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Altrocchi C, Van Ammel K, Steemans M, Kreir M, Tekle F, Teisman A, Gallacher DJ, Lu HR. Evaluation of chronic drug-induced electrophysiological and cytotoxic effects using human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). Front Pharmacol 2023; 14:1229960. [PMID: 37492082 PMCID: PMC10364322 DOI: 10.3389/fphar.2023.1229960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/28/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction: Cardiotoxicity is one of the leading causes of compound attrition during drug development. Most in vitro screening platforms aim at detecting acute cardio-electrophysiological changes and drug-induced chronic functional alterations are often not studied in the early stage of drug development. Therefore, we developed an assay using human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) that evaluates both drug-induced acute and delayed electrophysiological and cytotoxic effects of reference compounds with clinically known cardiac outcomes. Methods: hiPSC-CMs were seeded in 48-well multielectrode array (MEA) plates and were treated with four doses of reference compounds (covering and exceeding clinical free plasma peak concentrations -fCmax values) and MEA recordings were conducted for 4 days. Functional-electrophysiological (field-potentials) and viability (impedance) parameters were recorded with a MEA machine. Results: To assess this platform, we tested tyrosine-kinase inhibitors with high-cardiac risk profile (sunitinib, vandetanib and nilotinib) and low-cardiac risk (erlotinib), as well as known classic cardiac toxic drugs (doxorubicin and BMS-986094), ion-channel trafficking inhibitors (pentamidine, probucol and arsenic trioxide) and compounds without known clinical cardiotoxicity (amoxicillin, cetirizine, captopril and aspirin). By evaluating the effects of these compounds on MEA parameters, the assay was mostly able to recapitulate different drug-induced cardiotoxicities, represented by a prolongation of the field potential, changes in beating rate and presence of arrhythmic events in acute (<2 h) or delayed phase ≥24 h, and/or reduction of impedance during the delayed phase (≥24 h). Furthermore, a few reference compounds were tested in hiPSC-CMs using fluorescence- and luminescence-based plate reader assays, confirming the presence or absence of cytotoxic effects, linked to changes of the impedance parameters measured in the MEA assay. Of note, some cardiotoxic effects could not be identified at acute time points (<2 h) but were clearly detected after 24 h, reinforcing the importance of chronic drug evaluation. Discussion: In conclusion, the evaluation of chronic drug-induced cardiotoxicity using a hiPSC-CMs in vitro assay can contribute to the early de-risking of compounds and help optimize the drug development process.
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Affiliation(s)
- C. Altrocchi
- A Division of Janssen Pharmaceutica NV, Global Safety Pharmacology, Preclinical Sciences and Translational Safety, Janssen R&D, Beerse, Belgium
| | - K. Van Ammel
- A Division of Janssen Pharmaceutica NV, Global Safety Pharmacology, Preclinical Sciences and Translational Safety, Janssen R&D, Beerse, Belgium
| | - M. Steemans
- A Division of Janssen Pharmaceutica NV, Cell Health Assessment Group, Preclinical Sciences and Translational Safety, Janssen R&D, Beerse, Belgium
| | - M. Kreir
- A Division of Janssen Pharmaceutica NV, Global Safety Pharmacology, Preclinical Sciences and Translational Safety, Janssen R&D, Beerse, Belgium
| | - F. Tekle
- A Division of Janssen Pharmaceutica NV, Statistics and Decision Sciences, Global Development, Janssen R&D, Beerse, Belgium
| | - A. Teisman
- A Division of Janssen Pharmaceutica NV, Global Safety Pharmacology, Preclinical Sciences and Translational Safety, Janssen R&D, Beerse, Belgium
| | - D. J. Gallacher
- A Division of Janssen Pharmaceutica NV, Global Safety Pharmacology, Preclinical Sciences and Translational Safety, Janssen R&D, Beerse, Belgium
| | - H. R. Lu
- A Division of Janssen Pharmaceutica NV, Global Safety Pharmacology, Preclinical Sciences and Translational Safety, Janssen R&D, Beerse, Belgium
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Abstract
Pentamidine (PTM), which is a diamine that is widely known for its antimicrobial activity, is a very interesting drug whose mechanism of action is not fully understood. In recent years, PTM has been proposed as a novel potential drug candidate for the treatment of mental illnesses, myotonic dystrophy, diabetes, and tumors. Nevertheless, the systemic administration of PTM causes severe side effects, especially nephrotoxicity. In order to efficiently deliver PTM and reduce its side effects, several nanosystems that take advantage of the chemical characteristics of PTM, such as the presence of two positively charged amidine groups at physiological pH, have been proposed as useful delivery tools. Polymeric, lipidic, inorganic, and other types of nanocarriers have been reported in the literature for PTM delivery, and they are all in different development phases. The available approaches for the design of PTM nanoparticulate delivery systems are reported in this review, with a particular emphasis on formulation strategies and in vitro/in vivo applications. Furthermore, a critical view of the future developments of nanomedicine for PTM applications, based on recent repurposing studies, is provided. Created with BioRender.com.
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Abstract
About one-sixth of the world's population is affected by a neglected tropical disease as defined by the World Health Organization and Center for Disease Control. Parasitic diseases comprise most of the neglected tropical disease list and they are causing enormous amounts of disability, morbidity, mortality, and healthcare costs worldwide. The burden of disease of the top five parasitic diseases has been estimated to amount to a total 23 million disability-adjusted life-years. Despite the massive health and economic impact, most drugs currently used for the treatment of parasitic diseases have been developed decades ago and insufficient novel drugs are being developed. The current review provides a compilation of the systemic and target-site pharmacokinetics of established antiparasitic drugs. Knowledge of the pharmacokinetic profile of drugs allows for the examination and possibly optimization of existing dosing schemes. Many symptoms of parasitic diseases are caused by parasites residing in different host tissues. Penetration of the antiparasitic drug into these tissues, the target site of infection, is a prerequisite for a successful treatment of the disease. Therefore, for the examination and improvement of established dosing regimens, not only the plasma but also the tissue pharmacokinetics of the drug have to be considered. For the current paper, almost 7000 scientific articles were identified and screened from which 429 were reviewed in detail and 100 were included in this paper. Systemic pharmacokinetics are available for most antiparasitic drugs but in many cases, not for all the relevant patient populations and only for single- or multiple-dose administration. Systemic pharmacokinetic data in patients with organ impairment and target-site pharmacokinetic data for relevant tissues and body fluids are mostly lacking. To improve the treatment of patients with parasitic diseases, research in these areas is urgently needed.
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Affiliation(s)
- Valentin Al Jalali
- Department of Clinical Pharmacology, Vienna University Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Vienna University Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Takahashi M, Takahashi K, Inose R, Sugimoto T, Koh H, Hino M, Nagayama K. Safety profile of the concomitant use of foscarnet and aerosolized pentamidine in allogeneic hematopoietic stem cell transplantation recipients. Transpl Infect Dis 2019; 22:e13239. [PMID: 31883423 DOI: 10.1111/tid.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/25/2019] [Accepted: 12/19/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Concomitant use of foscarnet and intravenous pentamidine can very frequently cause severe hypocalcemia. However, it is unknown whether aerosolized pentamidine has a similar adverse interaction with foscarnet. The present study was aimed at examining the safety profile of concomitantly used foscarnet and aerosolized pentamidine in patients receiving allogeneic hematopoietic stem cell transplantation. METHODS Data from allogeneic hematopoietic stem cell recipients who had been administered foscarnet therapy for over 7 days were analyzed. We compared electrolyte abnormalities and serum creatinine level between patients who received aerosolized pentamidine concomitantly and those who did not. RESULTS A total of 84 consecutive patients and 135 episodes of foscarnet therapy between May 2011 and April 2016 were evaluable. Of these 135 episodes, 25 episodes of therapy included concurrent therapy with 300 mg dose of aerosolized pentamidine once a month (pentamidine group) and 110 episodes did not (non-pentamidine group). The incident rates of grade 3/4 hypocalcemia did not significantly differ between the pentamidine and non-pentamidine groups (P = .207; 0/25 [0%] vs 10/110 [9.1%], respectively). In addition, we observed no significant difference in the incident rates of grade 3/4 serum creatinine increase between the two groups (P = 1.00; 0/25 [0%] vs 4/110 [3.6%], respectively). CONCLUSION Our results suggest that the drug interactions between foscarnet and aerosolized pentamidine may not be clinically significant.
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Affiliation(s)
- Masaya Takahashi
- Department of Pharmacy, Osaka City University Hospital, Osaka, Japan
| | | | - Ryo Inose
- Department of Pharmacy, Osaka City University Hospital, Osaka, Japan
| | - Takashi Sugimoto
- Department of Pharmacy, Osaka City University Hospital, Osaka, Japan
| | - Hideo Koh
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masayuki Hino
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Katsuya Nagayama
- Department of Pharmacy, Osaka City University Hospital, Osaka, Japan
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5
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Al-Horani RA, Clemons D, Mottamal M. The In Vitro Effects of Pentamidine Isethionate on Coagulation and Fibrinolysis. Molecules 2019; 24:E2146. [PMID: 31174390 PMCID: PMC6600542 DOI: 10.3390/molecules24112146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022] Open
Abstract
Pentamidine is bis-oxybenzamidine-based antiprotozoal drug. The parenteral use of pentamidine appears to affect the processes of blood coagulation and/or fibrinolysis resulting in rare but potentially life-threatening blood clot formation. Pentamidine was also found to cause disseminated intravascular coagulation syndrome. To investigate the potential underlying molecular mechanism(s) of pentamidine's effects on coagulation and fibrinolysis, we studied its effects on clotting times in normal and deficient human plasmas. Using normal plasma, pentamidine isethionate doubled the activated partial thromboplastin time at 27.5 µM, doubled the prothrombin time at 45.7 µM, and weakly doubled the thrombin time at 158.17 µM. Using plasmas deficient of factors VIIa, IXa, XIa, or XIIa, the concentrations to double the activated partial thromboplastin time were similar to that obtained using normal plasma. Pentamidine also inhibited plasmin-mediated clot lysis with half-maximal inhibitory concentration (IC50) value of ~3.6 μM. Chromogenic substrate hydrolysis assays indicated that pentamidine inhibits factor Xa and plasmin with IC50 values of 10.4 µM and 8.4 µM, respectively. Interestingly, it did not significantly inhibit thrombin, factor XIa, factor XIIIa, neutrophil elastase, or chymotrypsin at the highest concentrations tested. Michaelis-Menten kinetics and molecular modeling studies revealed that pentamidine inhibits factor Xa and plasmin in a competitive fashion. Overall, this study provides quantitative mechanistic insights into the in vitro effects of pentamidine isethionate on coagulation and fibrinolysis via the disruption of the proteolytic activity of factor Xa and plasmin.
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Affiliation(s)
- Rami A Al-Horani
- Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA.
| | - Daytriona Clemons
- Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA.
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Kip AE, Schellens JHM, Beijnen JH, Dorlo TPC. Clinical Pharmacokinetics of Systemically Administered Antileishmanial Drugs. Clin Pharmacokinet 2019; 57:151-176. [PMID: 28756612 PMCID: PMC5784002 DOI: 10.1007/s40262-017-0570-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This review describes the pharmacokinetic properties of the systemically administered antileishmanial drugs pentavalent antimony, paromomycin, pentamidine, miltefosine and amphotericin B (AMB), including their absorption, distribution, metabolism and excretion and potential drug–drug interactions. This overview provides an understanding of their clinical pharmacokinetics, which could assist in rationalising and optimising treatment regimens, especially in combining multiple antileishmanial drugs in an attempt to increase efficacy and shorten treatment duration. Pentavalent antimony pharmacokinetics are characterised by rapid renal excretion of unchanged drug and a long terminal half-life, potentially due to intracellular conversion to trivalent antimony. Pentamidine is the only antileishmanial drug metabolised by cytochrome P450 enzymes. Paromomycin is excreted by the kidneys unchanged and is eliminated fastest of all antileishmanial drugs. Miltefosine pharmacokinetics are characterized by a long terminal half-life and extensive accumulation during treatment. AMB pharmacokinetics differ per drug formulation, with a fast renal and faecal excretion of AMB deoxylate but a much slower clearance of liposomal AMB resulting in an approximately ten-fold higher exposure. AMB and pentamidine pharmacokinetics have never been evaluated in leishmaniasis patients. Studies linking exposure to effect would be required to define target exposure levels in dose optimisation but have only been performed for miltefosine. Limited research has been conducted on exposure at the drug’s site of action, such as skin exposure in cutaneous leishmaniasis patients after systemic administration. Pharmacokinetic data on special patient populations such as HIV co-infected patients are mostly lacking. More research in these areas will help improve clinical outcomes by informed dosing and combination of drugs.
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Affiliation(s)
- Anke E Kip
- Department of Pharmacy and Pharmacology, Antoni van Leeuwenhoek Hospital/MC Slotervaart, Amsterdam, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Jan H M Schellens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacology, Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, Antoni van Leeuwenhoek Hospital/MC Slotervaart, Amsterdam, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacology, Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas P C Dorlo
- Department of Pharmacy and Pharmacology, Antoni van Leeuwenhoek Hospital/MC Slotervaart, Amsterdam, The Netherlands.
- Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
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Asahi Y, Nomura F, Abe Y, Doi M, Sakakura T, Takasuna K, Yasuda K. Electrophysiological evaluation of pentamidine and 17-AAG in human stem cell-derived cardiomyocytes for safety assessment. Eur J Pharmacol 2019; 842:221-230. [DOI: 10.1016/j.ejphar.2018.10.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 10/28/2022]
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David S, Mathan V, Balaram P. Interactions of linear dicationic molecules with lipid A: structural requisites for optimal binding affinity. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/096805199500200503] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The structural determinants of the binding affinity of linear dicationic molecules toward lipid A have been examined with respect to the distance between the terminal cationic functions, the basicity, and the type of cationic moieties using a series of spermidine derivatives and pentamidine analogs by fluorescence spectroscopic methods. The presence of two terminal cationic groups corresponds to enhanced affinity. A distinct sigmoidal relationship between the intercationic distance and affinity was observed with a sharp increase at 11 Å, levelling off at about 13 Å. The basicity (pK) and nature of the cationic functions are poor correlates of binding potency, since molecules bearing primary amino, imidazolino, or guanido termini are equipotent. The interaction of pentamidine, a bisamidine drug, with lipid A, characterized in considerable detail employing the putative intermolecular excimerization of the drug, suggests a stoichiometry of 1:1 in the resultant complex. The binding is driven almost exclusively by electrostatic forces, and is dependent on the ionization states of both lipid A and the drug. Under conditions when lipid A is highly disaggregated, pentamidine binds specifically to bis-phosphoryl- but not to monophosphoryl-lipid A indicating that both phosphate groups of lipid A are necessary for electrostatic interactions by the terminal amidininium groups of the drug. Based on these data, a structural model is proposed for the pentamidine-lipid A complex, which may be of value in designing endotoxin antagonists from first principles.
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Affiliation(s)
- S.A. David
- The Wellcome Trust Research Laboratory and Department of Gastrointestinal Sciences, Christian Medical College Hospital, Vellore and Molecular Biophysics Unit, Indian Institute of Science, Bangalore, India
| | - V.I. Mathan
- The Wellcome Trust Research Laboratory and Department of Gastrointestinal Sciences, Christian Medical College Hospital, Vellore and Molecular Biophysics Unit, Indian Institute of Science, Bangalore, India
| | - P. Balaram
- The Wellcome Trust Research Laboratory and Department of Gastrointestinal Sciences, Christian Medical College Hospital, Vellore and Molecular Biophysics Unit, Indian Institute of Science, Bangalore, India
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Hihara T, Yamazaki K, Taniguchi T, Yoshinaga T, Ito M, Sawada K. Use of Human Embryonic Stem Cell-Derived Cardiomyocyte Clusters to Assess Potential for Chronic Treatment with Compounds to Cause QT Prolongation. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/pp.2014.54044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Arino T, Karakawa S, Ishiwata Y, Nagata M, Yasuhara M. Effect of cimetidine on pentamidine induced hyperglycemia in rats. Eur J Pharmacol 2012; 693:72-9. [PMID: 22968103 DOI: 10.1016/j.ejphar.2012.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 07/07/2012] [Accepted: 07/27/2012] [Indexed: 01/08/2023]
Abstract
The antiprotozoal agent pentamidine, used for the treatment of Pneumocystis jirovecii pneumonia (PCP), is known to cause abnormalities in blood glucose homeostasis, such as hypoglycemia and hyperglycemia. Pentamidine has been reported to be a substrate of organic cation transporter 1 (OCT1). We investigated the combination effects of cimetidine, an OCT1 inhibitor, on the pharmacokinetics of pentamidine and on pentamidine-induced hyperglycemia. Pentamidine was infused intravenously to rats for 20 min at a dose of 7.5 or 15 mg/kg and serum samples were obtained periodically. The serum concentration of glucose did not change significantly after pentamidine infusion at 7.5mg/kg, while it increased with pentamidine at 15 mg/kg, and the maximal concentration of glucose was 167 ± 36 mg/dl, 30 min after the start of pentamidine infusion. Cimetidine (50mg/kg) enhanced the pentamidine-induced elevation of glucose concentration and the maximal concentration of glucose was 208 ± 33 mg/dl in the pentamidine 15 mg/kg treated group. Cimetidine combination significantly reduced total body clearance of pentamidine and increased pentamidine concentrations in the liver, kidneys, and lungs. A significant correlation was found between changes in serum glucose concentrations and serum concentrations of pentamidine 30 min after the start of pentamidine infusion. These results suggest that the hyperglycemic effect of pentamidine is dependent on the concentration of pentamidine and can be enhanced by cimetidine combination.
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Affiliation(s)
- Toru Arino
- Department of Pharmacy, University Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Abstract
The protozoan parasitesTrypanosoma bruceiandTrypanosoma cruziare the causative agents of African trypanosomiasis and Chagas disease, respectively. These are debilitating infections that exert a considerable health burden on some of the poorest people on the planet. Treatment of trypanosome infections is dependent on a small number of drugs that have limited efficacy and can cause severe side effects. Here, we review the properties of these drugs and describe new findings on their modes of action and the mechanisms by which resistance can arise. We further outline how a greater understanding of parasite biology is being exploited in the search for novel chemotherapeutic agents. This effort is being facilitated by new research networks that involve academic and biotechnology/pharmaceutical organisations, supported by public–private partnerships, and are bringing a new dynamism and purpose to the search for trypanocidal agents.
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Yokoyama H, Nakamura Y, Iwasaki H, Nagayama Y, Hoshiai K, Mitsumori Y, Sugiyama A. Effects of Acute Intravenous Administration of Pentamidine, a Typical hERG-Trafficking Inhibitor, on the Cardiac Repolarization Process of Halothane-Anesthetized Dogs. J Pharmacol Sci 2009; 110:476-82. [DOI: 10.1254/jphs.09071fp] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Cordes JS, Sun Z, Lloyd DB, Bradley JA, Opsahl AC, Tengowski MW, Chen X, Zhou J. Pentamidine reduces hERG expression to prolong the QT interval. Br J Pharmacol 2005; 145:15-23. [PMID: 15711592 PMCID: PMC1576113 DOI: 10.1038/sj.bjp.0706140] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Pentamidine, an antiprotozoal agent, has been traditionally known to cause QT prolongation and arrhythmias; however, its ionic mechanism has not been illustrated. In a stable HEK-293 cell line, we observed a concentration-dependent inhibition of the hERG current with an IC50 of 252 microM. In freshly isolated guinea-pig ventricular myocytes, pentamidine showed no effect on the L-type calcium current at concentrations up to 300 microM, with a slight prolongation of the action potential duration at this concentration. Since the effective concentrations of pentamidine on the hERG channel and APD were much higher than clinically relevant exposures (approximately 1 microM free or lower), we speculated that this drug might not prolong the QT interval through direct inhibition of I(Kr) channel. We therefore incubated hERG-HEK cells in 1 and 10 microM pentamidine-containing media (supplemented with 10% serum) for 48 h, and examined the hERG current densities in the vehicle control and pentamidine-treated cells. In all, 36 and 85% reductions of the current densities were caused by 1- and 10-microM pentamidine treatment (P<0.001 vs control), respectively. A similar level of reduction of the hERG polypeptides and a reduced intensity of the hERG protein on the surface membrane in treated cells were observed by Western blot analysis and laser-scanning confocal microscopy, respectively. Taken together, our data imply that chronic administration of pentamidine at clinically relevant exposure reduces the membrane expression of the hERG channel, which may most likely be the major mechanism of QT prolongation and torsade de pointes reported in man.
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Affiliation(s)
- Jason S Cordes
- Department of Safety Pharmacology, Pfizer Global Research and Development, Groton/New London Laboratories, MS 8274-1420, Eastern Point Road, Groton, CT 06340, U.S.A
| | - Zhuoqian Sun
- Department of Safety Pharmacology, Pfizer Global Research and Development, Groton/New London Laboratories, MS 8274-1420, Eastern Point Road, Groton, CT 06340, U.S.A
| | - David B Lloyd
- Department of Genomic and Proteomic Sciences, Pfizer Global Research and Development, Groton/New London Laboratories, MS 8274-1420, Eastern Point Road, Groton, CT 06340, U.S.A
| | - Jenifer A Bradley
- Department of Safety Pharmacology, Pfizer Global Research and Development, Groton/New London Laboratories, MS 8274-1420, Eastern Point Road, Groton, CT 06340, U.S.A
| | - Alan C Opsahl
- Department of Pathology, Pfizer Global Research and Development, Groton/New London Laboratories, MS 8274-1420, Eastern Point Road, Groton, CT 06340, U.S.A
| | - Mark W Tengowski
- Department of Pathology, Pfizer Global Research and Development, Groton/New London Laboratories, MS 8274-1420, Eastern Point Road, Groton, CT 06340, U.S.A
| | - Xian Chen
- Department of Safety Pharmacology, Pfizer Global Research and Development, Groton/New London Laboratories, MS 8274-1420, Eastern Point Road, Groton, CT 06340, U.S.A
| | - Jun Zhou
- Department of Safety Pharmacology, Pfizer Global Research and Development, Groton/New London Laboratories, MS 8274-1420, Eastern Point Road, Groton, CT 06340, U.S.A
- Author for correspondence:
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Kuryshev YA, Ficker E, Wang L, Hawryluk P, Dennis AT, Wible BA, Brown AM, Kang J, Chen XL, Sawamura K, Reynolds W, Rampe D. Pentamidine-Induced Long QT Syndrome and Block of hERG Trafficking. J Pharmacol Exp Ther 2004; 312:316-23. [PMID: 15340016 DOI: 10.1124/jpet.104.073692] [Citation(s) in RCA: 211] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The diamidine pentamidine is used to treat leishmaniasis, trypanosomiasis, and Pneumocystis carinii pneumonia. Treatment may be accompanied by prolongation of the QT interval of the electrocardiogram and torsades de pointes tachycardias. Up to now, it has been thought that therapeutic compounds causing QT prolongation are associated with direct block of the cardiac potassium channel human ether a-go-go-related gene (hERG), which encodes the alpha subunit of cardiac I(Kr) currents. We show that pentamidine has no acute effects on currents produced by hERG, KvLQT1/mink, Kv4.3, or SCNA5. Cardiac calcium currents and the guinea pig cardiac action potential were also not affected. After overnight exposure, however, pentamidine reduced hERG currents and inhibited trafficking and maturation of hERG with IC(50) values of 5 to 8 microM similar to therapeutic concentrations. Surface expression determined in a chemiluminescence assay was reduced on exposure to 10, 30, and 100 microM pentamidine by about 30, 40, and 70%, respectively. These effects were specific for hERG since expression of hKv1.5, KvLQT1/minK, and Kv4.3 was not altered. In isolated guinea pig ventricular myocytes, 10 microM pentamidine prolonged action potential duration APD(90) from 374.3 +/- 57.1 to 893.9 +/- 86.2 ms on overnight incubation. I(Kr) tail current density was reduced from 0.61 +/- 0.09 to 0.39 +/- 0.04 pA/pF. We conclude that pentamidine prolongs the cardiac action potential by block of hERG trafficking and reduction of the number of functional hERG channels at the cell surface. We propose that pentamidine, like arsenic trioxide, produces QT prolongation and torsades de pointes in patients by inhibition of hERG trafficking.
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Affiliation(s)
- Yuri A Kuryshev
- Rammelkamp Center, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA
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Watts RG, Conte JE, Zurlinden E, Waldo FB. Effect of charcoal hemoperfusion on clearance of pentamidine isethionate after accidental overdose. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 2001; 35:89-92. [PMID: 9022658 DOI: 10.3109/15563659709001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pentamidine isethionate is an antimicrobial agent effective in the treatment of Pneumocystis carinii pneumonia, trypanosomiasis and leishmaniasis. Severe and fatal toxicity is reported with pentamidine use. CASE REPORT A patient received an accidental overdose (40 times the prescribed dose) of intravenous pentamidine due to a pharmacy mixing error. Charcoal hemoperfusion was utilized to attempt to lower the serum concentration of pentamidine and lessen toxicity. RESULTS Measurement of pentamidine concentrations in the patient's blood demonstrates a beneficial effect of hemoperfusion. CONCLUSIONS Charcoal hemoperfusion may represent a useful modality in the management of pentamidine isethionate overdosage.
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Affiliation(s)
- R G Watts
- Division of Hematology-Oncology, University of Alabama at Birmingham 35233, USA
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Ubukata E, Mokuda O, Nagata M, Ogino Y, Sakamoto Y, Tanaka K, Shimizu N. A pentamidine-treated acquired immunodeficiency syndrome patient associated with sudden onset diabetes mellitus and high tumor necrosis factor alpha level. J Diabetes Complications 1997; 11:256-8. [PMID: 9201604 DOI: 10.1016/1056-8727(95)00111-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- E Ubukata
- Department of Internal Medicine, Teikyo University School of Medicine, Ichihara Hospital, Chiba, Japan
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17
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Thomas SH, Page CJ, Blower PJ, Chowienczyk P, Ward A, Kamali F, Bradbeer CS, Bateman NT, O'Doherty MJ. Disposition of intravenous 123iodopentamidine in man. Nucl Med Biol 1997; 24:327-32. [PMID: 9257331 DOI: 10.1016/s0969-8051(97)00006-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study compared the disposition of the radiopharmaceutical [123I]iodopentamidine with that of pentamidine after intravenous infusion by measuring plasma concentrations of each using scintilation counting and high-performance liquid chromatography (HPLC), respectively. There was rapid hepatic uptake and biliary excretion of the 123I label. Distribution kinetics of the 123I label were similar to those of pentamidine, but its elimination half-life (41 +/- 27 h) was longer than that of pentamidine measured by HPLC (11 +/- 8 h). [123I]iodopentamidine distribution reflects that of pentamidine, but elimination of the radiopharmaceutical appears slower.
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Affiliation(s)
- S H Thomas
- Wolfson Unit of Clinical Pharmacology, University of Newcastle, Newcastle-upon-Tyne, UK
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18
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Tuttle RH, Hall JE, Tidwell RR. High-performance liquid chromatographic assay detects pentamidine metabolism by Fisher rat liver microsomes. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 1997; 688:319-24. [PMID: 9061470 DOI: 10.1016/s0378-4347(96)00288-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Fisher rat liver microsomes metabolized the antimicrobial drug pentamidine to four new compounds detected by gradient elution reversed-phase high-performance liquid chromatography with variable wavelength detection. Coelution experiments with pentamidine metabolite standards determined the new peaks to be previously identified hydroxylated metabolites of pentamidine, with 1,5-bis(4'-amidinophenoxy)-3-pentanol and 1,5-di-(4'-amidinophenoxy)-2-pentanol formed in the greatest amount. The data contradict a previous report that Fisher rat liver homogenates do not metabolize pentamidine. Pentamidine and its known primary metabolites have almost identical absorption spectra; thus, pentamidine metabolism must be evaluated using gradient elution HPLC to resolve pentamidine from its metabolites. The current assay has now been used to demonstrate that Fisher and Sprague-Dawley rat, mouse, rabbit and human liver microsomes all metabolize pentamidine in vitro.
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Affiliation(s)
- R H Tuttle
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill 27599-7525, USA
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19
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Conte JE, Golden JA. Intrapulmonary and systemic pharmacokinetics of aerosolized pentamidine used for prophylaxis of pneumocystis carinii pneumonia in patients infected with the human immunodeficiency virus. J Clin Pharmacol 1995; 35:1166-73. [PMID: 8750367 DOI: 10.1002/j.1552-4604.1995.tb04042.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A study was conducted to determine the intrapulmonary and systemic pharmacokinetics of aerosolized pentamidine prophylaxis (APP) in patients infected with human immunodeficiency virus (HIV). 151 patients received high-dose (300 mg twice a month or 600 mg once a month) APP as part of a previously published clinical trial, and 29 additional patients received standard-dose (300 mg once a month) APP. Serial blood samples were obtained from the first cohort: 577 samples were obtained from 76 patients in the group given 600 mg once a month, and 554 blood samples were obtained from 75 patients in the group given 300 mg twice a month. In 9 of the 151 patients, bronchoscopy and tri-lobar (right upper, middle, and lower lobe) bronchoalveolar lavage (BAL) were performed 6 and 12 months after initiation of APP. Unilobar (right middle lobe) BAL was performed in the 29 patients infected with HIV who underwent bronchoscopy for diagnostic purposes. Pentamidine was measured using a chromatographic (HPLC) assay. The concentrations (mean +/- SD) of pentamidine in plasma in the groups given 300 mg twice a month and 600 mg once a month were 5.3 +/- 6.1 ng/mL and 8.8 +/- 9.6 ng/mL, respectively, and accumulation did not occur. The BAL supernatant and alveolar cell pentamidine concentrations were not significantly different in the 3 lobes and ranged from 16.5 +/- 7.7 ng/mL to 29.2 +/- 19.5 ng/mL and 1255 +/- 1142 ng/mg protein to 1572 +/- 1161 ng/mg protein in the group given 300 mg twice a month; and from 5.5 +/- 2.9 ng/mL to 9.4 +/- 7.7 ng/mL and 339 +/- 201 ng/mg protein to 571+/- 681 ng/mg protein in the group given 600 mg once a month. The intropulmonary concentrations of pentamidine at 6 and 12 months were not significantly different. In 18 of the 29 patients who received 1 to 7 prior monthly doses of standard APP, drug concentrations in BAL increased linearly (y = 2.05x) with the number of doses administered before bronchoscopy. These data indicate that intrapulmonary drug concentrations continue to increase for approximately 6 months after the initiation of APP, at which time steady state is achieved, and that administration of high dose APP is probably safe.
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Affiliation(s)
- J E Conte
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
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20
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Bronner U, Gustafsson LL, Doua F, Ericsson O, Miézan T, Rais M, Rombo L. Pharmacokinetics and adverse reactions after a single dose of pentamidine in patients with Trypanosoma gambiense sleeping sickness. Br J Clin Pharmacol 1995; 39:289-95. [PMID: 7619671 PMCID: PMC1365006 DOI: 10.1111/j.1365-2125.1995.tb04451.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
1. Plasma concentrations of pentamidine were measured up to 1-8 months after a single 2 h i.v. infusion of 3.0 to 4.8 mg kg-1 pentamidine isethionate in 11 patients with late stage Trypanosoma gambiense sleeping sickness. 2. Maximum plasma drug concentrations varied between 713 and 2461 nmol 1-1. After termination of infusion, a rapid distribution phase over 10 min was followed by a slower distribution phase and an elimination phase prolonged over weeks to months. 3. The 'terminal' elimination rate constant could be determined in six patients and subsequent kinetic calculations showed a three to fourfold variation in plasma clearance and 'terminal' half-life (median 1126 (range 553-2036) ml min-1 and 265 (107-446) h, respectively). The median apparent volume of distribution (Vss) was 11,850 1. Renal clearance accounted for a median of 11% of total plasma clearance, indicating that metabolism is a major route of pentamidine elimination in man. 4. Side effects were few and mild and a slight or moderate decrease in blood pressure was the most common registered adverse reaction observed in four subjects. 5. The prolonged elimination of pentamidine seems inconsistent with the present recommended dosage regimen of pentamidine for treatment of trypanosomiasis of 7 to 10 parenteral doses given once daily or every second day.
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Affiliation(s)
- U Bronner
- Division of Clinical Pharmacology, Karolinska Institute, Huddinge University Hospital, Sweden
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21
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Ludewig G, Williams JM, Li Y, Staben C. Effects of pentamidine isethionate on Saccharomyces cerevisiae. Antimicrob Agents Chemother 1994; 38:1123-8. [PMID: 8067749 PMCID: PMC188161 DOI: 10.1128/aac.38.5.1123] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We used Saccharomyces cerevisiae as a model system in which to examine the mechanism of action of the anti-Pneumocystis drug pentamidine. Pentamidine at low concentrations inhibited S. cerevisiae growth on nonfermentable carbon sources (50% inhibitory concentration [IC50] of 1.25 micrograms/ml in glycerol). Pentamidine inhibited growth on fermentable energy sources only at much higher concentrations (IC50 of 250 micrograms/ml in glucose). Inhibition at low pentamidine concentrations in glycerol was due to cytostatic activity rather than cytotoxic or mutagenic activity. Pentamidine also rapidly inhibited respiration by intact yeast cells, although inhibitory concentrations were much higher than those inhibitory to growth (IC50 of 100 micrograms/ml for respiration). Pentamidine also induced petite mutations, although only at concentrations much higher than those required for growth inhibition. These results suggest that a function essential for respiratory growth is inhibited by pentamidine and that pentamidine affects mitochondrial processes. We propose the hypothesis that the primary cellular target of pentamidine in S. cerevisiae is the mitochondrion.
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Affiliation(s)
- G Ludewig
- T. H. Morgan School of Biological Sciences, University of Kentucky, Lexington 40506-0225
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22
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Affiliation(s)
- J Pépin
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire, Sherbrooke, Québec, Canada
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23
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Golden JA, Katz MH, Chernoff DN, Duncan SM, Conte JE. A randomized comparison of once-monthly or twice-monthly high-dose aerosolized pentamidine prophylaxis. Chest 1993; 104:743-50. [PMID: 8365284 DOI: 10.1378/chest.104.3.743] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
RESULTS Ten of the 146 (7 percent) evaluable subjects developed PCP during the year study period, and there was no difference in the efficacy of the two regimens. Among patients receiving secondary prophylaxis, the attack rate of PCP at 1 year was 11 percent. This compares favorably with a 1-year attack rate of 19 percent in similar patients receiving standard dose (300 mg) prophylaxis and suggests, but does not prove, a dose-response effect. Concentrations of pentamidine in BAL fluid were not significantly different among the three lobes of the lung. Intrapulmonary pentamidine did not accumulate during the year of study. Aerosolized pentamidine was associated with a marginal but statistically significant increase in the residual volume, decreased flow rates, and increased airway reactivity. OBJECTIVE The optimal regimen of aerosolized pentamidine in unknown. Published data suggest that there is a dose-response effect and that the occurrence of Pneumocystis carinii pneumonia (PCP) has been associated with prolongation of the interval between doses. The purpose of this study was to compare the efficacy, pharmacokinetics, and physiologic effects of two high-dose regimens of aerosolized pentamidine prophylaxis. DESIGN Prospective, randomized study of 300 mg twice monthly vs 600 mg once monthly during a 1-year observation period. Pentamidine concentrations in plasma and bronchoalveolar lavage (BAL) fluid were measured and serial pulmonary function was measured. SETTING A large teaching hospital in San Francisco. PATIENTS One hundred fifty-one adult (age > 18 years) men with human immunodeficiency virus infection. Of 146 evaluable patients, prophylaxis was primary (no prior PCP) in 108 (75 percent) and secondary (one prior episode of PCP) in 38 (25 percent). MEASUREMENTS Date and diagnosis of PCP, occurrence of drug toxicity, pulmonary function testing, and concentrations of pentamidine in BAL and plasma. CONCLUSIONS The data suggest, but do not prove, that a dose-response effect has been demonstrated, and that high-dose aerosolized pentamidine may further reduce the attack rate of PCP. These preliminary observations should be confirmed in a double-blind trial comparing 300 mg with 600 mg administered once monthly. The clinical relevance of the adverse pulmonary effects is unclear and requires further investigation.
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Affiliation(s)
- J A Golden
- University of California, San Francisco 94143-0208
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24
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Thalhammer C, Bogner JR, Lohmöller G. Chronic pentamidine aerosol prophylaxis does not induce QT prolongation. THE CLINICAL INVESTIGATOR 1993; 71:319-22. [PMID: 8471819 DOI: 10.1007/bf00184735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Intravenous administration of pentamidine is known to cause long-QT syndrome (Torsade de pointes tachycardias and large QT prolongation) in rare cases and to cause small QT prolongation regularly. A similar pattern is seen with other drugs known to cause a long-QT syndrome. Pentamidine aerosol prophylaxis is commonly used to prevent Pneumocystis carinii pneumonia in HIV-infected persons. The goal of this study was to clarify whether pentamidine aerosol prophylaxis induces QT prolongation. We examined 100 patients receiving pentamidine aerosol prophylaxis at a rather high dose (300 mg biweekly) for at least 1 month (range 1-24) by determining the QT interval corrected for heart rate (QTc), blind for treatment. In a cross-sectional study, QTc was not different in 50 HIV-infected patients with chronic pentamidine aerosol prophylaxis (413 ms), 50 similar HIV-infected patients without pentamidine (407 ms), and 50 similar patients without HIV-infection and without pentamidine (407 ms). In a longitudinal study in another 50 HIV-infected patients, QTc was the same before (414 ms) and on long-term (median 9-month) pentamidine aerosol prophylaxis (414 ms). In contrast to the case with intravenous pentamidine, we found no QT prolongation and thereby no risk of long-QT syndrome with pentamidine aerosol prophylaxis.
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25
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Affiliation(s)
- H Masur
- Critical Care Medicine Department, National Institutes of Health, Bethesda, MD 20892
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26
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Blower PJ, Smith CM, Smith RJ, Moores GE, O'Doherty MJ. Preparation and stability of a radioiodinated pentamidine isethionate analog. INTERNATIONAL JOURNAL OF RADIATION APPLICATIONS AND INSTRUMENTATION. PART A, APPLIED RADIATION AND ISOTOPES 1992; 43:1189-95. [PMID: 1330978 DOI: 10.1016/0883-2889(92)90193-i] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Iodopentamidine isethionate was heated for 70 min with [I-123]- or [I-125]-sodium iodide and ammonium sulphate in the absence of solvent at 140 degrees C. The product, [I-123]- or [I-125]-iodopentamidine isethionate, was purified by ion exchange chromatography. It was stable at room temperature in aqueous solution over several days, in human blood in vitro for at least 24 h (showing no binding to either cells or proteins), in urine over at least 15 h, and during nebulization in both ultrasonic and jet nebulizers.
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Affiliation(s)
- P J Blower
- Nuclear Medicine Department, Kent and Canterbury Hospital, England
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27
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Berger BJ, Naiman NA, Hall JE, Peggins J, Brewer TG, Tidwell RR. Primary and secondary metabolism of pentamidine by rats. Antimicrob Agents Chemother 1992; 36:1825-31. [PMID: 1416874 PMCID: PMC192194 DOI: 10.1128/aac.36.9.1825] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The antiprotozoal drug pentamidine [1,5-bis(4'-amidinophenoxy)pentane] has been previously shown to be metabolized by rat liver microsomes, and five of the seven putative primary metabolites have been identified. With the synthesis and identification of 5-(4'-amidinophenoxy)pentanoic acid and 5-(4'-amidinophenoxy)-1-pentanol as the remaining two metabolites, the primary metabolism of pentamidine in rats appears fully characterized. Use of [14C]pentamidine with rat liver microsomes confirms this conclusion, since no unidentified radioactive peaks were detected by high-performance liquid chromatography (HPLC). Isolated, perfused rat livers were used with [14C]pentamidine to identify secondary metabolites. Only two novel radioactive peaks were detected by HPLC analysis of perfused liver samples. The treatment of liver samples with sulfatase or beta-glucuronidase resulted in the reduction or elimination of these peaks and gave rise to peaks identified as para-hydroxybenzamidine and 5-(4'-amidinophenoxy)pentanoic acid. It was concluded from these results that only these two primary metabolites were conjugated with sulfate or glucuronic acid. After 4 h of incubation in the perfused liver system, approximately 15% of the recovered radiolabel was pentamidine. These results suggest that pentamidine metabolism can be rapid and extensive in rats.
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Affiliation(s)
- B J Berger
- Department of Parasitology and Laboratory Practice, University of North Carolina, Chapel Hill 27599
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28
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Comtois R, Pouliot J, Gervais A, Vinet B, Lemieux C. High pentamidine levels associated with hypoglycemia and azotemia in a patient with Pneumocystis carinii pneumonia. Diagn Microbiol Infect Dis 1992; 15:523-6. [PMID: 1424505 DOI: 10.1016/0732-8893(92)90102-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report on a patient who presented with a Pneumocystis carinii pneumonia. Intravenous pentamidine (4 mg/kg/day) was given for 14 days without the occurrence of adverse effects. During this treatment, the mean (+/- SD) serum pentamidine trough concentration was 94 +/- 16 ng/ml. Three days later, the patient was admitted because of fever, and pentamidine (4 mg/kg/day) was again started. Fasting hypoglycemia and azotemia then occurred; the mean serum trough pentamidine level was 190 +/- 10 ng/ml during this week of treatment. We conclude that the occurrence of hypoglycemia and azotemia during pentamidine therapy may not be idiosyncrasic, but seemed associated in our patient with high levels of serum pentamidine.
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Affiliation(s)
- R Comtois
- Department of Medicine, Notre-Dame Hospital, University of Montreal, Canada
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29
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Vinet B, Comtois R, Gervais A, Lemieux C. Clinical usefulness of high-pressure liquid chromatographic determination of serum pentamidine in AIDS patients. Clin Biochem 1992; 25:93-7. [PMID: 1623582 DOI: 10.1016/0009-9120(92)80050-q] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We have developed a reproducible HPLC method to determine serum pentamidine, which demonstrates good chromatographic performance, and is sensitive enough to measure therapeutic doses. Pentamidine is first extracted from serum by passage through a C-18 extraction cartridge. Potential interfering substances are then removed by washing with 100% methanol. Pentamidine is eluted from the extraction cartridge with 1-heptanesulfonic acid. The extract is chromatographed on a highly deactivated column for basic compounds in the presence of minimal concentrations of 1-heptanesulfonic acid as the pairing agent. Detection is by fluorescence. The method can determine serum pentamidine levels in the range of 15-600 ng/mL free of interference from other drugs. In monitoring pentamidine levels in AIDS patients with Pneumocystis carinii, we found that trough serum levels over 100 ng/mL were associated with toxicity (hypoglycemia or azotemia) in 100% of patients. With levels under 100 ng/mL, signs of toxicity were observed in only 29% of the patients. We conclude that dose adjustment based on serum levels reduces the incidence of toxicity and enhances pentamidine therapy.
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Affiliation(s)
- B Vinet
- Biochemistry, Department, Hôpital Notre-Dame, Montréal, Québec, Canada
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30
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Balslev U, Berild D, Nielsen TL. Cardiac arrest during treatment of Pneumocystis carinii pneumonia with intravenous pentamidine isethionate. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1992; 24:111-2. [PMID: 1589716 DOI: 10.3109/00365549209048410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 27-year-old man, HIV-positive for 4 years, developed ventricular fibrillation and cardiac arrest during treatment of Pneumocystis carinii pneumonia with intravenous pentamidine isethionate. The dosage was 4 mg/kg/day for 18 days. Nephrotoxicity occurred and raised serum potassium. The plasma concentration of pentamidine was 580 nmol/l. Careful monitoring of renal and cardiac functions is recommended during intravenous therapy with pentamidine isethionate.
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Affiliation(s)
- U Balslev
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Denmark
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31
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Smaldone GC, Vinciguerra C, Morra L. Urine pentamidine as an indicator of lung pentamidine in patients receiving aerosol therapy. Chest 1991; 100:1219-23. [PMID: 1935274 DOI: 10.1378/chest.100.5.1219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
To determine if urine pentamidine was reflective of lung pentamidine, we compared levels of the drug in bronchoalveolar lavage fluid and simultaneously obtained urine. Thirty-one patients who were receiving aerosolized pentamidine either as treatment or as prophylaxis underwent BAL and submitted urine samples for pentamidine analysis. Pentamidine was analyzed in both phases of BAL fluid (supernatant and cell pellet) and in urine using high performance liquid chromatography. Urine results were normalized for creatinine. Patients were categorized as prophylaxis failures (active Pneumocystis carinii pneumonia on prophylaxis), electives (free from PCP on prophylaxis), treatment (daily AP in treatment doses for active PCP, or miscellaneous (single dose of AP). Levels in BAL fluid and urine varied widely over several orders of magnitude. However, for all patients, we found a highly significant relationship between BAL supernatant and urine (r = 0.97, p less than 0.0001). No statistical differences were found when comparing levels of pentamidine between failures and electives; however, the number of failures was small. We conclude that urine pentamidine is related to lung pentamidine and can be used as a clinical indicator in patients receiving aerosolized therapy.
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Affiliation(s)
- G C Smaldone
- Department of Medicine, State University of New York, Stony Brook 11794-8172
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32
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33
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Bronner U, Doua F, Ericsson O, Gustafsson LL, Miézan TW, Rais M, Rombo L. Pentamidine concentrations in plasma, whole blood and cerebrospinal fluid during treatment of Trypanosoma gambiense infection in Côte d'Ivoire. Trans R Soc Trop Med Hyg 1991; 85:608-11. [PMID: 1780988 DOI: 10.1016/0035-9203(91)90364-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Pentamidine concentrations in plasma, whole blood and cerebrospinal fluid (CSF) were determined in 11 patients with Trypanosoma gambiense infection without involvement of the central nervous system in Côte d'Ivoire. Blood samples were drawn during a 48 h period after the first and last dose of pentamidine dimesylate given as 10 intramuscular injections on alternate days. Maximum plasma concentrations were generally attained within one hour after injection but varied extensively (420-13420 nmol/litre). The median plasma concentration 48 h after the last dose was approximately 5 times higher than that after the first dose. The ratio between whole blood and plasma concentration was approximately 2. Small amounts of the drug were found in the CSF after the last dose. The findings showed inter-individual differences in the pharmacokinetics of pentamidine. The currently recommended daily dose regimen could be questioned, as drug accumulation was pronounced. All patients were cured and the concentrations attained should be considered as parasiticidal. Further studies on the kinetics and distribution after single and multiple doses of pentamidine as well as studies on the possible relationship between adverse effects and plasma concentrations are, however, needed.
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Affiliation(s)
- U Bronner
- Department of Infectious Diseases, Karolinska Institute, Roslagstull Hospital, Stockholm, Sweden
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34
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Das NK, Hopper CL, Jencks M, Silva J. A University of California State-supported AIDS research award program--a unique state and university partnership in AIDS research. J Clin Immunol 1991; 11:65-73. [PMID: 2056014 DOI: 10.1007/bf00917742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This article describes the State-supported University of California AIDS research award program and its major accomplishments. It shows how a partnership between a University and a State resulted in the formation of a successful, efficient, and cost-effective AIDS research award program. This program provides funds for rapid testing of investigator-initiated meritorious research ideas, new drugs, and treatment modalities. Funds were also utilized to establish three AIDS Clinical Research Centers, which evolved into regional consortia that coordinate trials of new drugs and other modalities. This program succeeded in involving investigators whose efforts have led to excellent medical care, advanced technologies, and new drugs for treating AIDS and AIDS-related diseases. The University remains committed to continuing support of all areas of AIDS research, emphasizing drug and vaccine development, pediatric AIDS, and AIDS prevention studies in groups at high risk for HIV infection.
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Affiliation(s)
- N K Das
- University of California Office of the President, Office of Health Affairs, Oakland 94612-3550
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35
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Taburet AM, Tollier C, Richard C. The effect of respiratory disorders on clinical pharmacokinetic variables. Clin Pharmacokinet 1990; 19:462-90. [PMID: 2292169 DOI: 10.2165/00003088-199019060-00004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Respiratory disorders induce several pathophysiological changes involving gas exchange and acid-base balance, regional haemodynamics, and alterations of the alveolocapillary membrane. The consequences for the absorption, distribution and elimination of drugs are evaluated. Drug absorption after inhalation is not significantly impaired in patients. With drugs administered by this route, an average of 10% of the dose reaches the lungs. It is not completely clear whether changes in pulmonary endothelium in respiratory failure enhance lung absorption. The effects of changes in blood pH on plasma protein binding and volume of distribution are discussed, but relevant data are not available to explain the distribution changes observed in acutely ill patients. Lung diffusion of some antimicrobial agents is enhanced in patients with pulmonary infections. Decreased cardiac output and hepatic blood flow in patients under mechanical ventilation cause an increase in the plasma concentration of drugs with a high hepatic extraction ratio, such as lidocaine (lignocaine). On a theoretical basis, hypoxia should lead to decreased biotransformation of drugs with a low hepatic extraction ratio, but in vivo data with phenazone (antipyrine) or theophylline are conflicting. The effects of disease on the lung clearance of drugs are discussed but clinically relevant data are lacking. The pharmacokinetics of drugs in patients with asthma or chronic obstructive pulmonary disease are reviewed. Stable asthma and chronic obstructive pulmonary disease do not appear to affect the disposition of theophylline or beta 2-agonists such as salbutamol (albuterol) or terbutaline. Important variations in theophylline pharmacokinetics have been reported in critically ill patients, the causes of which are more likely to be linked to the poor condition of the patients than to a direct effect of hypoxia or hypercapnia. Little is known regarding the pharmacokinetics of cromoglycate, ipratropium, corticoids or antimicrobial agents in pulmonary disease. In patients under mechanical ventilation, the half-life of midazolam, a new benzodiazepine used as a sedative, has been found to be lengthened but the underlying mechanism is not well understood. Pulmonary absorption of pentamidine was found to be increased in patients under mechanical ventilation. Pharmacokinetic impairment does occur in patients with severe pulmonary disease but more work is needed to understand the exact mechanisms and to propose proper dosage regimens.
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Affiliation(s)
- A M Taburet
- Clinical Pharmacy, Hôpital de Bicêtre, Paris, France
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36
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Berger BJ, Lombardy RJ, Marbury GD, Bell CA, Dykstra CC, Hall JE, Tidwell RR. Metabolic N-hydroxylation of pentamidine in vitro. Antimicrob Agents Chemother 1990; 34:1678-84. [PMID: 2285279 PMCID: PMC171904 DOI: 10.1128/aac.34.9.1678] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
By using high-performance liquid chromatography, the in vitro conversion of pentamidine to the corresponding amidoximes (N-hydroxypentamidine and N,N'-dihydroxypentamidine) was studied in supernatants of rat liver homogenate centrifuged at 9,000 x g. The presence of the two amidoxime peaks in chromatograms was confirmed by liquid secondary ion mass spectrometry and by unequivocal synthesis of the suspected metabolites. The metabolic reactions were found to be catalyzed by the cytochrome P-450 system (mixed-function oxidases). The formation of the monohydroxylated product was found to have a Km of 0.48 mM and a Vmax of 29.50 pmol/min per mg of protein, while the dihydroxylated metabolite had a Km of 0.73 mM and a Vmax of 4.10 pmol/min per mg of protein. N,N'-Dihydroxypentamidine was found to have highly reduced antiprotozoal activity in vitro relative to that of pentamidine, and neither of the hydroxylated metabolites nor pentamidine was found to be significantly mutagenic by the Ames test. Contrary to previous reports, pentamidine is readily metabolized to at least two hydroxylated products, and this conversion may be relevant to the clinical use of the compound and to future drug design.
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Affiliation(s)
- B J Berger
- Department of Parasitology and Laboratory Practice, School of Public Health, University of North Carolina, Chapel Hill 27599
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37
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Shah GM, Alvarado P, Kirschenbaum MA. Symptomatic hypocalcemia and hypomagnesemia with renal magnesium wasting associated with pentamidine therapy in a patient with AIDS. Am J Med 1990; 89:380-2. [PMID: 2393042 DOI: 10.1016/0002-9343(90)90354-g] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- G M Shah
- Nephrology Section, Veterans Affairs Medical Center, Long Beach, California 90822
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38
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Libman MD, Miller MA, Richards GK. Antistaphylococcal activity of pentamidine. Antimicrob Agents Chemother 1990; 34:1795-6. [PMID: 2285292 PMCID: PMC171928 DOI: 10.1128/aac.34.9.1795] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pentamidine isethionate was bacteriostatic against Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Streptococcus sanguis, Micrococcus sp., and Candida albicans. S. aureus was inhibited by concentrations of 16 to 64 micrograms/ml and killed by 64 to greater than or equal to 128 micrograms/ml. Staphylococcal killing was consistently greater in the presence of cations and was unaffected by methicillin resistance.
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Affiliation(s)
- M D Libman
- McGill University, Montreal General Hospital, Quebec, Canada
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39
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Harstad TW, Little BB, Bawdon RE, Knoll K, Roe D, Gilstrap LC. Embryofetal effects of pentamidine isethionate administered to pregnant Sprague-Dawley rats. Am J Obstet Gynecol 1990; 163:912-6. [PMID: 2403167 DOI: 10.1016/0002-9378(90)91095-t] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effects of pentamidine isethionate on the developing embryo and fetus have not been previously published. Pregnant Sprague-Dawley rats were given various doses of pentamidine during the period of embryogenesis. Animals were killed on days 18 to 20 of pregnancy and their fetuses were removed by hysterectomy. Autopsies were performed on all fetuses. There were significant differences among groups with regard to maternal weight gain and pregnancy resorption. More pregnancy resorptions were noted in the group that received normal human doses (4 mg/kg/day) of pentamidine than in the control group (p less than 0.05). One structural anomaly consisting of unilateral renal agenesis was noted in the 711 fetuses examined. Skeletal survey of fetal rats was unremarkable. Pentamidine was without teratogenic effects in rats when administered in doses similar to those recommended for adult humans; however, it appears to have an embryocidal effect when given in those same doses during embryogenesis.
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Affiliation(s)
- T W Harstad
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235-9032
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40
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Farinotti R, Decazes J. Faut-il recourir aux dosages des medicaments anti-pneumocystis et/ou de leurs metabolites pour optimiser le traitement de la pneumopathie a Pneumocystis carinii (PPC) ? Med Mal Infect 1990. [DOI: 10.1016/s0399-077x(05)81108-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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41
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Berger BJ, Hall JE, Tidwell RR. The distribution of multiple doses of pentamidine in rats. PHARMACOLOGY & TOXICOLOGY 1990; 66:234-6. [PMID: 2333279 DOI: 10.1111/j.1600-0773.1990.tb00740.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- B J Berger
- Department of Parasitology, School of Public Health, University of North Carolina, Chapel Hill 27599
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42
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Berger BJ, Hall JE, Tidwell RR. High-performance liquid chromatographic method for the quantification of several diamidine compounds with potential chemotherapeutic value. JOURNAL OF CHROMATOGRAPHY 1989; 494:191-200. [PMID: 2584316 DOI: 10.1016/s0378-4347(00)82668-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A high-performance liquid chromatographic method has been developed for the detection and quantification of pentamidine and pentamidine analogues of chemotherapeutic value in order to measure their concentration in physiological fluids. The compounds were extracted from urine over octadecyl solid-phase extraction columns, followed by chromatographic separation with an octadecyl reversed-phase column. For the mobile phase, a gradient of 31.5-37.5% acetonitrile in water, with sodium heptanesulfonate and tetramethylammonium chloride as ion modifiers, was used. This method was used to reliably detect levels as low as 341 ng/ml without concentration of the compounds during the solid-phase extraction. The assay was used to determine the effectiveness of several solid-phase extraction columns for isolating the compounds of interest and to quantify the amount of pentamidine and its analogues contained in the urine of dosed rats.
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Affiliation(s)
- B J Berger
- Department of Parasitology, School of Public Health, University of North Carolina, Chapel Hill 27599
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43
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Affiliation(s)
- M Shen
- Department of Medicine, Oregon Health Sciences University, Portland
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44
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Abstract
Insulin-dependent diabetes mellitus occurred following intravenous pentamidine treatment of two AIDS patients with Pneumocystis carinii pneumonia. Both patients also experienced drug-induced nephrotoxicity. Patients receiving pentamidine must be observed for multisystem dysfunction, including the onset of severe diabetes mellitus. Dosage adjustment or alternative therapy should be considered with the onset of toxicity.
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Affiliation(s)
- J Collins
- Department of Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu
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45
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Conte JE, Golden JA. Concentrations of aerosolized pentamidine in bronchoalveolar lavage, systemic absorption, and excretion. Antimicrob Agents Chemother 1988; 32:1490-3. [PMID: 3263832 PMCID: PMC175904 DOI: 10.1128/aac.32.10.1490] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Pentamidine pulmonary pharmacokinetics were studied in 13 patients receiving once-daily inhaled therapy and 4 patients receiving low-dose intravenous treatment for Pneumocystis carinii pneumonia. Twenty-four hours after inhaled or intravenous therapy, the mean (+/- standard deviation) concentrations of pentamidine in serial bronchoalveolar specimen fluid ranged from 28.6 +/- 10 to 177.5 +/- 28 ng/ml and 6.05 +/- 2.29 to 21.4 +/- 15.7 ng/ml, respectively. Pentamidine concentrations in brochoalveolar fluid were generally higher after 2 weeks than after day 1 of therapy; however, the differences were not statistically different (P greater than 0.05). The pulmonary half-life after inhaled therapy is long; pentamidine was detectable in bronchoalveolar fluid at 33 (one patient), 69 (one patient), and 115 (one patient) days following the completion of 2 weeks of therapy. Systemic absorption of pentamidine was minimal; the mean (+/- standard deviation) plasma concentration at the completion of inhalation was 13.84 +/- 11.8 ng/ml, or 5% of the mean peak plasma concentration achieved after intravenous administration. Accumulation in the plasma did not occur with repeated inhalation as has been described with multiple intravenous dosing. Cumulative urinary excretion 24 h after the first dose was 5% of that observed with intravenous administration. These data may have importance in designing dosage regimens for the further investigation of inhaled pentamidine for treatment or prophylaxis of P. carinii pneumonia.
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Affiliation(s)
- J E Conte
- Infectious Diseases Research Laboratory, University of California, San Francisco 94143-0208
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46
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Montgomery AB, Debs RJ, Luce JM, Corkery KJ, Turner J, Brunette EN, Lin ET, Hopewell PC. Selective delivery of pentamidine to the lung by aerosol. THE AMERICAN REVIEW OF RESPIRATORY DISEASE 1988; 137:477-8. [PMID: 3257663 DOI: 10.1164/ajrccm/137.2.477] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In 8 patients with diffuse infiltrates on chest radiograph undergoing fiberoptic bronchoscopy for suspected Pneumocystis carinii pneumonia, bronchoalveolar lavage sediment and supernatant concentrations of pentamidine were compared 18 to 24 h after administration of 4 mg/kg intravenous (n = 3) and aerosolized (n = 5) pentamidine isethionate. Aerosol was inhaled for 35 to 40 min with 300 mg of pentamidine isethionate in a jet nebulizer, baffled to decrease the particle size to 1.42 micron +/- 1.88 (mass median aerodynamic diameter +/- geometric standard deviation). Bronchoalveolar pentamidine concentrations were: In sediment, 9.34 +/- 1.74 postintravenous versus 705 +/- 242 ng/ml postaerosol (mean +/- SEM, p less than 0.05); supernatant, 2.64 +/- 0.73 postintravenous versus 23.2 +/- 7.75 ng/ml postaerosol (mean +/- SEM, p less than 0.05). Serum pentamidine levels were low or undetectable after aerosolization. Aerosol administration delivers significantly higher concentrations of pentamidine to the air spaces than does intravenous delivery in patients with diffuse alveolar infiltrates.
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Affiliation(s)
- A B Montgomery
- Medical Service, San Francisco General Hospital Medical Center, California
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47
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Fitzsimmons WE, Luskin SS. Pentamidine therapy in renal failure: case report and literature review. DRUG INTELLIGENCE & CLINICAL PHARMACY 1988; 22:25-8. [PMID: 3280279 DOI: 10.1177/106002808802200104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The literature lacks adequate dosing guidelines for modifying pentamidine therapy in renal failure. This report describes a patient in renal failure undergoing intermittent peritoneal dialysis who is treated with pentamidine for Pneumocystis carinii pneumonia. Data on pentamidine's disposition are reviewed.
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