A recent Rhazdrugs implementation sparked a valuable discussion about how and why certain drugs end up on hazardous drug lists.
One drug that prompted the conversation with a new client was pentamidine. It caught our attention because, unlike with other clients, this is the first time we’ve seen pentamidine appear on a hazardous drug list.
What is Pentamidine?
Pentamidine is an antimicrobial medication used to treat various infections, including African trypanosomiasis, leishmaniasis, Balamuthia infections, and babesiosis. It is also used to prevent and treat pneumocystis pneumonia in individuals with weakened immune systems.
Pentamidine can be administered intravenously, intramuscularly, or via inhalation. The inhaled form, which is what we are focused on here, is commonly used to prevent Pneumocystis jirovecii pneumonia, particularly in patients with HIV/AIDS. Source: Mayo Clinic
The standard dose of administration is 300 mg of lyophilized pentamidine isethionate dissolved in sterile water and aerosolized until the nebulizer runs dry. Adequate ventilation is required. It is recommended that pentamidine be administered in a HEPA-filtered exhaust containment booth. If a facility does not have a containment booth, it should use a negative-pressure room or a single room and use a portable HEPA filter. Source: Pediatric Oncology Group of Ontario
Why is pentamidine on this Rhazdrugs client list?
In the late 1980s/early 1990s, an incident occurred where the inhaled form of pentamidine was being administered. During the treatment, 11 employees in the room experienced some tightness in their chest and some difficulties breathing.
Ultimately, NIOSH was called in 6 to 7 months later to investigate what had happened and whether there were any lasting effects. Some employees still experienced ongoing issues, including rare cases of mucosal irritation during treatment administration.
NIOSH did not find anything unique about the administration, other than the fact that there was a pentamidine treatment going on in that area at the time that this occurred.
This incident, although 35-some-odd years ago, made a lasting impression on this organization and its medication safety officer to the point that they want to ensure an incident like this doesn't happen at their facility.
Why should people consider adding it to their organization’s list?
Maybe there is not a need to add pentamidine to your facility’s hazardous drug list, but perhaps it is a drug you should consider adding in an abundance of caution. That’s the purpose of these conversations - to share what your peers are doing and help you to make decisions for your health system or organization.
We have clients doing really incredible things, including some that put all cellular and gene therapy drugs on their Rhazdrugs sites, and others who have all illicit drugs on their sites. Again, it may not make sense for your organization to add cellular and gene therapy drugs to your hazardous drugs list or Rhazdrugs site, but the awareness that your peers are doing X, Y, and Z and how they are doing it can help you make educated decisions and better protect your colleagues.
Something that sets our Spidey sense off is when a client or prospect leans in or starts writing notes when we discuss subjects they may not have considered, such as pentamidine. We then want to share that information with the larger community in case it helps even one other facility or healthcare system better protect their employees from exposure to hazardous drugs.
We’d love to know your thoughts on pentamidine and whether this information has sparked a curiosity about whether this drug or any others should be included on your hazardous drugs list. Contact us with questions or feedback: info@rpharmy.com
ICYMI: We published a blog recapping a webinar with step-by-step tips for staying on top of hazardous drugs updates. We’re always here to help you do the critical job of protecting healthcare workers from hazardous drug exposure.