Pentamidine, Injection/Inhalation

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KEY POINTS

• This medicine is inhaled to prevent pneumocystis pneumonia (PCP), or given by injection to treat PCP in people with immune system problems. Use it exactly as directed.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: anti-infective

Generic and brand names: pentamidine, inhalation; pentamidine, injection; NebuPent; Pentam 300

What is this medicine used for?

This medicine is given by injection (shots) to treat a certain type of pneumonia (called PCP) in people with immune system problems. It may also be inhaled to prevent PCP in people at high risk for infection.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• An irregular heart beat
• A severe skin rash called Stevens-Johnson syndrome
• Asthma or other lung problems
• Bleeding problems or a blood disorder
• Diabetes
• Heart disease or heart attack
• Kidney or liver disease
• Low blood sugar
• Low or high blood pressure
• Pancreatitis
• Problems with high or low blood levels of calcium or potassium

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

This medicine may be given as an injection (shots) or by inhaling from a nebulizer. Injections (shots):

The shots are given by your healthcare provider as an injection into a muscle or by IV infusion (slow drip through a needle into a large vein), usually once a day for 14 days. You will be monitored closely while you are receiving this medicine.

Inhalation:

The inhalations are given every 4 weeks using a nebulizer to deliver the medicine to the lungs. A nebulizer provides a precise amount of medicine as an aerosol mist that you breathe into your lungs.

Sometimes your healthcare provider may teach you how to use this medicine and the nebulizer at home. Check the label on the medicine for directions about your specific dose. Read all instructions supplied with the nebulizer and the medicine. Use only the diluent that comes with your medicine. If you are not sure how to prepare the medicine or use the nebulizer, ask your healthcare provider or pharmacist to explain. Do not use any other medicine in the nebulizer. Do not stop taking this medicine without your healthcare provider's approval.

Check with your healthcare provider before using the inhaled medicine in children under age 16 years.

What if I miss a dose?

Do not miss a dose or an appointment to receive a dose. If you are using the inhaled medicine at home and miss a dose, contact your healthcare provider for instructions. If you miss an appointment to receive a dose, contact your healthcare provider to reschedule your dose as soon as possible.

What should I watch out for?

If you develop a new fever, cough, or breathing problems, contact your healthcare provider right away. These may be symptoms of a new or worsening infection.

You may develop a cough or shortness of breath during or after the inhalation treatment, especially if you have a history of smoking or lung problems. Contact your healthcare provider right away if this happens.

You will need to have blood tests, blood pressure checks, and EKG heart tests to find out how the medicine is affecting you. Keep all your appointments for these tests.

This medicine may make you feel dizzy or faint, especially when you get up quickly after sitting or lying down. Getting up slowly may help. Do not drive or operate machinery unless you are fully alert.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you have received this medicine.

If you have diabetes: This medicine may increase or decrease your blood sugar levels. Be sure the healthcare provider who prescribed this medicine is aware of your diabetes, and follow all instructions regarding your diet or diabetes medicine (insulin or oral medicines for diabetes).

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Shortness of breath or coughing after an inhalation; unusual bruising or bleeding; seizures; fast or irregular heartbeat; chest pain; severe stomach pain; severe nausea or vomiting; severe dizziness or fainting; pain or swelling at the spot where an injection was given; severe skin redness, blisters, or itching; increased or decreased urinating; unusual tiredness or weakness; unusual bruising or bleeding; increased thirst; confusion; hallucinations; dark urine; light-colored bowel movements; yellowing of skin or eyes; severe mouth sores; new or worsening fever, cough, sore throat, or breathing problems.

Other: Nausea, vomiting, diarrhea, bad taste in your mouth, decreased appetite, night sweats, dizziness, headache, trouble sleeping, drowsiness, facial numbness, dry mouth, hoarseness, blurred vision.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Alfuzosin (Uroxatral)
• Antiarrhythmic medicines (to treat irregular heartbeat) such as amiodarone (Cordarone, Pacerone), disopyramide (Norpace), dofetilide (Tikosyn), dronedarone (Multaq), flecainide, procainamide, propafenone (Rythmol), quinidine, and sotalol (Betapace, Sorine)
• Antibiotics such as amikacin, azithromycin (Zithromax, Zmax), chloramphenicol, clarithromycin (Biaxin), erythromycin (E.E.S., Ery-Tab, Erythrocin), gemifloxacin (Factive), gentamicin, isoniazid, levofloxacin (Levaquin), moxifloxacin (Avelox), rifampin (Rifadin), telithromycin (Ketek), tobramycin, and vancomycin (Vancocin)
• Antidepressants such as amitriptyline, citalopram (Celexa), desipramine (Norpramin), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Pamelor), sertraline (Zoloft), and trazodone
• Antifungal medicines such as amphotericin b (Abelcet, AmBisome, Amphotec), fluconazole (Diflucan), ketoconazole (Nizoral), and voriconazole (Vfend)
• Antipsychotic medicines such as asenapine (Saphris), chlorpromazine, fluphenazine, haloperidol (Haldol), iloperidone (Fanapt), paliperidone (Invega), pimozide (Orap), quetiapine (Seroquel), risperidone (Risperdal), thioridazine, and ziprasidone (Geodon)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol) and phenytoin (Dilantin, Phenytek)
• Antiviral medicines such as foscarnet (Foscavir) and ganciclovir (Cytovene)
• Apomorphine (Apokyn)
• Cancer medicines such as abiraterone (Zytiga), arsenic trioxide (Trisenox), cisplatin, crizotinib (Xalkori), degarelix (Firmagon), nilotinib (Tasigna), toremifene (Fareston), vandetanib (Caprelsa), and vemurafenib (Zelboraf)
• Diabetes medicines such as chlorpropamide, glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Glynase), insulin, metformin (Fortamet, Glucophage, Riomet), pioglitazone (Actos), repaglinide (Prandin), rosiglitazone (Avandia), and tolbutamide
• Doxepin (Silenor)
• Gemfibrozil (Lopid)
• HIV medicines such as delavirdine (Rescriptor), efavirenz (Sustiva), etravirine (Intelence), lopinavir/ritonavir (Kaletra), and saquinavir (Invirase)
• Ivabradine (Corlanor)
• Malaria medicines such as artemether/lumefantrine (Coartem), chloroquine, mefloquine, primaquine, and quinine
• Medicines to block or prevent stomach acid such as cimetidine (Tagamet), esomeprazole (Nexium), and omeprazole (Prilosec)
• Medicines to treat breathing or lung problems such as arformoterol (Brovana), formoterol (Perforomist), salmeterol (Serevent), and vilanterol (Breo Ellipta)
• Methadone (Dolophine, Methadose)
• Mifepristone (Korlym, Mifeprex)
• Nausea medicines such as dolasetron (Anzemet), ondansetron (Zofran), and palonosetron (Aloxi)
• Nicardipine (Cardene)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Ranolazine (Ranexa)
• Stimulants such as armodafinil (Nuvigil) and modafinil (Provigil)
• Tacrolimus (Astagraf, Prograf, Protopic)
• Vardenafil (Levitra, Staxyn)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store the unmixed (powder) for the inhaled medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light. After the powder is mixed with sterile water, you can keep it at room temperature in the original vial for up to 48 hours if protected from light. Discard any unused mixed medicine after 48 hours.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Keep all medicines out of the reach of children.

Do not share medicines with other people.