Pentacarinat Special Precautions

Pentamidine diisetionate should be used with particular caution in patients with hepatic and/or renal dysfunction, hypertension or hypotension, hyperglycaemia or hypoglycaemia, leucopenia, thrombocytopenia or anaemia.
Fatalities due to severe hypotension, hypoglycaemia, acute pancreatitis and cardiac arrhythmias have been reported in patients treated with pentamidine diisetionate, by both the intramuscular and intravenous routes. Baseline blood pressure should be established and patients should receive the drug lying down. Blood pressure should be closely monitored during administration and at regular intervals until treatment is concluded.
Therefore patients receiving pentamidine by inhalation should be closely monitored for the development of severe adverse reactions.
Bronchospasm has been reported to occur following the use of nebuliser (see Adverse Reactions). This has been particularly noted in patients who have a history of smoking or asthma. This can be controlled by prior use of bronchodilators.
Pentamidine diisetionate may prolong the QT interval. Cardiac arrhythmias indicative of QT prolongation, such as Torsades de Pointes, have been reported in isolated cases with administration of pentamidine diisetionate. Therefore, pentamidine diisetionate should be used with care in patients with conditions known to increase the proarrhythmic risk, including patients with long QT syndrome, cardiac disease (e.g. coronary heart disease, heart failure) a history of ventricular arrhythmias, uncorrected hypokalaemia and/or hypomagnesaemia, bradycardia (<50 bpm), or during concomitant administration of pentamidine diisetionate with QT prolonging agents (see Interactions).
Particular caution is necessary if the QTc exceeds 500 msec whilst receiving pentamidine diisetionate therapy, continuous cardiac monitoring should be considered in this case.
Should the QTc interval exceed 550 msec then an alternative regimen should be considered.
Laboratory monitoring: The following tests should be carried out before, during and after therapy by the parenteral route: See table.

Click on icon to see table/diagram/image

The benefit of aerosolised pentamidine therapy in patients at high risk of a pneumothorax should be weighed against the clinical consequences of such a manifestation.
Effects on ability to drive and use machines: Pentamidine has no known effect on the ability to drive and use machines.
Considering the risk of dizziness, one should be careful.