Hypotension pentamidine

This drug is contraindicated in individuals who have had previous hypersensitivity reactions to pentamidine isethionate. Pentamidine isethionate is used cautiously in patients with hypertension, hypotension, hyperglycemia, renal impairment, diabetes mellitus, liver impairment, bone marrow depression, pregnancy (Category C), or lactation. 

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

Hypotension Patients may develop sudden, severe hypotension after a single dose, whether given IV or IM. Therefore, patients receiving the drug should be supine monitor blood pressure closely during drug administration and several times thereafter until the blood pressure is stable. Have equipment for emergency resuscitation readily available. If pentamidine is administered IV, infuse over 60 minutes. 

Pentamidine can cause serious renal toxicity and is toxic to pancreatic beta-cells. Its adverse reactions further include hypotension, dizziness and rashes. After inhalation bronchoconstriction can occur. 

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. 

Pentamidine is a highly toxic drug, with adverse effects noted in about 50% of patients receiving 4 mg/kg/d. Rapid intravenous administration can lead to severe hypotension, tachycardia, dizziness, and dyspnea, so the drug should be administered slowly (over 2 hours), and patients should be recumbent and monitored closely during treatment. With intramuscular administration, pain at the injection site is common, and sterile abscesses may develop. 

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function may be markedly impaired in some patients, but kidney function usually returns to normal when the drug is withdrawn.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. 

Pentamidine is a synthetic aromatic amidine it must be administered parenterally or by inhalation as it is unreliably absorbed from the gastrointestinal tract it does not enter the CSF. Given systemically it frequently causes nephrotoxicity, which is reversible acute hypotension and syncope are common esp-ecicdly after rapid i.v. injection. Pancreatic damage may cause h5q>oglycaemia due to insulin release. 

When atovaquone was compared with intravenous pentamidine in the treatment of mild and moderate Pneumocystis jiroveci pneumonia in an open trial, the success rates were similar. However, withdrawal of the original treatment was much more frequent with pentamidine (36%) than atovaquone (4%) (4). However, the authors conclusion that the two approaches have a similar success rate has been challenged, and their series was small (5,6). Treatment-limited adverse effects occurred in only 7% of patients given atovaquone, compared with 41 % given pentamidine. They included cases of rash and an increase in creatinine concentrations atovaquone (unlike pentamidine) produced no vomiting, nausea, hypotension, leukopenia, acute renal insufficiency, or electrocardiographic abnormalities, but it did cause one case of dementia (4). 

In an uncontrolled study in French Guiana, intramuscular pentamidine isethionate (two 4 mg/kg injections 48 hours apart) in 198 patients with cutaneous leishmaniasis produced a cure rate of 87% 80% of treatment failures responded to an identical second course (1). Compared with published studies, adverse events were relatively mild pain on injection (54%), gastrointestinal effects (53%), and hypotension (8%). There were no dysrhythmias or glucose abnormalities. This may reflect the brief course of pentamidine used. 

Severe hypotension can occur after a single intramuscular injection of pentamidine or with rapid intravenous administration, but has been seen with slow infusion as well Infusing the drug over 60 minutes or more may reduce this risk. Facial flushing, breathlessness, dizziness, and nausea and vomiting can occur at the same time. 

Pentamidine 4 mg/kg/day 5% q. 24hr q. 24hr q.48hr Inhalation may cause bronchospasm IV administration may cause hypotension, hvpoalvcemia, and nephrotoxicitv NC NC NC... 

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. 

Pentamidine (Pentam) Unknown Pneumocystis carinii (PCP. PCP prophylaxis in HIV patients. Dangerous hypotension if administered intravenously. 

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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