Dapsone

Oral
Topical
Class
Antibiotics
Subclass
Antifolates
Substance name
Dapsone, 4, 4-sulfonyldianiline, diaminodiphenyl sulfone
Brand names
Aczone®
Common formulations
Tablet
Dosage and administration
Adults patients
Treatment
Dermatitis herpetiformis
•
Start at: 50 mg PO daily
•
Maintenance: 50-300 mg PO daily
Titrate down to the minimum maintenance dose.
Bullous pemphigoid • Off-label
•
Maintenance: 1-1.5 mg/kg PO daily
•
Maximum: 150 mg per day
Administered as monotherapy or in combination with topical and/or oral steroids.
Immune thrombocytopenia • Off-label
•
100 mg PO daily for a minimum of 3 weeks
Adjunctive treatment
Leprosy • Paucibacillary
•
100 mg PO daily for 12 months (resource-rich settings)
Administered in combination with rifampin 600 mg orally daily.
Alternative
•
100 mg PO daily for 6 months (resource-limited settings)
Administered in combination with rifampin 600 mg orally once a month and clofazimine 300 mg orally once a month plus 50 mg daily.
Leprosy • Multibacillary
•
100 mg PO daily for 24 months (resource-rich settings)
Administered in combination with rifampin 600 mg orally daily and clofazimine 50 mg orally daily.
Alternative
•
100 mg PO daily for 12 months (resource-limited settings)
Administered in combination with rifampin 600 mg orally once a month and clofazimine 300 mg orally once a month plus 50 mg daily.
Other off-label uses
•
Treatment of Pneumocystis pneumonia in patients with HIV infection (mild-to-moderate)
•
Treatment of lichen planus (cutaneous or oral)
•
Adjunctive treatment for pemphigus vulgaris
•
Prevention of Pneumocystis pneumonia in patients with HIV infection
•
Prevention of toxoplasmosis in patients with HIV infection
•
Secondary prevention of Pneumocystis pneumonia in patients with HIV infection
Indications for use
Labeled indications
Adults
•
Treatment of dermatitis herpetiformis
•
Adjunctive treatment for leprosy (multibacillary)
•
Adjunctive treatment for leprosy (paucibacillary)
Off-label indications
Adults
•
Treatment of Pneumocystis pneumonia in patients with HIV infection (mild-to-moderate)
•
Treatment of bullous pemphigoid
•
Treatment of immune thrombocytopenia
•
Treatment of lichen planus (cutaneous or oral)
•
Adjunctive treatment for pemphigus vulgaris
•
Prevention of Pneumocystis pneumonia in patients with HIV infection
•
Prevention of toxoplasmosis in patients with HIV infection
•
Secondary prevention of Pneumocystis pneumonia in patients with HIV infection
Safety risks
Contraindications
Hypersensitivity to dapsone and/or its derivatives
Warnings and precautions
Agranulocytosis, aplastic anemia
•
Maintain a high level of suspicion, as dapsone is associated with an increased risk of blood dyscrasias, particularly when coadministered with folic acid antagonists. Monitor blood counts weekly during the first month, monthly for the following 6 months, and semi-annually thereafter. Discontinue dapsone immediately if there's a significant decline in WBCs, platelets, or bone marrow activity, and monitor the patient closely with intensive follow-up.
Exacerbation of anemia
•
Use caution in patients with severe anemia. Treat anemia before initiating oral dapsone and regularly monitor hemoglobin levels.
Exacerbation of hemolytic anemia, Heinz bodies, methemoglobinemia, hemolysis
•
Use caution in patients with G6PD deficiency, methemoglobin reductase deficiency, or hemoglobin M. Monitor blood counts weekly during the first month, monthly for the following 6 months, and semi-annually thereafter.
Hepatotoxicity, Stevens-Johnson syndrome, DRESS syndrome, erythema multiforme, maculopapular rash
•
Maintain a high level of suspicion, as dapson is associated with an increased risk of delayed hypersensitivity reactions.
Superinfection, pseudomembranous colitis, C. difficile infection
•
Use caution in patients on long-term dapsone therapy.
Specific populations
Renal impairment
GFR 20-50 mL/min
•
Use acceptable. No dose adjustment required. Monitor complete blood count.
GFR 10-20 mL/min
•
Use with caution. Monitor complete blood count.
GFR < 10 mL/min
•
Use with caution. Start at dose of 50 mg. Maximal dose of 100 mg. Do not exceed frequency of once daily. Monitor complete blood count.
Renal replacement therapy
Continuous renal replacement
•
No dose adjustment required. Use with caution. Dose as in eGFR 10-20 mL/min/1.73 m². Monitor complete blood count.
Intermittent hemodialysis
•
Reduce dose. Dose as in eGFR < 10 mL/min/1.73 m². Start at a dose of 50 mg. Maximal dose of 100 mg. Maximal frequency of daily. Monitor complete blood count.
Peritoneal dialysis
•
Reduce dose. Dose as in eGFR < 10 mL/min/1.73 m². Start at a dose of 50 mg. Maximal dose of 100 mg. Maximal frequency of daily. Monitor complete blood count.
Hepatic impairment
Any severity
•
No guidance available. Monitor serum aminotransferases. Monitor for toxicity.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B2
•
Use only if benefits outweigh potential risks. There are no animal or controlled human pregnancy data available. However, experience with dapsone during all trimesters of human pregnancy has not shown an increased risk of fetal abnormalities.
Breastfeeding
Consider alternative agents that may be safer.
Low excretion in breastmilk (5-25%).
Unknown drug levels in breastfed infants.
May potentially cause adverse effects in breastfed infants.
Adverse reactions
Common 1-10%
•
Hemolysis, methemoglobinemia
Uncommon < 1%
•
Reactional States, exfoliative dermatitis, photosensitivity of skin, hepatitis, cholestatic jaundice, peripheral neuropathy, systemic lupus erythematosus, insomnia, headache, nausea, vomiting, tinnitus, blurred vision
Unknown frequency
•
Anemia, agranulocytosis, ↓ WBC count, male infertility, lupus-like symptoms, nephrotic syndrome, AKI
Interactions
Drug(s)
Check Interactions
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