World Health Organization. WHO Expert Committee on leprosy: eighth report. WHO Technical Report Series No. 968. Geneva: World Health Organization; 2012. If you are taking dapsone for a skin disorder, your doctor may start you on a low dose of dapsone and gradually adjust your dose to control your disease. If you are taking this medication to treat Hansen's disease or to prevent infections due to HIV, the drug is usually taken for years or for life. Analgesics, corticosteroids, and other agents may be used for ENL reactions. For guidance concerning the management of reactional states, the Gillis W. Long Hansen's Disease Center in Carville, Louisiana tel: 800-642-2477 should be contacted.
If you also take antacids, take this medication at least 1 hour before the antacid. Adverse hepatic effects reported shortly after initiation of dapsone therapy and may be manifested by increased serum concentrations of alkaline phosphatase, AST, bilirubin, and LDH. 113 Liver function test abnormalities occur more frequently when dapsone is used in conjunction with trimethoprim than when dapsone monotherapy is used. Gel, 5% for 12 weeks, talk to your doctor about continuing treatment. Seek emergency medical attention if an overdose is suspected. Safety and effectiveness in pediatric patients have not been established. Several cases of pediatric patients treated with Lamprene clofazimine have been reported in the literature.
Deferasirox: May decrease the serum concentration of CYP3A4 Substrates. What Is Dapsone and How Does It Work? Berlin G, Brodin B, Hilden JO et al. Acute dapsone intoxication: a case treated with continuous infusion of methylene blue, forced diuresis and plasma exchange. J Toxicol Clin Toxicol. Daneshmend T "The neurotoxicity of dapsone. Pneumocystis carinii pneumonia. J Acquir Immune Defic Syndr.
This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor directs you to do so. A different medication may be necessary in that case. Leprosy primarily affects the and the nerves outside the and spinal cord, called the peripheral nerves. It may also strike the and the thin tissue lining the inside of the nose. McConkey B "Adverse reactions to dapsone. MiFEPRIStone: May increase the serum concentration of CYP2C9 Substrates. Management: Use CYP2C9 substrates at the lowest recommended dose, and monitor closely for adverse effects, during and in the 2 weeks following mifepristone treatment.
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses. Albuminuria, male infertility, nephrotoxic syndrome, renal papillary necrosis. Existing lesions become erythematous and edematous and may ulcerate; fever and increased WBC count occur frequently; acute neuritis and loss of nerve function may develop. Pertel P, Hirschtick R "Adverse reactions to dapsone in persons infected with human immunodeficiency virus. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. When feasible, perform baseline liver function tests and monitor during therapy. 116 If any abnormality in liver function is evident, discontinue dapsone until the source of the abnormality is established. Kirk O, Lundgren JD, Pedersen C et al. Can chemoprophylaxis against opportunistic infections be discontinued after an increase in CD4 cells induced by highly active antiretroviral therapy? Other side effects including the "dapsone syndrome" have been reported. The "dapsone syndrome" is manifested by viral illness-like symptoms fever, chills, myalgias, arthralgias, exanthema, lymphadenopathy, edema, lymphocytosis hepatomegaly, elevated liver function tests, methemoglobinemia, and anemia. Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Adverse cutaneous effects may occur, including exfoliative dermatitis, toxic erythema, erythema multiforme, toxic epidermal necrolysis, morbilliform and scarlatiniform eruptions, urticaria, and erythema nodosum. Educate patient about signs of a significant reaction eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat. Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Store at room temperature between 59-86 degrees F 15-30 degrees C away from light and moisture. not store in the bathroom. Keep all medicines away from children and pets. Instruct patient to continue to take other prescribed medications while taking dapsone.
What happens if the patient's viral load increases while on HIV therapy? In addition to the warnings and adverse effects reported above, additional adverse reactions include: nausea, vomiting, abdominal pains, pancreatitis, vertigo, blurred vision, tinnitus, insomnia, fever, headache, psychosis, phototoxicity, pulmonary eosinophilia, tachycardia, albuminuria, the nephrotic syndrome, hypoalbuminemia without proteinuria, renal papillary necrosis, male infertility, drug induced Lupus erythematosus and an infectious mononucleosis like syndrome. In general, with the exception of the complications of severe anoxia from overdosage retinal and optic nerve damage, etc. Davey RT, Masur H. Recent advances in the diagnosis, treatment, and prevention of Pneumocystis carinii pneumonia. Antimicrob Agents Chemother. Atazanavir. Specifically, the risk of hyperbilirubinemia may be increased. If contact occurs, wash the affected skin area well with soap and water or rinse your with plain water. Consult your pharmacist for details.
Imkamp FMJH, Anderson R, Gatner EMS. Possible incompatibility of dapsone with clofazimine in the treatment of patients with erythema nodosum leprosum. Lepr Rev. Gel, 5 % will harm your unborn baby. Lawrence W, Olsen H, Nickles D "Dapsone hepatitis. Continue to take this medication for the full time prescribed, even if you feel well. Skipping doses or stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection and make the bacteria more difficult to treat resistant. not take more of this drug than directed because it may increase your chance of side effects. There are several options, including Isolaz, a “photopneumatic” treatment that uses a suction cup apparatus to suck deep into your pores and deliver an intense pulsed light treatment to the follicles. The disease has been around since ancient times, often surrounded by terrifying, negative stigmas and tales of patients being shunned as outcasts. Outbreaks of leprosy have affected, and panicked, people on every continent. A versus once weekly associated with aerosolized pentamidine once monthly group B to prevent P. carinii pneumonia events in AIDS. Int Conf AIDS.
Swallow the medication whole. not crush or chew. If you are taking the capsules, do not open them before swallowing. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. Other, less serious side effects may be more likely to occur. Beeching NJ, Ellis CJ. Leprosy and its chemotherapy. J Antimicrob Chemother. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. 'Multum' is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist. What is the history of HIV, and when was HIV discovered? In patients with leprosy, some clinicians recommend maintaining dapsone treatment during pregnancy. 116 In addition, dapsone has been important for management of dermatitis herpetiformis in some pregnant women. Bhargava P, Mal Kuldeep C, Mathur NK. Erythema nodosum leprosum in subgroups of lepromatous leprosy. Lepr Rev. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Lamprene clofazimine was not teratogenic in laboratory animals at dose levels equivalent to 8 times rabbit and 25 times rat the usual human daily dose. Bullous and exfoliative dermatitis, erythema multiforme, erythema nodosum, morbilliform and scarlatiniform reactions, phototoxicity, toxic epidermal necrolysis TEN urticaria. WHO recommends a 12-month MDT regimen of dapsone once daily rifampin once monthly and clofazimine once daily and once monthly. Not included in CDC, NIH, IDSA, and AAP recommendations for treatment of toxoplasmosis or chronic maintenance therapy to prevent relapse of toxoplasmosis secondary prophylaxis in HIV-infected adults, adolescents, and children. Symptoms of a dapsone overdose may include nausea, vomiting, excitation, seizures, and bluish skin color. Agranulocytosis, aplastic anemia, and other blood dyscrasias reported; fatalities have occurred.
Those who have the rare enzyme deficiency will need to have regular blood counts done, states the release. Peripheral neuropathy is a definite but unusual complication of Dapsone therapy in non-leprosy patients. Motor loss is predominant. If muscle weakness appears, Dapsone should be withdrawn. Recovery on withdrawal is usually substantially complete. The mechanism of recovery is reported by axonal regeneration. Some recovered patients have tolerated retreatment at reduced dosage. In leprosy this complication may be difficult to distinguish from a leprosy reactional state. There are many products available. Many can be purchased without a prescription. Some products such as cleansers, foam, or lotions may require a prescription. Consult your doctor or pharmacist on the choice of the product that is best for you. The main symptom of leprosy is disfiguring skin sores, lumps, or bumps that do not go away after several weeks or months. The skin sores are pale-colored. Alternative for treatment and prevention of Pneumocystis jirovecii formerly Pneumocystis carinii pneumonia PCP in adults, adolescents, or children. 110 134 153 154 155 156 161 174 176 Designated an orphan drug by FDA for treatment and prevention of PCP. Prussick R, Ali M, Rosenthal D, Guyatt G "The protective effect of vitamin E on the hemolysis associated with dapsone treatment in patients with dermatitis herpetiformis. Plasma concentrations of both dapsone and trimethoprim may be elevated, increasing the pharmacologic and toxic effects.
Tell your doctor if your condition worsens. Saito S, Ikezawa Z, Miyamoto H, Kim S "A case of the dapsone syndrome. Ahmad RA, Rogers HJ. Pharmacokinetics and protein binding interactions of dapsone and pyrimethamine. Br J Clin Pharmacol. This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use additional reliable birth control methods while using this medication. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well. Read the Guide provided by your before you start taking mycophenolate and each time you get a refill. If you have any questions, ask your doctor or pharmacist. What is the future for HIV-infected individuals with regards to treatment simplification and cure research? Ensure that CBC and differential are performed and evaluated prior to starting therapy, weekly for the first month of therapy, then monthly for 6 mo, and every 6 mo thereafter during treatment. Dabrafenib: May decrease the serum concentration of CYP2C9 Substrates. Management: Seek alternatives to the CYP2C9 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely particularly therapeutic effects. Recommended by CDC, NIH, and IDSA as preferred alternative for prevention of initial episodes of toxoplasmosis primary prophylaxis in HIV-infected adults and adolescents who cannot tolerate drug of choice co-trimoxazole; 155 used in conjunction with pyrimethamine and leucovorin for primary toxoplasmosis prophylaxis in HIV-infected adults and adolescents. Venkatesan K, Mathur A, Girdhar BK et al. The effect of clofazimine on the pharmacokinetics of rifampicin and dapsone in leprosy. J Antimicrob Chemother. Dapsone should be administered as part of combination therapy for prophylaxis of toxoplasmosis. What other drugs will affect dapsone? Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Hughes WT, Kennedy W, Dugdale M et al. Prevention of Pneumocystis carinii pneumonitis in AIDS patients with weekly dapsone. Lancet. No special population dosage recommendation at this time. Have you ever looked in the mirror and declared, “I should not have and pimples on the same face! We have used our best judgment in compiling this information. The Food and Drug Administration may not have evaluated the information presented.
We always recommend you take the approach of building health - and nerves are no different. Usual Dosage: Read accompanying literature. Mechanism of action in treatment of dermatitis herpetiformis unknown. 116 Dapsone only suppresses the disease; cutaneous IgA and complement deposition not affected by the drug. a May act as an immunomodulator when used in the treatment of this and other dermatologic diseases. Maximum 25 mg once daily. Recent data indicate vitamin E may be protective against dapsone-induced hemolytic anemia and methemoglobinemia, although more studies are needed. Emphasize to patient that treatment will be lengthy and that the entire course of treatment must be completed to avoid relapse or development of resistance.
It belongs to a class of medications called immunosuppressants. It works by weakening your body's defense system to help your body accept the new organ as if it were your own. Mohle-Boetani J, Akula SK, Holodniy M, et al "The sulfone syndrome in a patient receiving dapsone prophylaxis for pneumocystis carinii pneumonia. Rifampin is additionally recommended to reduce the incidence of dapsone resistance. If the disease relapses, this regimen should be repeated. This medication may rarely cause a severe intestinal condition Clostridium difficile-associated diarrhea due to a type of resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Do not use anti-diarrhea products or narcotic pain medications if you have any of the following symptoms because these products may make them worse. Adolescents mild to moderate disease: Refer to adult dosing. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. If using cleansers containing benzoyl peroxide, wet the affected area. Gently rub the cleanser into the skin for 10-20 seconds. Work into a full lather and rinse thoroughly and then pat dry. If too much drying occurs, you may need to rinse the cleanser off sooner or use it less often. Consult your doctor or pharmacist for further details. Check the ingredients on the label even if you have used the product before. The manufacturer may have changed the ingredients. Also, products with similar names may contain different ingredients meant for different purposes. Taking the wrong product could harm you. Abrupt changes in clinical activity occur in leprosy with any effective treatment and are known as reactional states. The majority can be classified into two groups. The "Reversal" reaction Type 1 may occur in borderline or tuberculoid leprosy patients often soon after chemotherapy is started. The mechanism is presumed to result from a reduction in the antigenic load: the patient is able to mount an enhanced delayed hypersensitivity response to residual infection leading to swelling "Reversal" of existing skin and nerve lesions. If severe, or if neuritis is present, large doses of steroids should always be used. If severe, the patient should be hospitalized. In general anti-leprosy treatment is continued and therapy to suppress the reaction is indicated such as analgesics, steroids, or surgical decompression of swollen nerve trunks. USPHS at Carville, LA should be contacted for advice in management. Included as part of the PRECAUTIONS section.
Figueiredo M, Pinto B, Zago M "Dapsone-induced haemolytic anaemia and agranulocytosis in a patient normal glucose-6-phosphate-dehydrogenase activity. MDT regimens can rapidly kill Mycobacterium leprae, render patient noninfectious after only a few days of treatment, delay or prevent emergence of resistant M. leprae, and reduce risk of relapse after treatment discontinuance. 105 216 MDT regimens do not enhance rate of clearance of dead bacilli from the body; 217 such clearance may take years 216 and depends largely on individual's immune response, which may be defective in leprosy patients. 217 Reactive episodes reported in leprosy patients receiving treatment appear to be due to destruction of M. leprae and immune responses to released bacterial antigens. 216 217 See Leprosy Reactional States under Cautions. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Results of mutagenicity studies were negative. There was some evidence of impaired fertility in one study in rats treated at a dose 25 times the usual human dose; the number of was reduced and there was a lower proportion of implantations. In: Mandell GL, Bennett JE, Dolin R, eds. Reiter WM, Cimoch PJ. Dapsone-induced methemoglobinemia in a patient with P. carinii pneumonia and AIDS. N Engl J Med. Do not change brands or forms of mycophenolate unless directed by your doctor. Histologically, there is vasculitis with an intense polymorphonuclear infiltrate. In general, antileprosy treatment is continued. Patients with severe reactions require hospitalization. Alternatively, 50 mg once daily in conjunction with oral pyrimethamine 50 mg once weekly and oral leucovorin 25 mg once weekly. 155 Alternatively, 200 mg once weekly in conjunction with oral pyrimethamine 75 mg once weekly and oral leucovorin 25 mg once weekly. BCG Vaccine Immunization: Antibiotics may diminish the therapeutic effect of BCG Vaccine Immunization. Closely monitor CBC and discontinue therapy if a significant reduction in leukocytes, platelets, or hemopoiesis is seen. Labeled for treatment of leprosy and for treatment of dermatitis herpetiformis in children. 116 Generally considered to have no effect on growth, development, and functional development of children. WHO recommends 50 mg once daily in conjunction with oral rifampin 450 mg once monthly and oral clofazimine 50 mg once every other day and 150 mg once monthly given for 12 months. Hispanic 2% or of other racial origin 5%. Keep out of the reach of children.
Rifampin lowers Dapsone levels 7 to 10-fold by accelerating plasma clearance; in leprosy this reduction has not required a change in dosage. Folic acid antagonists such as pyrimethamine may increase the likelihood of hematologic reactions. Adolescents: 50 mg once daily in conjunction with oral pyrimethamine 50 mg once weekly and oral leucovorin 25 mg once weekly. 155 Alternatively, 200 mg once weekly in conjunction with oral pyrimethamine 75 mg once weekly and oral leucovorin 25 mg once weekly. Store below 30ºC 86ºF. Protect from moisture. American Academy of Pediatrics. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. Mills J, Leoung G, Medina I et al. Dapsone treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Antimicrob Agents Chemother. The dosage is based on your age, weight, medical condition, and response to treatment. Are pregnant or plan to become pregnant. If you are using the liquid wash, cleansing pad, or cleanser bar, use it instead of soap once or twice a day. Wet the skin before applying, gently work up a lather for 10 to 20 seconds, and rinse thoroughly. not scrub the skin.
World Health Organization: 100 mg daily in combination with rifampin and clofazimine for 12 months WHO 2012. Has been reported with oral treatment. Patients with severe anemia should be treated for anemia before dapsone is initiated; monitor hemoglobin. Sanders S, Zone J, Foltz R, et al "Hemolytic anemia induced by dapsone transmitted through breast milk. However, it's taken as a pill for this condition. This drug is available at a higher level co-pay. Talk to your doctor about prescription treatments. Gel, 5%, from freezing. Cockburn EM, Wood SM, Waller PC, Bleehen SS "Dapsone-induced agranulocytosis: spontaneous reporting data. As physicians, it is hard for us to do nothing. Check G6PD levels prior to initiation; CBC weekly for first month, monthly for 6 months and semiannually thereafter; reticulocyte counts; liver function tests baseline and periodic. Monitor patients for signs of jaundice, hemolysis, and blood dyscrasias. CYP2C9 Inhibitors Strong: May decrease the metabolism of CYP2C9 Substrates. Because hemolysis and Heinz body formation may be exaggerated in individuals with G-6-PD deficiency, hemoglobin M, or methemoglobin reductase deficiency, give dapsone with caution to patients with these conditions or patients exposed to other agents or with conditions capable of producing hemolysis eg, diabetic ketosis. Meyerson MS. Erythema nodosum leprosum. Int J Dermatol. For topical use only. What are the key principles in managing HIV infection?
July 21, 2005 -- The FDA has approved a new gel to treat acne. US adults: NHDP recommends 100 mg once daily in conjunction with oral rifampin 600 mg once daily and oral clofazimine 50 mg once daily given for 24 months. What are nucleoside and nucleotide analogue reverse transcriptase inhibitors NRTIs? The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Dapsone should be discontinued and the patient followed intensively. Rare cases of dapsone-induced lupus erythematosus and exacerbations of existing lupus erythematosus have been reported. Not all side effects for dapsone may be reported. You should always consult a doctor or healthcare professional for medical advice. St John's Wort: May decrease the serum concentration of CYP3A4 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Nasopharyngitis 5%; pharyngitis 2%; severe pharyngitis. Lamprene clofazimine does not show cross-resistance with dapsone or rifampin. Report these side effects to your doctor, who may need to lower your dose of methenamine or change your treatment to make your urine less acidic.
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Yawalkar SJ, Vischer W. Lamprene clofazimine in leprosy. Lepr Rev. Hornsten P, Keisu M, Wiholm B "The incidence of agranulocytosis during treatment of dermatitis herpetiformis with dapsone as reported in Sweden, 1972 through 1988. Food and Drug Administration. Recent drug approvals. FDA Drug Bull. Monitor hemoglobin, hematocrit, and methemoglobin concentrations periodically, particularly in HIV-infected individuals receiving dapsone in conjunction with trimethoprim. 160 161 162 164 See Specific Drugs under Interactions.
Hughes WT, Smith BL. Efficacy of diaminodiphenylsulfone and other drugs in murine Pneumocystis carinii pneumonitis. Antimicrob Agents Chemother. If you are using this product on a regular schedule and miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. For dapsone-sensitive multibacillary leprosy, a combination therapy with two other antileprosy drugs is recommended. The triple-drug should be given for at least 2 years and continued, if possible, until negative skin smears are obtained. At this time, monotherapy with an appropriate antileprosy drug can be instituted.
Gawkrodger D "Manic depression induced by dapsone in a patient with dermatitis herpetiformis. G6PD deficiency, methemoglobin reductase deficiency liver disease, heart disease, lung disease, serious infection, very high blood sugar diabetic ketosis. Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine Ty21a should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents.
Store dapsone at room temperature away from moisture and heat. Many other drugs can interact with dapsone, especially those that may also affect the blood. Do not take any other prescription or over-the-counter medicines, including vitamins, minerals, and herbal products, during treatment with dapsone without first talking to your doctor. Many people need them only when it flares, such as when they have a particularly bad period. For the best possible benefit, it is important to take each scheduled dose of this medication as directed. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule.