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Dapsone

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Dapsone

  • Indications
  1. Mycobacterium
    1. Tuberculosis (Second line agent)
    2. Leprosy
  2. Fungal infections
    1. Pneumocystis carinii Pneumonia (second line agent)
  3. First line in certain autoimmune Bullous Conditions
    1. Dermatitis Herpetiformis
    2. Linear IgA Dermatosis
    3. Chronic Bullous Disease of Childhood
  • Contraindications
  1. G6PD Deficiency
  • Mechanism
  1. Synthetic derivative of di-amino-sulfone
  2. Antiinflammatory activity
    1. Interferes with Neutrophil adherence and chemotaxis and its oxidation damage via myeloperoxidase
  3. Antibacterial activity
    1. Analog of p-aminobenzoic acid (PABA)
    2. Inhibits dihydropteroate synthase (DHPS), and therefore Folate synthesis
    3. Reduced Folate results in reduced thymidylate needed for DNA synthesis
  1. Combine with other agents
  2. Adult: 100 mg orally daily
  3. Child: 1 mg/kg (up to 100 mg) orally daily
  1. PCP Pneumonia prophylaxis
    1. Adult
      1. Dapsone 100 mg orally daily
    2. Child (age >=1 month)
      1. Dapsone 2 mg/kg (up to 100 mg) orally daily OR
      2. Dapsone 4 mg/kg/week (up to 200 mg) orally once weekly
  2. PCP Pneumonia treatment
    1. Dapsone 100 mg orally daily for 21 days
    2. Combine with other agents (e.g. trimethoprim 5 mg/kg orally three times daily)
  • Adverse Effects
  1. Nausea or Vomiting
  2. Peripheral Neuropathy (rare)
  3. Hepatotoxicity
  4. Blood dyscrasias
    1. Hemoglobin decreased (1-2 grams)
    2. Reticulocytes increased (2-12%)
    3. Hemolysis in G6PD Deficiency
    4. Methemoglobinemia
  5. Renal effects
    1. Proteinuria or Albuminuria
    2. Nephrotic Syndrome
  6. Skin effects
    1. Photosensitivity (Sunburn risk)
    2. Erythema Nodosum leprosum in Leprosy treatment (50%)
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Monitoring
  1. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)
    1. Screen for G6PD Deficiency before starting Dapsone
  2. Complete Blood Count
    1. Obtain baseline and monthly for at least 6 months (then twice yearly) while on Dapsone
  3. Liver Function Tests
    1. Obtain periodic levels
  • Resources
  1. Dapsone Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=0792169d-c6f9-4af0-93ae-b75d710c47a9