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

Dose for preventing Pneumocystis jirovecii pneumonia (PCP):

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

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

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 once a month (every 4 weeks) in a Respirgard II nebulizer (maximum dose: 300 mg/dose).

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

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

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

  • Despite aerosolized pentamidine prophylaxis, acute PCP can still occur.
  • PCP extrapulmonary may happen, although it's uncommon. It has been connected to pentamidine aerosol.
  • Take the necessary steps to prevent coming into contact with medical staff. Consult the specific institution's policies.

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:
  • Once the Respirgard II nebulizer is empty, administer (30-45 minutes).
    administer at a flow rate of 5 to 7 L/minute from an oxygen or air source that has a PSI of 40 to 50.
  • Alternately, a 4050 PSI air compressor with a set flow rate of 5 to 7 L/minute or a set pressure of 22 to 25 PSI might be employed.
  • Use of air compressors under 20 PSI is not advised.
  • Utilize the proper safety measures to reduce your exposure to medical staff; consult the specific institutional regulation.

Mechanism of action of Pentacarinat (Inhalational Pentamidine):

• Inhibits oxidative phosphorylation and/or interferes with the integration of nucleotides or nucleic acids into DNA and RNA, interfering with the synthesis of phospholipids, protein, and microbial DNA/DNA.

Absorption:

• Inhalation: Chronic therapy only has a modest amount of systemic absorption. Unknown are potential accumulating and systemic consequences.

Distribution:

• High concentrations are seen in the liver and kidneys, adrenals and spleens, lungs and pancreas; it binds to plasma proteins and tissues. Poor CNS penetration.
• 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.