Pentamidine diisethionate

Pentamidine is an aromatic diamine with the following effects in Leishmania: inhibition of dihydrofolate reductase, inhibition of RNA and protein synthesis.

Prophylaxis of Pneumocystis carinii pneumonia in HIV patients with < 200 CD4 cells/μl, African tryposomiasis (African sleeping sickness caused by Trypanosoma brucei gambiense and Trypanosoma brucei rhodiense), leishmaniasis.

Visceral leishmaniasis not responding to antimony compounds: 4 mg/kg bw/day for 2 weeks or 4 mg/kg bw 3 times/week (until parasites are no longer detected in 2 spleen biopsies 2 weeks apart).

Cutaneous leishmaniasis (L. aethiopica, L. guyanensis): 3-4 mg/kg bw 1-2 times/week until the ulcers have healed.

Mucocutaneous leishmaniasis (L. brasiliensis, L. aethiopica): 4 mg/kg bw 3 times/week until the ulcers have healed, possibly for several months.

Diffuse cutaneous leishmaniasis (L. aethiopica): 3-4 mg/kg bw/day for months, at least another 4 months until the smears have become negative.

Trypanosoma brucei spp.: 5 mg/kg bw/day every 2nd day, 10 cycles in total.

Pneumocystis carinii pneumonia:

• Prophylaxis: 200 mg/day for 4 days by inhalation, then 300 mg every 28 days.
• Therapy: 4 mg/kg bw/day i.v. (over 60 min.) for 14 days, then 300-600 mg/day.

Essential interactions of pentamidine diisethionate