pentamidine) 300 mg powder is an antiprotozoal medicine for oral inhalational use. 

Pentacarinat (Inhalational Pentamidine) Uses:

• Prevention of Pneumocystis jirovecii pneumonia (PCP) in high-risk, HIV-infected patients either with a history of PCP or with a CD4+ count ≤200/mm3

Pentacarinat (Inhalational Pentamidine) Dose in Adults

Pentacarinat (Inhalational Pentamidine) Dose in the prevention of Pneumocystis jirovecii pneumonia (PCP):

• Primary or secondary prophylaxis (alternative to preferred therapy):

  • Inhalation: 300 mg once every 4 weeks via Respirgard II nebulizer.

Pentacarinat (Inhalational Pentamidine) Dose in Childrens

Pentacarinat (Inhalational Pentamidine) Dose in the Primary and Secondary prophylaxis of Pneumocystis jirovecii (PCP):

• Note: For patients intolerant to sulfamethoxazole and trimethoprim.

• Children <5 years who are HSCT recipients:

  • Inhalation: 9 mg/kg (maximum dose: 300 mg/dose) once monthly (every 4 weeks) via Respirgard II nebulizer.

• Children ≥5 years and Adolescents; independent of HIV status:

  • Inhalation: 300 mg once a month (every 4 weeks) via Respirgard II nebulizer.

Pregnancy Risk Factor C

• Aerosolized routes may not be safe for pregnant women.
• Limited information is available on fetal outcomes after maternal pentamidine use.
• Aerosolized administration of maternal serum results in lower maternal serum concentrations, which minimizes the risk to the fetus.
• The literature has discussed concerns about occupational exposure and the theoretical risk to pregnant healthcare workers. If possible, pregnant health care workers should avoid exposure to aerosols.
• For pregnant women with HIV infection, aerosolized pentamidine can be used as an alternative therapy to prevent Pneumocystis Jirovecii pneumonia.

Pentamidine use during breastfeeding:

• It is unknown if pentamidine can be found in breast milk.
• The manufacturer suggests that the mother decide whether to stop breastfeeding or discontinue using the drug.
• This is in consideration of the possibility of serious adverse reactions in breastfeeding infants.
• To reduce the risk of HIV transmission, pregnant women with HIV should stop breastfeeding.

Pentacarinat (Inhalational Pentamidine) Dose in Kidney Disease:

• There are no dosage adjustments provided in the drug manufacturer’s labeling (has not been studied). Use with caution.

Pentacarinat (Inhalational Pentamidine) Dose in Liver Disease:

• There are no dosage adjustments provided in the drug manufacturer’s labeling (has not been studied). Use with caution.

Common Side Effects of Pentacarinat (Inhalational Pentamidine):

• Central Nervous System:

  • Fatigue
  • Dizziness

• Gastrointestinal:

  • Decreased Appetite

• Infection:

  • Infection

• Respiratory:

  • Cough
  • Dyspnea
  • Wheezing
  • Bronchospasm

• Miscellaneous:

  • Fever

Less Common Side Effects Of Pentacarinat (Inhalational Pentamidine):

• Cardiovascular:

  • Chest Pain

• Central Nervous System:

  • Headache

• Dermatologic:

  • Night Sweats

• Gastrointestinal:

  • Diarrhea
  • Dysgeusia
  • Nausea
  • Oral Candidiasis

• Hematologic & Oncologic:

  • Anemia

• Infection:

  • Herpes Virus Infection
  • Herpes Zoster
  • Influenza

• Respiratory:

  • Pharyngitis
  • Bronchitis
  • Sinusitis
  • Upper Respiratory Tract Infection

• Miscellaneous:

  • Night Sweats

Contraindications to Pentacarinat (Inhalational Pentamidine):

• Hypersensitivity to pentamidine Isethionate and any component of the formulation

Warnings and precautions

• Asthma

  • Patients with asthma should be cautious when using inhalation formulas.
  • This condition can cause bronchospasm and cough in those with asthma or who smoke.
  • An inhaled bronchodilator before pentamidine could help to alleviate symptoms.

• Pancreatitis

  • Patients with a history or elevated levels of amylase/lipase should be cautious.
  • Reports of acute pancreatitis with fatalities have been made.
  • If you experience signs or symptoms of acute pancreatitis, discontinue inhalational pentamidine.

• PCP

  • Acute PCP may develop despite aerosolized pentamidine prophylaxis.
  • Extrapulmonary PCP may occur, although it is rare. It has been linked to aerosolized pentamidine.
  • Take appropriate precautions to avoid exposure to healthcare personnel. Refer to the individual institution policy.

Pentamidine (oral inhalation): Drug Interaction

Monitoring Parameters:

• Liver function tests,
• renal function tests,
• blood glucose,
• serum potassium and calcium,
• CBC and platelets

How to administer Pentacarinat (Inhalational Pentamidine)?

• Inhalation:
  • Deliver via Respirgard II nebulizer until the nebulizer is emptied (30-45 minutes).
  • Administer at a flow rate of 5 to 7 L/minute from a 40 to 50 pound-per-square inch (PSI) oxygen or air source.
  • A 4050 PSI air compressor can be used alternatively, with a set flow rate at 5 to 7 L/minute or a set pressure of 22 to 25 PSI.
  • Air compressors <20 PSI should not be used.
  • Use appropriate precautions to minimize exposure to healthcare personnel; refer to individual institutional policy.

Mechanism of action of Pentacarinat (Inhalational Pentamidine):

• Interferes in microbial DNA/DNA, phospholipids, and protein synthesis through inhibition of oxidativephosphorylation, and/or interference at the incorporation nucleotides or nucleic acids into DNA and RNA

Absorption:

• Inhalation: There is limited systemic absorption in chronic therapy. Potential accumulation and systemic effects are unknown.

Distribution:

• It binds to plasma proteins and tissues; high levels are found in the liver and kidneys, adrenals and spleens, lungs and pancreas. CNS penetration is poor.
• High concentrations of bronchoalveolar liquid are produced after oral inhalation

Half-life elimination:

• IV: 5 to 8 hours;
• IM: 7 to 11 hours;
• may be prolonged with severe renal impairment

International Brands of Inhalational Pentamidine:

• Nebupent
• Pentacarinat

Pentamidine Brands Names in Pakistan:

No Brands Available in Pakistan.