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Previous Volume 328:889-890 March 25, 1993 Number 12 Next

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To the Editor: Grinspoon and Bilezikian state (Nov. 5 issue)¹ that "There is no evidence that pentamidine administered by aerosol alters pancreatic function." At least three cases of pancreatitis,^2,3 one of hypoglycemia,⁴ and two of diabetes mellitus^5,6 have been reported after treatment with aerosolized pentamidine. Pentamidine can be absorbed systemically after being inhaled in aerosol form, although plasma levels are usually low⁷. Potential predisposing conditions include previous subclinical pancreatic damage, therapy with other drugs associated with acute pancreatitis (such as trimethoprim-sulfamethoxazole and didanosine), and overdosing of pentamidine administered by aerosol due to problems with nebulizer use. . . .

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