Dadps

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 31.12.2020

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Synonym(s)

Dapson; Diaminodiphenylsulfone

Definition
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Half-life
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20–45 h

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Spectrum of action
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Mycobacterium leprae, Toxoplasma gondii, Pneumocystis jirovecii.

Indication
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  • Blistering dermatoses such as pemphigus vulgaris, pemphigus herpetiformis, pemphigus chronicus benignus familiaris, mucous membrane pemphigoid, dermatitis herpetiformis.
  • Dapsone is also indicated in the following skin diseases in the absence of lower-risk treatment: bullous pemphigoid (monotherapy or in combination with systemic glucocorticoids and immunosuppressive drugs), in rare diseases such as subcorneal pustular dermatoses, erythema elevatum diutinum, granuloma annulare, granuloma faciale, prurigo pigmentosa, recurrent polychondritis.
  • Also approved for pustular psoriasis and bullous, urticarial or ulcerative exacerbations of lupus erythematosus.
  • There are individual findings of positive treatment results in vasculitis and arteritis temporalis, when systemic glucocorticoids alone are not sufficiently effective.
  • Application (off-label use) in leprosy, toxoplasmosis (in AIDS patients), leishmaniasis, pneumocystis jirovecii pneumonia (in AIDS patients).

Dosage and method of use
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  • Leprosy: 50-100 mg/day p.o. for 6-12 months.
  • Leishmaniasis: adults: 50-100 mg/day p.o. for 6 days a week. Children: 1 mg/kg bw/day.
  • Pneumocystis carinii pneumonia (PCP) Prophylaxis: 50-100 mg/day p.o.
  • Therapy of mild PCP: 100 mg/day in combination with Trimethoprim 20 mg/kg bw p.o.
  • Dermatitis herpetiformis: initial 100-200 mg/day p.o. with slow dose reduction.
  • Bullous dermatosis of childhood: Initial 50-100 mg/day p.o.
  • Subcorneal pustulose: Initial 100-150 mg/day p.o.
  • Erythema elevatum et diutinum: Initial 100-150 mg/day p.o.

Remember!

Determination of glucose-6-phosphate dehydrogenase before starting therapy. Treatment of leprosy only in combination with rifampicin or clofazimine, as secondary resistance often develops!

Undesirable effects
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Methemoglobinemia; leukopenia; thrombocytopenia; pancytopenia; exanthema; livedo reticularis, urticaria, Lyell syndrome; Stevens-Johnson syndrome; erythema nodosum; allergic vasculitis; photodermatoses; lupus erythematosus; peripheral neuropathies; allergic conjunctivitis; psychoses.

Very rarely: dapson hypersensitivity syndrome (usually 2-8 weeks after the start of therapy): fever, arthralgias, haemolytic anaemia, skin changes (erythema, maculopapular exanthema.

Very rare: Non-specific interstitial pneumonia (NSIP).

Interactions
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Enhancing the action of: antidiabetics; phenytoin; methotrexate; enhancing the action of DADPS: indometacin; salicylates; phenylbutazone.

Recipe(s)
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Dapsone can be used in a 5% or 7.5% gel preparation (marketed in the USA under the name Aczone® for the indication acne vulgaris) . As a formulation, dapsone 5% in hydrophobic base cream DAC can be easily prepared. Single case reports are available for the indications rosacea papulopustulosa, dermatitis herpetiformis, erythema elevatum diutinum, granuloma anulare and granuloma faciale (Wohlrab J et al. 2018).

Preparations
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Dapsone Fatol

Note(s)
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Side effects should be largely avoidable by additional administration of cimetidine, vitamin C and vitamin E.

Literature
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  1. Hertl M, Schuler G (2002) Bullous autoimmune dermatoses. 1: Classification. dermatologist 53: 207-219
  2. Semira et al (2014) Livedo reticularis associated with dapsone therapy in a patient with chronicurticaria
    . Indian J Pharmacol 46:438-440
  3. Wohlrab J et al (2018) Dapsone for topical use in extemporaneous preparations. J Dtsch Dermatol Ges 16:34-40.

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Last updated on: 31.12.2020