Dapsone

Indications
Oral
Primary and secondary prophylaxis of Pneumocystis (carinii) jiroveci pneumonia
Adult: 50 mg daily, with pyrimethamine 50 mg once wkly. Alternatively, 100 mg with pyrimethamine 50 mg twice wkly.
Child: 1 mth-18 yr: 2 mg/kg daily (max: 100 mg daily) or 4 mg/kg wkly (max: 200 mg wkly).
Oral
Multibacillary leprosy
Adult: 100 mg daily with clofazimine 50 mg daily, together with rifampicin 600 mg and clofazimine 300 mg once a mth for 12 mth. <35 kg: dapsone dose: 1-2 mg/kg/day.
Child: and child 10-14 yr old: daily doses of dapsone 50 mg, or 1 to 2 mg/kg if their body-weight is low
Oral
Paucibacillary leprosy
Adult: 100 mg daily with 600 mg rifampicin once a mth, both given for 6 mth.
Child: Reduce dose as for multibacillary leprosy.
Oral
Dermatitis herpetiformis
Adult: Initially, 50 mg daily increased gradually to 300 mg daily if required.
Topical/Cutaneous
Acne
Adult: ≥ 12 yr: As 5% gel: Apply a pea-sized amount thinly to the affected area bid, after washing and patting dry the skin with a clean towel. Rub the gel in, gently and completely, and wash hands after application. Reassess if no improvement after 12 wk.
Contraindications
Hypersensitivity. Severe anaemia, porphyria.
Warnings / Precautions
G6PD deficiency, methaemoglobin or Hb M. Perform regular blood counts and monitor liver function regularly. Pregnancy and lactation.
Adverse Reactions
Anaemia, peripheral neuropathy, haemolysis and methaemoglobinaemia (dose-related), nephrotic syndrome, psychological changes, hepatitis. Others: Nausea, vomiting, anorexia, headache, maculopapular rash, toxic epidermal necrolysis, Stevens-Johnson syndrome. Topical: Dryness, redness, oiliness and peeling at application site.
Potentially Fatal: Agranulocytosis, serious cutaneous hypersensitivity reactions, exfoliative dermatitis.
Overdose Reactions
Symptoms: nausea, vomiting, hyperexcitability (within a few min to up to 24 hr later), methemoglobin-induced depression, haemolysis (7-14 days after ingestion), seizures and severe cyanosis. Treatment: activated charcoal (20g four times daily) and haemolysis may enhance elimination of dapsone and its monoacetyl derivative. For patients without G6PD deficiency, methemoglobinemia may be treated with methylene blue 1-2 mg/kg given by slow IV injection (repeated if methemoglobin reaccumulates) or in less severe cases, 3-5 mg/kg every 4-6 hr orally.
Drug Interactions
Decreased serum conc of dapsone when used with rifampicin. Increased plasma conc with probenecid, trimethoprim. Antagonize clofazimine.
See Below for More dapsone Drug Interactions
Mechanism of Actions
Dapsone inhibits folic acid synthesis by preventing normal bacterial utilization of PABA (PABA).
Absorption: Completely absorbed from the GI tract (oral); peak plasma concentrations after 2-8 hr.
Distribution: Saliva, crosses the placenta and enters breast milk. Protein-binding: 50-80% (plasma proteins); 100% (monoacetylated metabolite).
Metabolism: Acetylated to monoacetyldapsone (major metabolite and other mono and diacetyl derivatives); hydroxylation (to hydroxylamine dapsone); undergoes enterohepatic recycling.
Excretion: Via urine (20% as unchanged drug).
Administration
Should be taken with food.
Storage Conditions
Oral: Store at 15-30°C. Topical/Cutaneous: Store at 15-30°C. Protect from light.
ATC Classification
J04BA02 - dapsone ; Belongs to the class of drugs used in the systemic treatment of lepra.
Storage
Oral: Store at 15-30°C. Topical/Cutaneous: Store at 15-30°C. Protect from light.
Available As
  • Dapsone 100 mg
  • Dapsone 25 mg
  • Dapsone 5% w/w
  • Dapsone 50 mg
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