PDF of Ask a Pharmacist 1211What effect does pentamidine (Nebupent, Pentam, generic) have on glucose control? — Veronica Brady, FNP-BC, BC-ADM, CDE

Pentamidine is used to treat and prevent Pneumocystis jiroveci pneumonia (commonly referred to as PCP or PJP) in immunocompromised patients. It is administered both intravenously and through inhalation, and alterations in glucose have been reported with both formulas. Although not occurring commonly, pentamidine has been associated with hypoglycemia, hyperglycemia, and development of non-insulin dependent diabetes mellitus (NIDDM). Hypoglycemia is thought to be due to increased basal hypersecretion of insulin from the beta cells of the pancreas and can occur early or at any point during therapy. Hyperglycemia and non-insulin dependent diabetes mellitus is caused by decreased insulin secretion, especially after a meal. As hyperglycemia is thought to be due to toxic effects of pentamidine on the beta cells, it typically occurs later in therapy.

Blood glucose should be monitored regularly in patients receiving pentamidine. Animal and retrospective human studies suggest that renal dysfunction may make a patient more likely to experience changes in glucose control; however, baseline renal dysfunction is not a contraindication to receiving pentamidine. Hypoglycemia should be managed with oral or IV glucose products, as indicated by the clinical situation. Hyperglycemia or non-insulin dependent diabetes mellitus should be managed with oral diabetes medications or insulin as appropriate. ONA

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Lisa Thompson is assistant professor, Department of Clinical Pharmacy, University of Colorado Denver School of Pharmacy, Aurora, Colorado.