Dapsone

Dapsone Brand Name– Aczone

What is Dapsone

Dapsone is a versatile drug. It is a synthetic sulfone and is chemically similar to sulfonamides, but cross-sensitivity has not been substantiated.

It is used as an antiinfective (for leprosy, Pneumocystis pneumonia (PCP), and prophylaxis of malaria) and as an immunosuppressive agent (for relapsing polychondritis and systemic lupus erythematosus).

Dapsone also has been used to treat various dermatologic disorders such as actinomycotic mycetoma, dermatitis herpetiformis, pemphigoid, subcorneal pustular dermatosis, granuloma annulare, and pyoderma gangrenosum. In addition, dapsone is commonly used to treat Loxosceles reclusa (e.g., brown recluse spider) bites; however, both human and animal data to support its routine use are conflicting.

A few case reports and small case series indicate efficacy in humans, but prospective human trials supporting its use are not available.

Furthermore, in addition to the lack of evidence to support its use, dapsone can cause serious, life-threatening toxicities (e.g., hemolytic anemia, hepatitis, methemoglobinemia).

A prospective epidemiologic study found that patients treated with dapsone for suspected loxoscelism experienced a nonsignificant increase in healing time and scarring.

The benefits of administering dapsone for the treatment of loxoscelism should be carefully balanced against the risks; supportive therapy and wound care are the treatment modalities of choice in patients presenting with loxoscelism.

Dapsone is currently the agent of choice in the treatment of all forms of leprosy, unless the organism exhibits dapsone resistance.

Dapsone can be used for prophylaxis of PCP either as a single agent or in combination with pyrimethamine. In combination with trimethoprim, dapsone is effective for treatment of PCP.

In combination with pyrimethamine, dapsone is effective for prevention of toxoplasmosis in patients with AIDS.

Acedapsone is a long-acting repository form. In Canada, a commonly used brand name of oral dapsone is Avlosulfon. Dapsone was originally approved by the FDA in 1955.

A topical dapsone gel (Aczone) was approved in a 5% strength for the treatment of acne vulgaris in July 2005, and in a 7.5% strength in February 2016.

Indications

1. acne vulgaris
2. Actinomadura madurae
3. actinomycotic mycetoma
4. dermatitis herpetiformis
5. granuloma annulare
6. immune thrombocytopenic purpura (ITP)
7. leprosy (Hansen’s disease)
8. Mycobacterium leprae
9. Mycobacterium tuberculosis
10. Nocardia sp.
11. Plasmodium falciparum
12. Pneumocystis jirovecii (formerly Pneumocystis carinii)
13. Pneumocystis pneumonia (PCP)
14. Pneumocystis pneumonia (PCP) prophylaxis
15. polychondritis
16. Propionibacterium acnes
17. pyoderma gangrenosum
18. Streptomyces somaliensis
19. subcorneal pustular dermatosis
20. Toxoplasma gondii
21. toxoplasmosis prophylaxis

Side Effects

1. abdominal pain
2. agranulocytosis
3. anemia
4. aplastic anemia
5. blurred vision
6. bullous rash
7. cough
8. depression
9. elevated hepatic enzymes
10. eosinophilic pneumonia
11. epistaxis
12. erythema
13. erythema multiforme
14. erythema nodosum
15. exfoliative dermatitis
16. fever
17. headache
18. hemolysis
19. hemolytic anemia
20. hepatitis
21. hyperbilirubinemia
22. hypoalbuminemia
23. infection
24. infertility
25. influenza
26. insomnia
27. iritis
28. jaundice
29. leukopenia
30. lupus-like symptoms
31. malaise
32. methemoglobinemia
33. nausea
34. nephrotic syndrome
35. neuritis
36. pancreatitis
37. pancytopenia
38. peripheral neuropathy
39. pharyngitis
40. photosensitivity
41. pruritus
42. psychosis
43. rash
44. renal papillary necrosis
45. sinus tachycardia
46. sinusitis
47. tinnitus
48. toxic epidermal necrolysis
49. urticaria
50. vasculitis
51. vertigo
52. vomiting
53. weakness
54. xerosis

Monitoring Parameters

• CBC
• LFTs
• platelet count
• reticulocyte count

Contraindications

• anemia
• breast-feeding
• children
• G6PD deficiency
• hepatic disease
• infants
• methemoglobin reductase deficiency
• neonates
• pregnancy
• sulfonamide hypersensitivity

Interactions

• Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
• Acetaminophen
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
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• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
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