Indications: Pneumocystis Jiroveci, Pneumonia (pneumocystis carinii)pneumonia, prophylaxis of pneumocystis jiroveci (pneumocystis carinii)pneumonia, visceral leishmaniasis, cutaneous leishmaniasis, trypanosomiasis.

Cautions: risk of severe hypotension following administration (monitor blood pressure before starting treatment, during administration, and at regular intervals, until treatment concluded.

patient should be lying downwhen receiving drug parenterally). hypokalaemia, hypomagnesaemia, coronary heart disease, bradycardia, history of ventricular arrhythmias, concomitant use with other drugs which prolong QT-interval. hypertension or hypotension. hyperglycaemia or hypoglycaemia leucopenia, thrombocytopenia, or anaemia. carry out laboratory monitoring according to product literature (care required to protect personnel during handling and administration).

Contra-indications: Hypersensitivity Hepatic impairment: Manufacturer advises caution.

Renal impairment: Reduce intravenous dose for pneumocystis pneumonia if creatinine clearance less than 10 ml/minute: in life threatening infection, use 4 mg/kg once daily for 7–10 days, then 4 mg/kg on alternate days to complete course of at least 14 doses.

in less severe infection, use 4 mg/kg on alternate days for at least 14 doses.

Pregnancy: manufacturer advises avoid unless essential.

Breast-feeding: Manufacturer advises avoid unless essential.

Side Effects: severe reactions, sometimes fatal, due to hypotension, hypoglycaemia, pancreatitis, and arrhythmias; also leucopenia, thrombocytopenia, acute renal failure, hypocalcaemia; also reported: azotaemia, abnormal liver-function tests, anaemia, hyperkalaemia, nausea and vomiting, dizziness, syncope, flushing, hyperglycaemia, rash, and taste disturbances; Stevens-Johnson syndrome reported; on inhalation, bronchoconstriction (may be prevented by prior use of bronchodilators), cough, and shortness of breath; discomfort, pain, induration, abscess formation, and muscle necrosis at injection site.

Dose: Treatment of Pneumocystis jiroveci (Pneumocystis carinii) pneumonia, by intravenous infusion: 4 mg/kg once daily for at least 14 days.

Prophylaxis of Pneumocystis jiroveci (Pneumocystis carinii) pneumonia: by inhalation of nebulised solution: 300 mg every 4 weeks or 150 mg every 2 weeks.

Visceral leishmaniasis by deep intramuscular injection: 3–4 mg/kg on alternate days to max. total of 10 injections course may be repeated if necessary Cutaneous leishmaniasis by deep intramuscular injection 3–4 mg/kg once or twice weekly until condition resolves Trypanosomiasis: by deep intramuscular injection or intravenous infusion: 4 mg/kg daily or on alternate days to total of 7–10 injections.

Note: Direct intravenous injection should be avoided whenever possible and never given rapidly; intramuscular injections should be deep and preferably given into the buttock.