Pentamidine hypocalcemia with

Another previous report [187] described severe hypocalcemia with tetany in patients with AIDS concomitantly receiving pentamidine and foscarnet. The hypocalcemia, however, was attributed to the administration of foscarnet. Despite magnesium replacement, magnesium wasting may persist up to two months after the discontinuation of pentamidine, suggesting that anatomic renal tubular injury may be responsible [183,185]. Both abnormalities developed within 6 to 10 days of pentamidine administration. Because life-threatening arrhythmias can develop, especially at serum magnesium levels less than 1.6 mg/dl, early replacement therapy is clinically warranted. 

Foscarnet should not be used in combination with drugs that cause renal toxicity (e.g., acyclovir, aminoglycosides, amphotericin B, NSAIDs). Abnormal renal function has been noted when foscarnet is used with ritonavir or ritonavir and saquinavir. Pentamidine may increase the risk of nephrotoxicity, hypocalcemia, and... 

In summary, parenteral pentamidine administration for the treatment of PCP can be associated with the development of usually mild, reversible acute kidney injury. Compounding risk factors, of which volume depletion is the most important, are found in the majority of cases of pentamidine nephrotoxicity. There is no convincing evidence that the aerosol route of pentamidine administration for PCP prophylaxis results in nephrotoxicity. Hypocalcemia and hypomagnesemia with renal magnesium wasting, and particularly, hyperkalemia are seen with pentamidine therapy. 

Shah GM, Alvarado P, Kirschenbaum MA. Symptomatic hypocalcemia and hypomagnesemia with renal magnesium wasting associated with pentamidine therapy in a patient with AiDS.The American journal of medicine. 1990 Sep 89(3) 380-2. 

Pentamidine therapy for Pneumocystis carinii infections is also limited by nephrotoxicity. Prospective studies have shown azotemia in 60% to 90% of treated patients. Hyperkalemia, metabolic acidosis, hypomagnesemia, and hypocalcemia may also occur. Toxicity is more frequent in patients with the acquired immunodeficiency syndrome (AIDS) than in patients without this immune deficiency, and may... 

Dose-limiting nephrotoxicity with acute tubular necrosis, electrolyte imbalance with hypocalcemia — tremors and seizures. Avoid pentamidine (IV) - T nephrotoxicity and hypocalcemia. 

Youle MS, Clarbour J, Gazzard B, Chanas A. Severe hypocalcemia in AIDS patients treated with foscarnet and pentamidine. Lancet 1988 1 1455-1456. 

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