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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Dapsone

Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
11-23-2010

Zambia Specific Information

  • Available formulation in Zambia: 100 mg tablet 
  • PCP treatment (mild to moderately severe): dapsone 100 mg once-daily + TMP 5 mg/kg q8h.
  • PCP prophylaxis: dapsone 100 mg once-daily.
  • Avoid in severe G6-PD deficiency.
Zambia Information Author: Paul A. Pham, Pharm.D.

INDICATIONS

FDA

  • Leprosy
  • Dermatitis herpetiformis
  • Acne vulgaris (dapsone 5% gel)
NON-FDA APPROVED USES

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
Dapsone (generic)DapsoneGeneric manufacturers  oral
tablet
25 mg
$0.20
      oral
tablet
100 mg
$0.21
     

Aczone dapsone QLT topical
gel
5% (30gm)
$165.50 

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

No data, metabolite excreted renally, may need adjustment.

DOSING IN HEMODIALYSIS

No data.

DOSING IN PERITONEAL DIALYSIS

No data.

DOSING IN HEMOFILTRATION

No data.

ADVERSE DRUG REACTIONS

COMMON

  • Nausea and anorexia.
  • Hemolytic anemia with G6PD deficiency.
OCCASIONAL

  • Blood dyscrasias (methemoglobinemia & sulfhemoglobinemia with or without G6-PD def).
  • Hepatitis
  • Rash
  • Pruritus
  • Dose dependent hemolytic anemia without G6PD deficiency.
RARE

  • Sulfone syndrome: fever, malaise, exfoliative dermatitis, hepatic necrosis, lymphadenopathy, and hemolytic anemia w/ methemoglobinemia.
  • Nephrotic syndrome; blurred vision; photosensitivity; tinnitis; insomnia; irritability; and headache.
  •  Neutropenia 

DRUG INTERACTIONS

  • ddI EC (preferred).
Drug-to-Drug Interactions

Drug-to-Drug Interaction

DrugEffect of InteractionRecommendations/Comments
Rifampin Dapsone serum levels decreased by 85-90%. Avoid co-administration.
Zidovudine Risk of anemia may be increased. Monitor.
Pyrimethamine Risk of anemia may be increased. Monitor.
Primaquine Risk of hemolysis may be increased, particularly in G6PD deficiency. Avoid or monitor closely with co-administration.
ddI (buffered suspension) Dapsone solubility may decreased and result in decreased absorption.  Clinical significance unknown (a PK study did not find interaction). Use ddI (enteric-coated).
Bismuth Dapsone absorption may be decreased. Avoid co-administration. Administer dapsone 2 hours before bismuth
Cimetidine Dapsone absorption may be decreased. Avoid co-administration. Administer dapsone 2 hours before H-2 blockers.
Esomeprazole Dapsone absorption may be decreased. Avoid co-administration.
Famotidine Dapsone absorption may be decreased. Avoid co-administration. Administer dapsone 2 hours before H-2 blockers.
Lansoprazole Dapsone absorption may be decreased. Avoid co-administration.
Nizatidine Dapsone absorption may be decreased. Avoid co-administration. Administer dapsone 2 hours before H-2 blockers.
Omeprazole Dapsone absorption may be decreased. Avoid co-administration.
Pantoprazole Dapsone absorption may be decreased. Avoid co-administration
Probenecid Dapsone serum concentrations may be increased. Monitor for anemia with co-administration.
Rabeprazole Dapsone absorption may be decreased. Avoid co-administration.
Ranitidine Dapsone absorption may be decreased. Avoid co-administration. Administer dapsone 2 hours before H-2 blockers.
Ribavirin Risk of hemolysis may be increased. Avoid or monitor closely with co-administration 
Sucralfate Dapsone absorption may be decreased. Avoid co-administration. Administer dapsone 2 hours before sucralfate.
Trimethoprim Trimethoprim serum levels increased by 48%. Dapsone serum levels increased by 40%. Methemoglobinemia has been reported with co-administration. Clinical significance unknown, but cases of methemoglobinemia reported with TMP + dapsone in pts who tolerated dapsone alone. 

SPECTRUM

P. jiroveci, Toxoplasma gondii, and M. leprae.

PHARMACOLOGY

Pharmacology

COMMENTS

Oral agent used for treatment and prevention of PCP and leprosy. Strong oxidizing agent; G6-PD deficiency screening recommended (especially in high-risk pts including African American men and Mediterranean descendent males). Contraindicated use with Mediterranean but not African variant of G6-PD deficiency. In addition to hemolytic anemia, may cause methemoglobinemia, and bone marrow suppression.

Basis for Recommendations

  • National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA) ; Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents ; http://AIDSinfo.nih.gov ; 2008 ; Vol.
    Rating: Basis for recommendation
    Comments:Current opportunistic infection guidelines.

REFERENCES

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