Dapsone hemolytic anemia

Dapsone hemolytic anemia and/or methemoglobinemia Diuretics, loop and thiazide hyponatremia and hypokalemia Dopamine receptor agonists pathological gambling Dopamine receptor agonists sleep attacks Ephedrine ischemic heart disease... 

Although dapsone (Avlosulfon) was once used in the treatment and prophylaxis of chloroquine-resistant P. falciparum malaria, the toxicities associated with its administration (e.g., agranulocytosis, methemoglobinemia, hemolytic anemia) have severely reduced its use. 

The answers are 484-k, 483-j. (Hardman, pp 1061—1062, 1682-1683.) Sulfonamides can cause acute hemolytic anemia. In some patients it may be related to a sensitization phenomenon, and in other patients the hemolysis is due to a glucose-6-phosphate dehydrogenase deficiency. Sulfamethoxazole alone or in combination with trimethoprim is used to treat UTIs. The sulfonamide sulfasalazine is employed in the treatment of ulcerative colitis. Dapsone, a drug that is used in the treatment of leprosy, and primaquine, an antimalarial agent, can produce hemolysis, particularly in patients with a glucose-6-phosphate dehydrogenase deficiency. 

Dapsone (Avlosulfon) is a member of a class of chemical agents known as the sulfones. Dapsone is especially effective against M. leprae and is used with rifampin as the primary method of treating leprosy. Dapsone appears to exert its antibacterial effects in a manner similar to that of the sulfonamide drugs that is, dapsone impairs folic acid synthesis by competing with PABA in bacterial cells. Primary adverse effects associated with dapsone include peripheral motor weakness, hypersensitivity reactions (skin rashes, itching), fever, and blood dyscrasias, such as hemolytic anemia. 

Glucose 6-phosphate dehydrogenase deficiency (G-6-PD) Aspirin, BAL (dimercaprol), chloroquine, chloramphenicol, dapsone hydroxychloroquine, nalidixic acid, nitrofurantoin, primaquine, probenecid, quinine, quinidine, sulfonamides Hemolytic anemia... 

Mild hemolytic anemia occurred in a breast-fed infant and his mother, who had continuously been taking 100-150 mg/day dapsone and its metabolite, mono-acetyldapsone, were identified in the infant s serum (SEDA-8, 290). 

Dapsone (alone or in combination with pyrimethamine) can cause methemoglobinemia and hemolytic anemia. These complications tend to be dose-related and are more often encountered in G6PD-deficient subjects (SEDA-18, 287). 

Three patients developed a hypersensitivity syndrome after taking pyrimethamine 12.5 mg + dapsone 100 mg weekly as malaria prophylaxis (16). The diagnosis was based on the presence of fever, lymphadenopathy, a maculopapular rash, and hepatitis. A mild Coombs -positive hemolytic anemia was also observed in one of the patients. All the clinical, hematological, and biochemical abnormalities normalized within 3 months of tapering regimens of moderate-dose prednisolone. 

Dapsone in combination with trimethoprim is also used for the treatment of mild to moderate first episodes of TCP, or alone for PCP prophylaxis [115, 198]. The most frequent adverse events are dose related metheglobinemia and hemolytic anemia. Since multi-drug therapy began to be used in leprosy patients, an increasing number of a rare, idiosyncratic reaction with multiorgan involvement... 

Note A hypersensitivity reaction - termed the sulfone syndrome or dapsone syndrome - may infrequently develop during the first six weeks of treatment. This syndrome consists of exfoliative dermatitis, fever, malaise, nausea, anorexia, hepatitis, jaundice, lymphadenopathy and hemolytic anemia. See (1982) Kromann NP +, Arch Dermatol I 18, 531... 

Idiosyncratic Hemolytic anemia from primaquine or dapsone Could be serious... 

Sanders SW, Zone JJ, Foltz RR, et al. Hemolytic anemia induced by dapsone transmitted through breast milk. Ann Intern Med 1981 96 465 66. 

Figure 1 The FIDOS and DoTS descriptions of hemolytic anemia and methemoglobinemia due to dapsone.

The most common hematological adverse effects of dapsone are hemolytic anemia and methemoglobinemia. Agranulocytosis [45, 46 ] can also occur, as can rarely sulfhemo-globinemia [47", 48 ], aplastic anemia [49 ], and pure red cell aplasia [5(1 ]. 

Dapsone-induced hemolytic anemia in lung transplant recipients who received dapsone for prophylaxis of Pneumocystis jirovecii pneumonia has been reported in a retrospective study of 43 patients, of whom 10 had hemolytic anemia without G6PD deficiency [55 ]. The mean fall in hemoglobin from baseline was 2.7 g/h (95% Cl = 1.9, 3.5). The odds ratio for hemolysis was 4.75 for each 1.0 mg/dl increase in serum creatinine (95% Cl = 1.07, 21). The authors concluded that the prevalence of dapsone-induced hemolytic anemia in lung transplant recipients is five times higher than the reported rates for other groups who routinely use dapsone prophylaxis for Pneumocystis pneumonia and that individuals with renal insufficiency or low body weight and for whom the dose exceeds 1.5 mg/kg may be at increased risk of dapsone-induced hemolytic anemia. 

Hemodialysis Severe dapsone poisoning, which resulted in methemoglobinemia and hemolytic anemia, improved after hemodialysis f 60 ]. 

Naik PM, Lyon 3rd GM, Ramirez A, Lawrence EC, Neujahr DC, Force S, Pelaez A. Dapsone-induced hemolytic anemia in lung allograft recipients. J Heart Lung Transplant 2008 27(11) 1198-202. 

Pamba A, Richardson ND, Carter N, Duparc S, Piemji Z, Tiono AB, et al. Clinical spectrum and severity of hemolytic anemia in glucose 6-phosphate dehydrogenase-deficient children receiving dapsone. Blood 2012 120(20) 4123-33. 

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