Dermatitis herpetiformis: The dosage should be individually
titrated starting in adults with 50 mg daily and correspondingly smaller doses
in children. If full control is not achieved within the range of 50-300 mg
daily, higher doses may be tried. Dosage should be reduced to a minimum
maintenance level as soon as possible. In responsive patients there is a prompt
reduction in pruritus followed by clearance of skin lesions. There is no effect
on the gastrointestinal component of the disease. Dapsone levels are influenced
by acetylation rates. Patients with high acetylation rates, or who are receiving
treatment affecting acetylation may require an adjustment in dosage.
A strict gluten free diet is an option for the patient to elect, permitting many
to reduce or eliminate the need for Dapsone; the average time for dosage
reduction is 8 months with a range of 4 months to 2 1/2 years and for dosage
elimination 29 months with a range of 6 months to 9 years.
Leprosy: In order to reduce secondary Dapsone resistance, the
WHO Expert Committee on Leprosy and the USPHS at Carville, LA, recommended that
Dapsone should be commenced in combination with one or more anti-leprosy drugs.
In the multidrug program Dapsone should be maintained at the full dosage of 100
mg daily without interruption (with corresponding smaller doses for children)
and provided to all patients who have sensitive organisms with new or
recrudescent disease or who have not yet completed a two year course of Dapsone
monotherapy. For advice and other drugs, the USPHS at Carville, LA
(1-800-642-2477) should be contacted. Before using other drugs consult
appropriate product labeling.
In bacteriologically negative tuberculoid and indeterminate disease, the
recommendation is the coadministration of Dapsone 100 mg daily with six months
of Rifampin 600 mg daily. Under WHO, daily Rifampin may be replaced by 600 mg
Rifampin monthly, if supervised. The Dapsone is continued until all signs of
clinical activity are controlled - usually after an additional six months. Then
Dapsone should be continued for an additional three years for tuberculoid and
indeterminate patients and for five years for borderline tuberculoid patients.
In lepromatous and borderline lepromatous patients, the recommendation is the
co-administration of Dapsone 100 mg daily with two years of Rifampin 600 mg
daily. Under WHO daily Rifampin may be replaced by 600 mg Rifampin monthly, if
supervised. One may elect the concurrent administration of a third anti-leprosy
drug, usually either Clofazamine 50-100 mg daily or Ethionamide 250-500 mg
daily. Dapsone 100 mg daily is continued 3-10 years until all signs of clinical
activity are controlled with skin scrapings and biopsies negative for one year.
Dapsone should then be continued for an additional 10 years for borderline
patients and for life for lepromatous patients.
Secondary Dapsone resistance should be suspected whenever a lepromatous or
borderline lepromatous patient receiving Dapsone treatment relapses clinically
and bacteriologically, solid staining bacilli being found in the smears taken
from the new active lesions. If such cases show no response to regular and
supervised Dapsone therapy within three to six months or good compliance for the
past 3-6 months can be assured, Dapsone resistance should be considered
confirmed clinically. Determination of drug sensitivity using the mouse footpad
method is recommended and, after prior arrangement, is available without charge
from the USPHS, Carville, LA. Patients with proven Dapsone resistance should be
treated with other drugs.
Probably no dosage adjustment needed, some sources recommend
decreased dosage but no specific recommendation
No adjustment (please see comments in renal impairment section)
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical
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