Aerosolized pentamidine is widely used for pneumocystis carinii pneumonitis in AIDS patients. Conversely, theintravenous form of the drug is seldom used, for reasons of efficacy and toxicity.
Bronchospasm: 10 to 29%.
Cutaneous reactions: morbilliform eruptions 15%.
Cutaneous: morbilliform eruptions, erythroderma; generalized urticaria, contact urticaria (nurses), facial rash.
Respiratory: bronchospasm (aerosolized pentamidine), laryngeal edema, tongue swelling, hypersensitivity pneumonitis.
Skin-prick tests positive with 3 mg/ ml pentamidine isethionate in contact urticaria and some cases of bronchospasm.
Intradermal skin-tests: false positive with 0.015 and 0.15 mg/ ml pentamidine.
Intravenous test dose is dangerous (2 deaths reported).
Non specific histamine release (documented with intravenous pentamidine).
IgE-mediated hypersensitivity (contact urticaria, some cases of bronchospasm).
Irritative effect (bronchospasm).
Use premedication with nebulized albuterol and/ or cromolyn sodium prior to aerosolized pentamidine.
Slow intravenous administration (decreases non specific histamine release).
In patients with hypersensitivity to systemic pentamidine; cautious administration of aerosolized pentamidine is safe when the following protocol is applied:
Dilution of 300 mg of pentamidine isethionate in 20 ml of sterile water (15 mg/ ml).