Hemolysis dapsone

Administration of dapsone may result in hemolysis (destruction of red blood cells), nausea, vomiting, anorexia, and blurred vision. 

Dapsone Hemolysis in patients with glucose-6-phosphate... 

Dapsone is a sulfone that, like sulfonamides, inhibits dihydrofolate synthesis (p. 272). It is bactericidal against susceptible strains of M. leprae. Dapsone is given orally. The most frequent adverse effect is methemoglobinemia with accelerated erythrocyte degradation (hemolysis). 

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. 

The adverse effects of dapsone have been comprehensively reviewed (8). The most common untoward effect is hemolysis of varying degree it is usually mild, except in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Methemoglobinemia and Heinz... 

In France, dapsone is available in combination with ferrous oxalate as Disulone (Aventis), and in 1983-98, 249 adverse reactions were reported to French pharma-covigilance centers, mainly blood dyscrasias (often neutropenia and agranulocytosis, rarely hemolysis and anemia) (11). Five patients died three of them had septicemia secondary to agranulocytosis. There were 29 cases of dapsone syndrome, 39 skin reactions, 27 cases of hver damage, and 27 cases of neurological and psychiatric adverse effects. Patients taking dapsone need to be under close medical supervision for early recognition of adverse reactions. 

A patient who had been taking dapsone inappropriately instead of an antispasmodic that had been prescribed for a spinal condition, because of incorrect labeling in a pharmacy, developed methemoglobinemia (24). Methylene bine was given intravenously and may have contribnted to the severe hemolysis that followed. 

Renal insnfficiency can be associated with severe hemolysis dne to dapsone (27). 

Prussick R, Ah MA, Rosenthal D, Guyatt G. The protective effect of vitamin E on the hemolysis associated with dapsone treatment in patients with dermatitis herpetiformis. Arch Dermatol 1992 128(2) 210-13. 

Dapsone 10-50h As little as 100 mg in an 18-month-old Methemoglobinemia, sulfhemoglobinemia, hemolysis metabolic acidosis hallucinations, confusion hepatitis (see p 179). 

Pathogenesis Dapsone is metabolized either by acetylation to non-toxic acetyldapsone or by N-hydroxylation by multiple CYP isoenzymes to toxic hydroxylamines [51 ]. The latter are thought to be responsible for methemoglobinemia and hemolysis. 

Susceptibility factors The association of dapsone-induced hemolysis with G6PD deficiency is well known [SED-15, 1051]. Cytochrome b5 reductase deficiency can be associated with an increased risk of methemoglobinemia [54 ]. 

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. 

Cimetidine increases plasma dapsone concentrations without increased hemolysis, reduces methemoglobin concentrations by selective inhibition of dapsone N-hydroxyl-ation, and does not interfere with the control of the skin disorder. These features seem to be detectable within weeks and are sustained. The effects of cimetidine appear to be greatest on methemoglobin concentrations. 

Darbepoetin alfa Darbepoetin alfa has been used to treated dapsone-induced hemolysis [59 ]. 

East J, Blanton LS. Symptomatic hyperbilirubinemia secondary to dapsone-induced hemolysis and atazanavir therapy. Antimicrob Agents Chemother 2012 56(2) 1081-3. 

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