pentamidine (Rx)

Brand and Other Names:NebuPent, Pentam
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 300mg

powder for nebulizer solution

  • 300mg

Pneumocystis Jiroveci Pneumonia

Treatment: 4 mg/kg IV/IM qDay for 14-21 days  

Prophylaxis: 4 mg/kg IV/IM q2-3Weeks OR

Nebulized 300 mg q4Weeks

African Trypanosomiasis (Off-label)

4 mg/kg IM qDay x10 days

Leishmaniasis (Off-label)

Visceral: 2-4 mg/kg IM q24-48hr x 15-30 doses

Cutaneous: 2 mg/kg IV/IM qODay x7 doses OR 3 mg/kg IM qODay x4 doses

Orphan Designations

Pancreatic cancer

Liver and intrahepatic bile duct cancer

Ovarian cancer

Orphan sponsor

  • Oncozyme Pharma, Inc; 555 Rene-Levesque West - 9th Floor; Montreal, Quebec H2Z 1B1, Canada

Renal Impairment

CrCl >10 mL/min: No adjustment necessary

CrCl <10 mL/min: 4 mg/kg IV/IM q24-36hr

Other Information

Monitor: Renal function

Dosage Forms & Strengths

powder for injection

  • 300mg

powder for nebulizer solution

  • 300mg

Pneumocystis Jiroveci Pneumonia

<4 months

  • Safety and efficacy not established

>4 months

  • Treatment: 4 mg/kg IV/IM qDay for 14-21 days
  • Prophylaxis: 4 mg/kg IV/IM q2-3Weeks OR
  • Nebulized 300 mg q4Weeks

African Trypanosomiasis (Off-label)

4 mg/kg IM qDay x10 days

Leishmaniasis (Off-label)

Visceral: 2-4 mg/kg IM q24-48hr x 15-30 doses

Cutaneous: 2 mg/kg IV/IM qODay x7 doses OR 3 mg/kg IM qODay x4 doses

Renal Impairment

CrCl >30 mL/min: No adjustment necessary

CrCl 10-30 mL/min: 4 mg/kg IV/IM q36hr

CrC<10 mL/min: 4 mg/kg IV/IM q48hr

Hemodialysis: 4 mg/kg IV/IM q48hr after dialysis on dialysis day

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Interactions

Interaction Checker

and pentamidine

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            Contraindicated (48)

            • amiodarone

              amiodarone and pentamidine both increase QTc interval. Contraindicated.

            • amitriptyline

              amitriptyline and pentamidine both increase QTc interval. Contraindicated.

            • amoxapine

              amoxapine and pentamidine both increase QTc interval. Contraindicated.

            • artemether/lumefantrine

              artemether/lumefantrine and pentamidine both increase QTc interval. Contraindicated.

            • chlorpromazine

              chlorpromazine and pentamidine both increase QTc interval. Contraindicated.

            • clarithromycin

              clarithromycin and pentamidine both increase QTc interval. Contraindicated.

            • clomipramine

              clomipramine and pentamidine both increase QTc interval. Contraindicated.

            • desipramine

              desipramine and pentamidine both increase QTc interval. Contraindicated.

            • disopyramide

              disopyramide and pentamidine both increase QTc interval. Contraindicated.

            • dofetilide

              dofetilide and pentamidine both increase QTc interval. Contraindicated.

            • doxepin

              doxepin and pentamidine both increase QTc interval. Contraindicated.

            • dronedarone

              dronedarone and pentamidine both increase QTc interval. Contraindicated.

            • droperidol

              droperidol and pentamidine both increase QTc interval. Contraindicated.

            • epinephrine

              epinephrine and pentamidine both increase QTc interval. Contraindicated.

            • epinephrine racemic

              epinephrine racemic and pentamidine both increase QTc interval. Contraindicated.

            • erythromycin base

              erythromycin base and pentamidine both increase QTc interval. Contraindicated.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate and pentamidine both increase QTc interval. Contraindicated.

            • erythromycin lactobionate

              erythromycin lactobionate and pentamidine both increase QTc interval. Contraindicated.

            • erythromycin stearate

              erythromycin stearate and pentamidine both increase QTc interval. Contraindicated.

            • fluconazole

              fluconazole and pentamidine both increase QTc interval. Contraindicated.

            • fluphenazine

              fluphenazine and pentamidine both increase QTc interval. Contraindicated.

            • haloperidol

              haloperidol and pentamidine both increase QTc interval. Contraindicated.

            • ibutilide

              ibutilide and pentamidine both increase QTc interval. Contraindicated.

            • imipramine

              imipramine and pentamidine both increase QTc interval. Contraindicated.

            • indapamide

              indapamide and pentamidine both increase QTc interval. Contraindicated.

            • ketoconazole

              ketoconazole and pentamidine both increase QTc interval. Contraindicated.

            • lofepramine

              lofepramine and pentamidine both increase QTc interval. Contraindicated.

            • lumefantrine

              lumefantrine and pentamidine both increase QTc interval. Contraindicated.

            • maprotiline

              maprotiline and pentamidine both increase QTc interval. Contraindicated.

            • moxifloxacin

              moxifloxacin and pentamidine both increase QTc interval. Contraindicated.

            • nilotinib

              nilotinib and pentamidine both increase QTc interval. Contraindicated.

            • nortriptyline

              nortriptyline and pentamidine both increase QTc interval. Contraindicated.

            • octreotide

              octreotide and pentamidine both increase QTc interval. Contraindicated.

            • octreotide (Antidote)

              octreotide (Antidote) and pentamidine both increase QTc interval. Contraindicated.

            • perphenazine

              perphenazine and pentamidine both increase QTc interval. Contraindicated.

            • pimozide

              pentamidine and pimozide both increase QTc interval. Contraindicated.

            • procainamide

              pentamidine and procainamide both increase QTc interval. Contraindicated.

            • prochlorperazine

              prochlorperazine and pentamidine both increase QTc interval. Contraindicated.

            • promazine

              promazine and pentamidine both increase QTc interval. Contraindicated.

            • promethazine

              promethazine and pentamidine both increase QTc interval. Contraindicated.

            • protriptyline

              protriptyline and pentamidine both increase QTc interval. Contraindicated.

            • quinidine

              quinidine and pentamidine both increase QTc interval. Contraindicated.

            • sotalol

              pentamidine and sotalol both increase QTc interval. Contraindicated.

            • thioridazine

              thioridazine and pentamidine both increase QTc interval. Contraindicated.

            • trazodone

              trazodone and pentamidine both increase QTc interval. Contraindicated.

            • trifluoperazine

              trifluoperazine and pentamidine both increase QTc interval. Contraindicated.

            • trimipramine

              trimipramine and pentamidine both increase QTc interval. Contraindicated.

            • ziprasidone

              pentamidine and ziprasidone both increase QTc interval. Contraindicated.

            Serious - Use Alternative (62)

            • alfuzosin

              alfuzosin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • apalutamide

              apalutamide will decrease the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.

            • apomorphine

              apomorphine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • aripiprazole

              aripiprazole and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • arsenic trioxide

              arsenic trioxide and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether

              artemether and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • atomoxetine

              atomoxetine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • bacitracin

              pentamidine and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs

            • ceritinib

              ceritinib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • clozapine

              clozapine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • dasatinib

              dasatinib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • degarelix

              degarelix and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • desflurane

              desflurane and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • deutetrabenazine

              deutetrabenazine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • dolasetron

              dolasetron and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • donepezil

              donepezil and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • efavirenz

              efavirenz and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • encorafenib

              encorafenib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • entrectinib

              pentamidine and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • eribulin

              eribulin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

            • escitalopram

              escitalopram increases toxicity of pentamidine by QTc interval. Avoid or Use Alternate Drug.

            • fedratinib

              pentamidine will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.

            • fexinidazole

              fexinidazole and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

            • flecainide

              flecainide and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • fluoxetine

              fluoxetine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • fluvoxamine

              fluvoxamine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • formoterol

              formoterol and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • foscarnet

              foscarnet and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • glasdegib

              pentamidine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • iloperidone

              iloperidone and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • inotuzumab

              inotuzumab and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

            • ivosidenib

              ivosidenib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

            • lapatinib

              lapatinib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • lefamulin

              lefamulin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • levofloxacin

              levofloxacin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • lonafarnib

              pentamidine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

              lonafarnib will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.

            • macimorelin

              macimorelin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

            • methadone

              methadone and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • mobocertinib

              mobocertinib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

            • ofloxacin

              ofloxacin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • ondansetron

              pentamidine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

            • paliperidone

              paliperidone and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • panobinostat

              pentamidine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

            • paroxetine

              paroxetine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • pitolisant

              pentamidine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • posaconazole

              pentamidine and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • ranolazine

              pentamidine and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.

            • ribociclib

              ribociclib increases toxicity of pentamidine by QTc interval. Avoid or Use Alternate Drug.

            • risperidone

              pentamidine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • romidepsin

              pentamidine and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.

            • saquinavir

              saquinavir, pentamidine. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Increased risk of PR or QT prolongation and cardiac arrhythmias.

            • sulfamethoxazole

              sulfamethoxazole and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • telavancin

              pentamidine and telavancin both increase QTc interval. Avoid or Use Alternate Drug.

            • trimethoprim

              pentamidine and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.

            • tropisetron

              pentamidine and tropisetron both increase QTc interval. Avoid or Use Alternate Drug.

            • umeclidinium bromide/vilanterol inhaled

              pentamidine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • vandetanib

              pentamidine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

            • vemurafenib

              vemurafenib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

            • venlafaxine

              pentamidine and venlafaxine both increase QTc interval. Avoid or Use Alternate Drug.

            • vilanterol/fluticasone furoate inhaled

              pentamidine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • voriconazole

              pentamidine and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

            Monitor Closely (91)

            • albuterol

              albuterol and pentamidine both increase QTc interval. Use Caution/Monitor.

            • alfuzosin

              pentamidine and alfuzosin both increase QTc interval. Use Caution/Monitor.

            • amikacin

              amikacin and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • amphotericin B deoxycholate

              amphotericin B deoxycholate and pentamidine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • atogepant

              pentamidine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • avapritinib

              pentamidine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • axitinib

              pentamidine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • azithromycin

              azithromycin and pentamidine both increase QTc interval. Modify Therapy/Monitor Closely.

            • bedaquiline

              pentamidine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • canagliflozin

              pentamidine and canagliflozin both increase serum potassium. Use Caution/Monitor.

            • cannabidiol

              cannabidiol will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

            • carboplatin

              carboplatin and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • cenobamate

              cenobamate will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

            • cidofovir

              cidofovir and pentamidine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • ciprofloxacin

              ciprofloxacin and pentamidine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • cisplatin

              cisplatin and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • citalopram

              pentamidine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • contrast media (iodinated)

              contrast media (iodinated) and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • crizotinib

              crizotinib and pentamidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • cyclosporine

              cyclosporine and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • elagolix

              elagolix will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              pentamidine and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • eslicarbazepine acetate

              eslicarbazepine acetate will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

            • etravirine

              etravirine increases levels of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Potential for increased toxicity.

            • ezogabine

              ezogabine, pentamidine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

            • fedratinib

              fedratinib will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.

            • fexinidazole

              fexinidazole will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

            • finerenone

              pentamidine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • flibanserin

              pentamidine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

            • fostemsavir

              pentamidine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • gemtuzumab

              pentamidine and gemtuzumab both increase QTc interval. Use Caution/Monitor.

            • glucarpidase

              glucarpidase will decrease the level or effect of pentamidine by increasing metabolism. Modify Therapy/Monitor Closely. Leucorvorin, reduced folates, and folate antimetabolites are substrates for glucarpidase (hydrolyzes glutamate residue from folic acid and antifolates)

            • goserelin

              goserelin increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • histrelin

              histrelin increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • hydroxyzine

              hydroxyzine increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • ifosfamide

              ifosfamide, pentamidine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Monitor renal function.

            • indacaterol, inhaled

              indacaterol, inhaled, pentamidine. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

            • insulin aspart

              pentamidine, insulin aspart. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • insulin aspart protamine/insulin aspart

              pentamidine, insulin aspart protamine/insulin aspart. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • insulin degludec

              pentamidine, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Pentamidine may either increase or decrease the blood glucose lowering effect of antidiabetic agents; pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia.

              pentamidine, insulin degludec. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • insulin degludec/insulin aspart

              pentamidine, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Pentamidine may either increase or decrease the blood glucose lowering effect of antidiabetic agents; pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia.

            • insulin detemir

              pentamidine, insulin detemir. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • insulin glargine

              pentamidine, insulin glargine. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • insulin glulisine

              pentamidine, insulin glulisine. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • insulin inhaled

              pentamidine, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Pentamidine may either increase or decrease the blood glucose lowering effect of antidiabetic agents; pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia.

              pentamidine, insulin inhaled. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • insulin isophane human/insulin regular human

              pentamidine, insulin isophane human/insulin regular human. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • insulin lispro

              pentamidine, insulin lispro. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • insulin lispro protamine/insulin lispro

              pentamidine, insulin lispro protamine/insulin lispro. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • insulin NPH

              pentamidine, insulin NPH. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • insulin regular human

              pentamidine, insulin regular human. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.

            • ioversol

              ioversol and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • isavuconazonium sulfate

              pentamidine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ivacaftor

              pentamidine increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

            • lemborexant

              pentamidine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

            • lenvatinib

              pentamidine and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

            • leuprolide

              leuprolide increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • lomitapide

              pentamidine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

            • lumacaftor/ivacaftor

              lumacaftor/ivacaftor, pentamidine. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .

            • metformin

              pentamidine decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor.

            • midazolam intranasal

              pentamidine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

            • mifepristone

              mifepristone, pentamidine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

            • neomycin PO

              neomycin PO and pentamidine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • olodaterol inhaled

              pentamidine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

            • osilodrostat

              osilodrostat and pentamidine both increase QTc interval. Use Caution/Monitor.

            • osimertinib

              osimertinib and pentamidine both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

            • oxaliplatin

              oxaliplatin and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              oxaliplatin will increase the level or effect of pentamidine by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

            • ozanimod

              ozanimod and pentamidine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • pasireotide

              pentamidine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • pazopanib

              pazopanib and pentamidine both increase QTc interval. Modify Therapy/Monitor Closely.

            • peramivir

              pentamidine increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

            • potassium citrate/citric acid

              pentamidine and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.

            • quetiapine

              quetiapine, pentamidine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

            • quinine

              pentamidine and quinine both increase QTc interval. Use Caution/Monitor.

            • rilpivirine

              rilpivirine increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

            • rucaparib

              rucaparib will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C19 substrates, if clinically indicated.

            • selpercatinib

              selpercatinib increases toxicity of pentamidine by QTc interval. Use Caution/Monitor.

            • sodium picosulfate/magnesium oxide/anhydrous citric acid

              pentamidine decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

            • sorafenib

              sorafenib and pentamidine both increase QTc interval. Use Caution/Monitor.

            • stiripentol

              stiripentol will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

            • streptozocin

              pentamidine and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • tacrolimus

              pentamidine and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • tazemetostat

              pentamidine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tecovirimat

              tecovirimat will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.

            • teicoplanin

              pentamidine and teicoplanin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • tenofovir DF

              pentamidine and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Combination may also increase tenofovir levels.

            • tinidazole

              pentamidine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tipranavir

              tipranavir, pentamidine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Increased risk of PR or QT prolongation and cardiac arrhythmias.

            • triclabendazole

              triclabendazole and pentamidine both increase QTc interval. Use Caution/Monitor.

              triclabendazole will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

            • trimethoprim

              trimethoprim and pentamidine both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.

            • triptorelin

              triptorelin increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • voclosporin

              voclosporin and pentamidine both increase serum potassium. Use Caution/Monitor.

              voclosporin, pentamidine. Either increases effects of the other by QTc interval. Use Caution/Monitor.

              voclosporin, pentamidine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            Minor (22)

            • acyclovir

              acyclovir and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • adefovir

              adefovir and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • capreomycin

              capreomycin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • cephaloridine

              cephaloridine and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • chloroquine

              chloroquine increases toxicity of pentamidine by QTc interval. Minor/Significance Unknown.

            • colistin

              colistin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • didanosine

              didanosine, pentamidine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Enhanced risk of pancreatitis.

            • entecavir

              pentamidine, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

            • folic acid

              pentamidine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • foscarnet

              foscarnet and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              foscarnet, pentamidine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of severe hypocalcemia.

            • ganciclovir

              ganciclovir increases toxicity of pentamidine by pharmacodynamic synergism. Minor/Significance Unknown.

            • gentamicin

              gentamicin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • L-methylfolate

              pentamidine decreases levels of L-methylfolate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • methoxyflurane

              methoxyflurane and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • paromomycin

              paromomycin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • polymyxin B

              pentamidine and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • ruxolitinib

              pentamidine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • streptomycin

              pentamidine and streptomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • tobramycin

              pentamidine and tobramycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • valganciclovir

              valganciclovir increases toxicity of pentamidine by pharmacodynamic synergism. Minor/Significance Unknown.

            • vancomycin

              pentamidine and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

            • zidovudine

              zidovudine increases toxicity of pentamidine by pharmacodynamic synergism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Injection

            • Increased SCr (23%)
            • IM site reactions (11%)
            • Leukopenia (10.3%)

            Nebulizer

            • Cough (1-63%)
            • Wheezing (32%)
            • Fever (51%)
            • Decreased appetite (50%)
            • Bronchospasm (48%)
            • Fatigue (66%)
            • Infection (15%)

            1-10%

            Injection

            • Anemia
            • Confusion/hallucinations
            • Hypoglycemia
            • Hypotension
            • Elevated LFT's
            • Fever
            • BUN increased
            • Azotemia
            • Anorexia/Nausea/Vomiting
            • Rash
            • Thrombocytopenia

            Nebulizer

            • Bitter/metallic taste
            • Headache
            • Diarrhea
            • Nausea
            • Oral Candida
            • Anemia
            • Pharyngitis
            • Night sweats
            • Upper respiratory tract infection

            <1%

            Anxiety

            Arthralgia

            Blepharitis

            Dizziness

            Neuralgia

            Anemia

            Bronchitis

            Chest tightness

            Colitis

            Blurred vision

            Neutropenia

            Pleuritis

            Rales

            Thrombocytopenia

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Hypotension, QT prolongation, and Stevens-Johnson syndrome reported with use

            Use caution in patients with history of pancreatitis, hyperglycemia, hypoglycemia, hypocalcemia, leukopenia, thrombocytopenia, anemia, hepatic/renal dysfunction

            Risk of nephrotoxicity with parenteral administration

            Risk of sudden, severe hypotension with parentera administration-keep patient supine

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            Pregnancy & Lactation

            Pregnancy Category: C

            There are no adequate and well controlled studies of aerosolized pentamidine in pregnant women; a literature report indicated that pentamidine 4 mg/kg/day IV administered to pregnant rats was embryolethal; teratogenicity was not observed in this study. It is unknown whether aerosolized pentamidine crosses the placenta at clinically significant concentrations

            Lactation: Not known if distributed in breast milk, discontinue drug or do not nurse

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits synthesis of DNA, RNA, phospholipids, protein by inhibiting oxidative phosphorylation and/or interfering with incorporation of nucleotides and nucleic acids into RNA and DNA

            Pharmacokinetics

            Half-Life: 5.8 hr (IV); 7-11 hr (IM)

            Metabolism: Liver

            Vdss: 286-1356 L (IV); 1658-3790 (IM)

            Excretion: Urine (12%)

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            Administration

            IV Incompatibilities

            Y-site: aldesleukin, cefazolin, cefoperazone, cefotaxime, cefoxitin, ceftazidime, ceftriaxone, fluconazole, foscarnet, linezolid

            IV Compatibilities

            Solution: D5W, NS

            Y-site: diltiazem, gatifloxacin, zidovudine

            IV Preparation

            Reconstitute w/ 3-5 mL SWI or D5W (do not use NS)

            Reconstituted solutions (60-100 mg/mL) stable for 48 hr at room temp; keep between 22-30°C to prevent crystallization

            For IV infusion, dilute in 50-250 mL D5W (stable at room temp for 24 hr)

            IV/IM Administration

            IM: deep IM using Z-track technique

            IV: Slow infusion over 60-120 min

            Pts should be in supine position

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            pentamidine injection
            -
            300 mg vial
            Nebupent inhalation
            -
            300 mg nebulizer soln
            Pentam injection
            -
            300 mg vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            pentamidine injection

            PENTAMIDINE ISETHIONATE - INJECTION

            (pen-TAM-ih-deen eye-seh-THIGH-oh-nate)

            COMMON BRAND NAME(S): Pentam 300

            USES: Pentamidine is used to treat a serious lung infection (Pneumocystis pneumonia-PCP) in people with immune system problems, including people with acquired immunodeficiency syndrome (AIDS). Pentamidine belongs to a class of drugs known as antiprotozoals. It works by killing the organism that causes the infection.

            HOW TO USE: This medication is given by injection into a vein or muscle as directed by your doctor, usually once a day. If it is given by injection into a vein, it is slowly injected over 1 to 2 hours. Tell your doctor right away if you notice leakage, redness, or pain during an injection into your vein. If this medication is given by injection into a muscle, it is usually injected into the buttock/hip area.The dosage is based on your medical condition, weight, and response to treatment.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.Tell your doctor if your condition does not improve or if it worsens.

            SIDE EFFECTS: Nausea, vomiting, loss of appetite, unusual taste/dryness in the mouth, dizziness, diarrhea, or redness/pain/leakage at the injection site may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.People using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, mental/mood changes (such as confusion, hallucinations), signs of kidney problems (such as change in the amount of urine), signs of anemia (such as severe tiredness, bluish skin/nails), signs of low blood pressure (such as severe dizziness, pale skin, fainting), signs of low blood sugar (such as sudden sweating, shaking, fast heartbeat, hunger), signs of another infection (such as increased fever, chills, persistent sore throat), abdominal pain, fast/irregular heartbeat, signs of high blood sugar (such as unusual increase in thirst or urination).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before using pentamidine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding/blood disorders, heart problems, high or low blood pressure, diabetes, kidney disease, liver problems, pancreatitis.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Pentamidine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using pentamidine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using pentamidine safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially QT prolongation (see above).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Because breast milk can transmit HIV, do not breast-feed if you have HIV infection. Consult your doctor for details.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: other drugs that may affect the kidneys (including aminoglycosides such as tobramycin, NSAIDs such as ibuprofen or naproxen), saquinavir.Many drugs besides pentamidine may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), among others.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Laboratory and/or medical tests (such as kidney/liver tests, blood pressure, blood sugar, complete blood counts, EKGs) should be performed regularly before, during, and after treatment to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

            STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            • View the formulary and any restrictions for each plan.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.