Names and pronunciation
(pen-tam′i-deen) NebuPent, Pentam 300
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Drug reference
(pen-tam′i-deen) NebuPent, Pentam 300
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Func. class.: Antiprotozoal
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Chem. class.: Aromatic diamide derivative
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ACTION: Interferes with DNA/RNA synthesis in protozoa
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USES: Treatment/prevention of P Pneumocystis jiroveci infections
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Unlabeled uses: PJP (inhalation)
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CONTRAINDICATIONS: Hyper sensitivity Precautions: Pregnancy, breastfeeding, children, blood dyscrasias, cardiac/ renal/hepatic disease, diabetes mellitus, hypocalcemia, hypo/hypertension, anemia
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SIDE EFFECTS CNS: Disorientation, hallucinations CV: Severe hypotension, chest pain, ven- tricular tachycardia, QT prolongation, dysrrthmias GI: Nausea, anorexia; metallic taste, pancreatitis HEMA: Anemia, leukopenia, thrombocy topenia INTEG: Sterile abscess, pain at inj site, pruritus, urticaria, rash, Stevens-Johnson syndrome MISC: Night sweats, anaphylaxis RESP: Cough, SOB, bronchospasm (with aerosol), sore throat
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INTERACTIONS • Nephrotoxicity: aminoglycosides, am- photericin B, CISplatin, NSAIDs, vancomy- cin • Fatal dysrhythmias: erythromycin IV Increase: QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pent- amidine; CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromy- cin, troleandomycin, arsenic trioxide); CYP3A4 substrates (methadone, pimo zide, QUEtiapine, quiNIDine, risperiDONE, ziprasidone) Increase: myelosuppression—antineo- plastics, radiation Drug/Lab Test Decrease: WBC, platelets, HB, Hct, cal- cium, magnesium Increase: BUN, creatinine, potassium, LFTs, bilirubin, alkaline phosphatase
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DOSAGE AND ROUTES • Adult and child ≥4 mo: IV/IM 4 mg/ kg/day × 2-3 wk; NEB 300 mg via Respir- gard II Jet (Nebupent) every 4 weeks; or 150 mg q2wk
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Available forms: Inj, aerosol 300 mg/ vial; sol for aerosol 300 mg
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Administer: • Store in refrigerator protected from light Inhalation route • Through nebulizer, using Respirgard II jet nebulizer; mix contents in 6 mL of sterile water; do not use low pressure (<20 psi); flow rate should be 5-7 L/min (40-50 psi) air or O2 source over 30-45 min until chamber is empty IM route • Reconstitute 300 mg in 3 mL sterile water (100 mg/mL), give deep IM by Z- track; if painful by this route, rotate inj site Intermittent IV INFUSION route • Check IV site frequently (vesicant properties) • Reconstitute 300 mg/3-5 mL of ster- ile water for inj, D5W, withdraw dose and further dilute in 50-250 mL D5W, give over 1-2 hr with patient lying down; check B/P often Y-site compatibilities: alemtuzumab, alfentanil, aminocaproic acid, anidula- fungin, argatroban, atracurium, atro- pine, benztropine, buprenorphine, calcium gluconate, CARBOplatin, caspofungin, chlorproMAZINE, cimeti- dine, CISplatin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINo- mycin, diltiaZEM, gatifloxacin, zidovudine
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Assess: • Blood tests, blood glucose, CBC, plate- lets, calcium, magnesium • GU: I&O ratio; report hematuria, oligu- ria • CV: ECG for cardiac dysrhythmias in cardiac patients; patient should be lying down when receiving product; severe hypotension may develop; monitor B/P during administration and until B/P stable • Hepatic studies: AST, ALT • Renal studies: urinalysis, BUN, creati- nine; nephrotoxicity may occur; any pa- tient with compromised renal system; product is excreted slowly with poor re- nal system function; toxicity may occur rapidly • Signs of infection, anemia • GI: Bowel pattern before, during treat- ment • Respiratory status: rate, character, wheezing, dyspnea • Dizziness, confusion, hallucination • Serious skin reactions, allergic reactions: rash, fever, fatigue, muscle or joint aches, oral lesions, blisters; discontinue product immediately if these occur • Pancreatitis: nausea, vomiting, se- vere abdominal pain; monitor lab values of lipase and amylase (elevated in pan- creatitis); if these signs or symptoms oc- cur, product may need to be discontinued • Diabetic patients, hypoglycemia may occur, then hyperglycemia with pro- longed therapy • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; cautious use in breastfeeding
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Evaluate: • Therapeutic response: resolution of AIDS-related PCP
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report sore throat, fever, fatigue (may indicate superinfection) • To maintain adequate fluid intake • That IM injection is painful • To complete entire course of medica- tion • Pancreatitis: To report to provider im- mediately nausea, vomiting, severe ab- dominal pain • To report immediately rash, bleeding, fever, sore throat, or flulike symptoms, to avoid crowds, persons with known infec- tions HIGH ALERT
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PHARMACOKINETICS IV: Peak 1 hr IM: Peak 30 min Excreted unchanged in urine (66%); half-life 9-12 hr (IM), 6 hr (IV)
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• Adult and child ≥4 mo: IV/IM 4 mg/ kg/day × 2-3 wk; NEB 300 mg via Respir- gard II Jet (Nebupent) every 4 weeks; or 150 mg q2wk
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