Hypoglycemia pentamidine

For pentamidine, side effects include hypotension, tachycardia, nausea, vomiting, severe hypoglycemia or hyperglycemia, pancreatitis, irreversible diabetes mellitus, elevated transaminases, nephrotoxicity, leukopenia, and cardiac arrhythmias. 

It is used in the treatment of pneumocystosis (pulmonary and extrapulmonary disease caused by P. carinii), African trypanosomiasis (disease caused by Trypanosoma brucei) and leishmaniasis. Systemic pentamidine is highly toxic and can lead to severe hypotension, tachycardia, dyspnea, dizziness, hypoglycemia. Other adverse effects are skin rash, metallic taste, gastrointestinal symptoms, thrombocytopenia and cardiac arrhythmias. 

Adverse Effects. The primary adverse effect of systemic pentamidine administration is renal toxicity. Renal function may be markedly impaired in some patients, but kidney function usually returns to normal when the drug is withdrawn. Other adverse effects include hypotension, hypoglycemia, gastrointestinal distress, blood dyscrasias (leukopenia, thrombocytopenia), and local pain and tenderness at the site of injection. Adverse effects are reduced substantially when the drug is given by inhalation, and this method of administration is desirable when pentamidine is used to prevent pneumocystis pneumonia in patients with human immunodeficiency virus (HIV) disease. 

Pancreatic toxicity is common. Hypoglycemia due to inappropriate insulin release often appears 5-7 days after onset of treatment, can persist for days to several weeks, and may be followed by hyperglycemia. Reversible renal insufficiency is also common. Other adverse effects include rash, metallic taste, fever, gastrointestinal symptoms, abnormal liver function tests, acute pancreatitis, hypocalcemia, thrombocytopenia, hallucinations, and cardiac arrhythmias. Inhaled pentamidine is generally well-tolerated but may cause cough, dyspnea, and bronchospasm. 

Perturbations in insulin regulation both resulting in hypoglycemia and diabetes mellitus have been shown in patients treated with pentamidine [188-192]. This is not surprising considering that pentamidine accumulates in the pancreas [149], and that in 1948 the drug was considered for use as an antihypoglycemic... 

Waskin El, Stehr-GreenJK, ElelmickCG,SattlerER. Risk factors for hypoglycemia associated with pentamidine therapy for Pneumocystis pneumonia. Jama. 1988Jul 15 260(3) 345-7. 

Bouchard P, Sai P, Reach G, Caubarrere i, Ganeval D, Assan R. Diabetes mellitus following pentamidine-induced hypoglycemia in humans. Diabetes. 1982 Jan 31(l) 40-5. 

Sharpe SM. Pentamidine and hypoglycemia. Annals of internal medicine. 1983 Jul 99(1) 128. 

Stahl-BaylissCM, Kalman CM, Laskin OL. Pentamidine-induced hypoglycemia in patients with the acquired immune deficiency syndrome. Clinical pharmacology and therapeutics. 1986 Mar 39(3) 271-5. 

Both the inhalant (aerosol) and parenteral dosage forms of pentamidine iselhionale arc sterile lyophilized powders that must be made up as sterile aqueous solutions prior to use. Sterile water fur injection must be used to reconstitute the aerosol, to avoid precipitation of the pentamidine salt. Adverse reactions to the drug ate common. These include cough and bmnehospasm (inhalation) and hypertension and hypoglycemia (injection). 

Inadequate experience has been obtained to determine the incidence of the infrequent adverse reactions that will be associated with aerosolized pentamidine therapy for acute PCP. In case reports, bronchial bleeding has been reported with high-dose therapy in one center [43]. This was associated with an invasive procedure and has not been seen in the large prospective treatment trial. Case reports of hypoglycemia, rash, and conjunctivitis have also been reported [44,45]. The conjunctivitis is not unexpected it would be the direct consequence of... 

Pentamidine 4 mg/kg/day 5% q24hrs q24hrs q48hrs Inhalation may cause bronchospasm, IV administration may cause hypotension, hypoglycemia and nephrotoxicity... 

TOXICITY AND SIDE EFFECTS Approximately 50% of individuals given pentamidine at recommended doses will show some adverse effect. Intravenous administration may be associated with hypotension, tachycardia, and headache, probably secondary to the abihty of pentamidine to bind imidazoline receptors, which can be ameliorated by slowing the infusion rate. Hypoglycemia, which can be life threatening, may occur at any time during pentamidine treatment. Careful monitoring... 

Toxicity Severe adverse effects follow parenteral use including respiratory stimulation followed by depression, hypotension due to peripheral vasodilation, hypoglycemia, anemia, neutropenia, hepatitis, and pancreatitis. Systemic toxicity is minimal when pentamidine is used by inhalation. 

Interactions with the following drugs may increase the risk of hypoglycemia other hypoglycemics, sulfonamides, propranolol, salicylates, clofibrate, probenecid, pentamidine, valproic acid, dicumarol, cimetidine, MAO inhibitors, and alcohol. In addition, co-ingestion of alcohol may occasionally produce a disulfiram-like interaction (see p 186). 

Pentamidine is highly toxic causes myalgias, pain at the injection site, nausea, and headache and less frequently results in a metafile taste, a burning sensation, numbness, and hypotension. Reversible hypoglycemia occurs in about 2% of cases [49]. 

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