Dapsone

	Zambia HIV National Guidelines
	Introduction HIV Counseling and Testing Sexually Transmitted Infections (STIs) General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents Initial Regimen for ARV Therapy Adherence Baseline evaluation and Monitoring Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance ARV Therapy for Individuals with Tuberculosis Co-Infection Adverse Effects and Toxicity Immune Reconstitution Inflammatory Syndrome (IRIS) Changing or Stopping ART Treatment Failure Stopping ARV Therapy Post Exposure Prophylaxis Cotrimoxazole Prophylaxis WHO Staging in Adults and Adolescents Nutrition Care and Support Palliative Care in HIV and AIDS
	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>

Dapsone

Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
09-12-2008

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

PCP prophylaxis.
Treatment of mild to moderately severe PCP (with trimethoprim).
Toxoplasmosis prophylaxis (with pyrimethamine and leucovorin).

FORMS

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

Aczone	dapsone	QLT	topical gel 5% (30gm)	tba

*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

PCP prophylaxis: 100 mg PO once-daily.
Treatment of mild to moderately severe PCP: dapsone 100 mg PO once-daily + trimethoprim 5 mg/kg q8h x 21 days.
PCP and toxoplasmosis prophylaxis: dapsone 50 mg PO once-daily + pyrimethamine 50 mg po qwk + leucovorin 25 mg PO qwk OR dapsone 200 mg PO qwk + pyrimethamine 75 mg PO qwk + leucovorin 25 mg q wk.

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

Drug	Effect of Interaction	Recommendations/Comments
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
Primaquine	Risk of hemolysis may be increased, particularly in G6PD deficiency.	Avoid or monitor closely with co-administration.
Probenecid	Dapsone serum concentrations may be increased.	Monitor for anemia with co-administration.
Pyrimethamine	Risk of anemia may be increased.	Monitor.
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
Rifampin	Dapsone serum levels decreased by 85-90%.	Avoid 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.
Zidovudine	Risk of anemia may be increased.	Monitor.

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

REFERENCED WITHIN THIS GUIDE

Cotrimoxazole Prophylaxis

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