Dapsone

CLINICAL USE

Treatment and prophylaxis of leprosy Dermatitis herpetiformis Pneumocystis jiroveci pneumonia (PCP)Malaria prophylaxis

DOSE IN NORMAL RENAL FUNCTION

Leprosy: 1–2 mg/kg or 100 mg daily PCP: 100 mg daily in 1 or 2 divided doses Dermatitis herpetiformis: 50–300 mg daily Malaria prophylaxis: 100 mg weekly in combination with pyrimethamine 12.5 mg weekly

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :248.3

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :50–80

%Excreted unchanged in urine &nbsp &nbsp : 20

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :1–1.5

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :10–80

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : Dose as in normal renal function, use with caution

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : 50–100mg daily, use with caution. No dose reduction is required for malaria prophylaxis.

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Likely dialysability. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Dialysed. Dose as in GFR

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/min

HDF/high flux &nbsp :Dialysed. Dose as in GFR

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/min

CAV/VVHD &nbsp &nbsp &nbsp:Likely dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsNone known

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Greater risk of haemolytic side effects in patients with glucose-6-phosphate-dehydrogenase deficiencyRegular blood counts are recommended in patients with severe anaemia or renal impairment: weekly for the 1st month, then monthly for 6 months, then semi-annuallyAlmost all patients lose 1–2 g of haemoglobinThe dose for herpetiformis can be reduced if the patient is on a gluten free diet One study used dapsone in a haemodialysis patient for bullous dermatosis: therapy was initiated at 100 mg but the dose had to be reduced to 50 mg due to haemolytic effects.

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