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Pentacarinat (pentamidine) Disease Interactions

There are 10 disease interactions with Pentacarinat (pentamidine):

Major

Pentamidine (applies to Pentacarinat) cardiovascular disease

Major Potential Hazard, High plausibility. Applicable conditions: Hypotension, Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction

Parenteral use of pentamidine may be associated with serious and potentially fatal cardiovascular effects. Sudden and severe hypotension, cardiorespiratory arrest, ventricular tachycardia, torsade de pointes, ECG abnormalities, and facial flushing have been reported. Therapy with pentamidine should be administered cautiously in all patients but in particular, those with preexisting hypotension, severe cardiovascular disease, or conditions that could be exacerbated by hypotension such as a history of myocardial infarction, angina, or ischemic stroke. Patients should be in a supine position and blood pressure monitored closely during and after administration of the drug until blood pressure is stable. Equipment for emergency resuscitation should be readily available if the parenteral route is used. ECGs should also be performed before, during, and after parenteral therapy.

References

  1. Gonzalez A, Sager PT, Akil B, et al "Pentamidine-induced torsade de pointes." Am Heart J 122 (1991): 1489-92
  2. Stein KM, Fenton C, Lehany AM, et al "Incidence of QT interval prolongation during pentamidine therapy of pneumocystis carinii pneumonia." Am J Cardiol 68 (1991): 1091-4
  3. Quadrel MA, Atkin SH, Jaker MA "Delayed cardiotoxicity during treatment with intravenous pentamidine: two case reports and a review of the literature." Am Heart J 123 (1992): 1377-9
  4. "Product Information. Pentam 300 (pentamidine)." Fujisawa, Deerfield, IL.
  5. Wharton JM, Demopulos PA, Goldschlager N "Torsade de pointes during administration of pentamidine isethionate." Am J Med 83 (1987): 571-6
  6. Eisenhauer MD, Eliasson AH, Taylor AJ, Coyne PE, Wortham DC "Incidence of cardiac arrhythmias during intravenous pentamidine therapy in hiv-infected patients." Chest 105 (1994): 389-95
  7. Zanetti LAF, Oliphant CM "Pentamidine-induced torsades de pointes." Ann Pharmacother 28 (1994): 282-3
  8. "Product Information. NebuPent (pentamidine)." Fujisawa, Deerfield, IL.
View all 8 references
Major

Pentamidine (applies to Pentacarinat) dehydration

Major Potential Hazard, High plausibility. Applicable conditions: Diarrhea, Vomiting

Patients who are dehydrated may be particularly susceptible to the nephrotoxic and hypotensive effects associated with the parenteral use of pentamidine. Dehydration should preferably be corrected prior to initiation of therapy. In patients who may be at risk for dehydration, such as those with severe and/or prolonged diarrhea or vomiting, fluid status and blood pressure should be monitored closely. If signs of renal irritation develop during therapy, hydration should be increased as indicated, accompanied by a reduction in dosage if necessary. Therapy should be withdrawn if urinary output decreases progressively or azotemia increases.

References

  1. "Product Information. Pentam 300 (pentamidine)." Fujisawa, Deerfield, IL.
  2. "Product Information. NebuPent (pentamidine)." Fujisawa, Deerfield, IL.
Major

Pentamidine (applies to Pentacarinat) diabetes mellitus

Major Potential Hazard, High plausibility. Applicable conditions: Abnormal Glucose Tolerance

Pentamidine may have direct toxic effects on beta cells of the pancreas. Hypoglycemia, which may be severe and/or prolonged, as well as hyperglycemia and insulin-dependent diabetes mellitus, the latter of which may be irreversible, have been reported. The onset of pentamidine-induced hypoglycemia generally varied from 5 to 7 days after start of therapy to several days after therapy stops. In some cases, hyperglycemia and progression to diabetes followed, although these effects have occurred independently also. Pancreatic toxicity has been reported with both parenteral use and, less frequently, oral inhalation of pentamidine. The risk appears to be related to total cumulative dosage and prior therapy with the drug, particularly within the last 3 months. Therapy with pentamidine, regardless of route of administration, should be administered cautiously in patients with or predisposed to diabetes or spontaneous hypoglycemia. Blood glucose should be monitored more closely during and for some time after pentamidine therapy.

References

  1. Stahl-Bayliss CM, Kalman CM, Laskin OL "Pentamidine-induced hypoglycemia in patients with the acquired immune deficiency syndrome." Clin Pharmacol Ther 39 (1986): 271-5
  2. Wood G, Wetzig N, Hogan P, Whitby M "Survival from pentamidine induced pancreatitis and diabetes mellitus." Aust N Z J Med 21 (1991): 341-2
  3. Assan R, Mayaud C, Perronne C, Matheron S, Assan D, Zucman D, Chotard L "Pentamidine-induced derangements of glucose homeostasis: determinant roles of renal failure and drug accumulation - a study of 128 patients." Diabetes Care 18 (1995): 47-55
  4. "Product Information. NebuPent (pentamidine)." Fujisawa, Deerfield, IL.
  5. Kallas EG, Galvao LL, Roland RK, Medeiros EA, Levi GC, Mendonca JS "Pentamidine induced ketoacidosis in acquired immunodeficiency syndrome patients." Int Conf AIDS 9 (1993): 474
  6. Liegl U, Bogner JR, Goebel FD "Insulin-dependent diabetes mellitus following pentamidine therapy in a patient with AIDS." Clin Investig 72 (1994): 1027-9
  7. Hardy H, Esch LD, Morse GD "Glucose disorders associated with HIV and its drug therapy." Ann Pharmacother 35 (2001): 343-51
  8. Shen M, Orwoll ES, Conte JE, Prince MJ "Pentamidine-induced pancreatic beta-cell dysfunction." Am J Med 86 (1989): 726-8
  9. Bouchard PH, Sai P, Reach G, et al "Diabetes mellitus following pentamidine-induced hypoglycemia in humans." Diabetes 31 (1982): 40-5
  10. Coyle P, Carr AD, Depczynski BB, Chisholm DJ "Diabetes mellitus associated with pentamidine use in HIV-infected patients." Med J Aust 165 (1996): 587-8
  11. "Product Information. Pentam 300 (pentamidine)." Fujisawa, Deerfield, IL.
  12. Millard PS, van der Horst C "Reversible diabetes mellitus after intravenous pentamidine." Am J Med 91 (1991): 442
  13. Ostrowski M, Walmsley S, Pluemecke G, Salit I, Rachlis A, Krajden S "Pentamidine-induced diabetes mellitus (PIDM)." Int Conf AIDS 9 (1993): 465
View all 13 references
Major

Pentamidine (applies to Pentacarinat) hematologic toxicity

Major Potential Hazard, Moderate plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts

Hematologic toxicities have been associated occasionally with the parenteral use of pentamidine. Leukopenia and, less frequently, thrombocytopenia have been reported and may be severe (e.g., leukocyte count < 1000/mm3, platelet count < 20,000/mm3). Anemia, neutropenia, pancytopenia, and prolonged clotting time have occurred rarely. Therapy with pentamidine should be administered cautiously in patients with preexisting blood dyscrasias and/or bone marrow depression. Complete blood counts, including platelets, should be performed prior to and periodically during and after therapy. Marked depression of blood counts may be indication for withdrawal of pentamidine therapy.

References

  1. "Product Information. NebuPent (pentamidine)." Fujisawa, Deerfield, IL.
  2. Andersen R, Boedicker M, Ma M, Goldstein EJ "Adverse reactions associated with pentamidine isethionate in AIDS patients: recommendations for monitoring therapy." Drug Intell Clin Pharm 20 (1986): 862-8
  3. "Product Information. Pentam 300 (pentamidine)." Fujisawa, Deerfield, IL.
Major

Pentamidine (applies to Pentacarinat) pancreatitis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Alcoholism, Hyperlipidemia

Acute and potentially fatal pancreatitis has been reported with parenteral use and, rarely, oral inhalation of pentamidine. Patients with a history of or known risk factors for pancreatitis, such as alcohol abuse or hypertriglyceridemia, should be monitored closely during therapy with pentamidine. Therapy should be discontinued at the first signs or symptoms suggestive of pancreatitis (e.g., nausea, vomiting, abdominal pain, hyperamylasemia with dysglycemia, rising triglycerides, decreasing serum calcium), and preferably permanently discontinued if clinical pancreatitis develops.

References

  1. Wood G, Wetzig N, Hogan P, Whitby M "Survival from pentamidine induced pancreatitis and diabetes mellitus." Aust N Z J Med 21 (1991): 341-2
  2. Tocci G, Alba L, D'Amato C, Grisetti S, Sampaolesi A, Visco GL "Pancreatitis associated with aerosolized pentamidine." Int Conf AIDS 9 (1993): 505
  3. Sauleda J, Gea JG, Aguar MC, Aran X, Pasto M, Broquetas JM "Probable pentamidine-induced acute pancreatitis." Ann Pharmacother 28 (1994): 52-3
  4. Klatt EC "Pathology of pentamidine-induced pancreatitis." Arch Pathol Lab Med 116 (1992): 162-4
  5. Schwartz MS, Cappell MS "Pentamidine-associated pancreatitis." Dig Dis Sci 34 (1989): 1617-20
  6. "Product Information. NebuPent (pentamidine)." Fujisawa, Deerfield, IL.
  7. "Product Information. Pentam 300 (pentamidine)." Fujisawa, Deerfield, IL.
View all 7 references
Major

Pentamidine (applies to Pentacarinat) renal dysfunction

Major Potential Hazard, High plausibility.

Parenteral use of pentamidine may be associated with nephrotoxicity, usually evidenced by elevations in BUN or serum creatinine concentrations. Azotemia has also been reported. Although pentamidine-induced nephrotoxicity is generally mild to moderate in severity and reversible following discontinuation of the drug, acute renal failure has occurred occasionally. Limited evidence suggests that nephrotoxicity may occur more frequently in patients with AIDS and may be accompanied by severe, sometimes life-threatening hyperkalemia. Therapy with pentamidine should be administered cautiously in patients with renal impairment. The need for dosage adjustments is uncertain. To minimize the risk of toxicity, patients should be adequately hydrated and use with other nephrotoxic agents should be avoided. Renal function and serum potassium levels should be closely monitored, and the dosing frequency reduced or therapy withdrawn if toxicity develops.

References

  1. Peltz S, Hashmi S "Pentamidine-induced severe hyperkalemia." Am J Med 87 (1989): 698-9
  2. "Product Information. Pentam 300 (pentamidine)." Fujisawa, Deerfield, IL.
  3. Miller RF, Delany S, Semple SJ "Acute renal failure after nebulised pentamidine." Lancet 06/03/89 (1989): 1271-2
  4. Conte JE, Upton RA, Lin ET "Pentamidine pharmacokinetics in patients with AIDS with impaired renal function." J Infect Dis 156 (1987): 885-90
  5. Lachaal M, Venuto RC "Nephrotoxicity and hyperkalemia in patients with AIDS treated with pentamidine." Am J Med 87 (1989): 260-3
  6. "Product Information. NebuPent (pentamidine)." Fujisawa, Deerfield, IL.
  7. Chapelon C, Raguin G, De Gennes C "Renal insufficiency with nebulised pentamidine." Lancet 10/28/89 (1989): 1045-6
View all 7 references
Major

Pentamidine (aerosolized) (applies to Pentacarinat) systemic effects 1

Major Potential Hazard, Moderate plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts, Hypotension, Renal Dysfunction, Dehydration, Diarrhea, Vomiting, Cardiovascular Disease, Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction

Orally inhaled pentamidine is generally not associated with significant systemic toxicity due to limited absorption from the respiratory tract. However, detectable serum concentrations have been reported in some patients receiving chronic oral inhalation therapy, and systemic adverse effects have occasionally occurred. Therefore, when pentamidine is administered by oral inhalation, clinicians may want to heed the usual warnings and precautions associated with parenteral use of the drug.

References

  1. "Multum Information Services, Inc. Expert Review Panel"
Moderate

Pentamidine (applies to Pentacarinat) asthma/COPD

Moderate Potential Hazard, High plausibility. Applicable conditions: Chronic Obstructive Pulmonary Disease

Orally inhaled pentamidine may induce bronchospasm and cough. Therapy with aerosolized pentamidine should be administered cautiously in patients with severe bronchospastic disease or a history of extensive smoking. Pretreatment with a beta-2 adrenergic bronchodilator prior to each dose of aerosolized pentamidine may be helpful in patients who experience respiratory symptoms from the medication.

References

  1. Leigh TR, Wiggins J, Gazzard BG, Collins JV "Effect of terbutaline on bronchoconstriction induced by nebulised pentamidine." Thorax 46 (1991): 122-3
  2. Quieffin J, Hunter J, Schechter MT, et al "Aerosol pentamidine-induced bronchoconstriction." Chest 100 (1991): 624-7
  3. "Product Information. NebuPent (pentamidine)." Fujisawa, Deerfield, IL.
  4. Ong EL, Hanley SP, Mandal BK "Bronchoconstriction, nebulised pantamidine, and mast cells." Lancet 04/29/89 (1989): 956
  5. Chan CK, Hyland RH, Yu D-G, et al "Acute pulmonary effects of aerosolized pentamidine: a randomized controlled study." Chest 98 (1990): 907-10
  6. Katzman M, Meade W, Iglar K, et al "High incidence of bronchospasm with regular administration of aerosolised pentamidine." Chest 101 (1992): 79-81
View all 6 references
Moderate

Pentamidine (applies to Pentacarinat) hepatotoxicity

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

Parenteral use of pentamidine may cause elevated liver function tests. Therapy with pentamidine should be administered cautiously in patients with hepatic impairment. Serum transaminase, alkaline phosphatase, and bilirubin levels should be measured periodically, and the dosing frequency reduced or therapy withdrawn if significant elevations develop.

References

  1. "Product Information. NebuPent (pentamidine)." Fujisawa, Deerfield, IL.
  2. Andersen R, Boedicker M, Ma M, Goldstein EJ "Adverse reactions associated with pentamidine isethionate in AIDS patients: recommendations for monitoring therapy." Drug Intell Clin Pharm 20 (1986): 862-8
  3. "Product Information. Pentam 300 (pentamidine)." Fujisawa, Deerfield, IL.
Moderate

Pentamidine (aerosolized) (applies to Pentacarinat) systemic effects 2

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

Orally inhaled pentamidine is generally not associated with significant systemic toxicity due to limited absorption from the respiratory tract. However, detectable serum concentrations have been reported in some patients receiving chronic oral inhalation therapy, and systemic adverse effects have occasionally occurred. Therefore, when pentamidine is administered by oral inhalation, clinicians may want to heed the usual warnings and precautions associated with parenteral use of the drug.

References

  1. "Multum Information Services, Inc. Expert Review Panel"

Pentacarinat (pentamidine) drug interactions

There are 345 drug interactions with Pentacarinat (pentamidine)

Pentacarinat (pentamidine) alcohol/food interactions

There is 1 alcohol/food interaction with Pentacarinat (pentamidine)

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.