As an antibacterial, dapsone inhibits bacterial synthesis of dihydrofolic acid,if an organism can not make folic acid,it eventually die. Though structurally distinct from dapsone, the sulfonamide group of antibacterial drugs also work in this way

1- leprosy(Hansen’s disease)

2- dermatitis herpetiformis and other skin conditions including lichen planus.

3-sometimes used to prevent Pneumocystis jirovici pneumonia (PCP) in patients with HIV.

4 -to treat idiopathic thrombocytopenic purpura .

5-used prophyactically to prevent P. jiroveci pneumonia and toxoplasmosis in patients unable to tolerate trimethoprim with sulfamethoxazole

6-)with pyrimethamine(for malaria prophylaxis

ACZONER Gel, 5%,(is indicated for the topical treatment of acne vulgaris

Most COMMON side effects persist or become bothersome when using Dapsone:

Blurred vision, feeling of a whirling motion, headache, nausea, ringing in the ears, sleeplessness, vomiting.

Severe allergic reactions (rash,hives,itching,difficulty breathing, tightness in the chest,swelling of the mouth,

face, lips, or tongue)………bloody stools,changes in skin color,dark urine or

pale stools,fever……………infection (fever, chills),loss of appetite,muscle weakness,numbness, tingling, or burning of your arms, hands, legs, or feet,personality changes,severe diarrhea,severe rash,sore throat,stomach pains/cramps,unusual fatigue, weight loss,yellowing of the skin or eyes.

Dryness, oiliness, peeling, or redness of the skin

.SEVERE side effects occur when using Dapsone Gel:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); dark urine; fever, chills, or persistent sore throat; mental or mood changes; numbness, tingling, or burning of the hands or feet; red, swollen, blistered, or peeling skin; severe stomach pain or vomiting; shortness of breath; sudden back pain; suicidal thoughts or attempts; unusual tiredness or weakness; yellow or pale skin.

Hematologic side effects have been the most pronounced. These have included methemoglobinemia, aplastic anemia, leukopenia, agranulocytosis, eosinophilia, macrocytic anemia, and Heinz bodies

included peripheral neuropathy and manifested predominantly as motor deficits, but in up to 40% of cases, also included sensory loss.The peripheral neuropathy is reversible upon discontinuation of dapsone. Dizziness, vertigo, blurred vision, and headache have also been reported. Renal side effects have rarely included nephritic syndrome and renal papillary necrosis.

included mild nausea, vomiting, and abdominal pains.

Hepatic side effects have frequently included elevations in liver function tests, which may occur as part of the dapsone syndrome. Rare cases of hepatitis and cholestatic jaundice have been reported. Hyperbilirubinemia has also been reported.

Respiratory side effects including at least two cases of pulmonary eosinophilia have been reported.

Rare cases of dapsone-induced lupus erythematosus and exacerbations of existing lupus erythematosus have been reported.

Psychiatric side effects have rarely included depression, psychosis,

and hypomania. side effects have been commonly reported, especially in HIV-infected patients. Rash has been reported the most frequently. Stevens-Johnson syndrome, toxic erythema, erythema multiforme, toxic epidermal necrolysis, and morbilliform and scariatiniform reactions have been reported in a few patients treated with

dapsone or other sulfone agents…

1-Take this medication by mouth with or without food, usually once daily or as directed by physician

2-Medications for heartburn/reducing stomach acid(e.g., large amounts of antacids, ranitidine, famotidine), or didanosine may prevent full absorption of dapsone into the bloodstream, possibly reducing its effectiveness. Therefore, separate dose of dapsone from doses of any of these products by at least 2 hours.

3-If taking dapsone for a skin disorder, may start on a low dose of dapsone and gradually adjust dose to control disease.

4-If taking this medication to treat Hansen's disease or to prevent infections due to HIV, the drug is usually taken every day as

long as 3 year or more or for life. 5-In children, the dosage is also based on age and weight .6-Use this medication regularly to get the most benefit from

it, take it at the same time each day.

Do not share this medication with others.

Laboratory and/or medical tests (e.g., complete blood counts/platelets, liver function tests) should be performed periodically to monitor progress or check for side effects. Iron, folic acid, and vitamin C might reduce the risk of developing a certain serious side effect (anemia) .

If you are using dapsone for dermatitis herpetiformis, a gluten-free diet may improve the condition.

1-cardiac or pulmonary disease.

2-anaemia (treat severe anaemia before starting.

3-susceptibility to haemolysis including G6PD deficiency.

4-susceptible breast-feeding infants also at risk(Haemolytic anaemia; although significant amount in milk, risk to infant very small unless infant is G6PD deficiency.

Dapsone is in the FDA pregnancy category C. This means that it is not known whether it will be harmful to an unborn baby.

-Folic 5mg mg should be given to mother throught pregnancy.

-Third trimester;Neonatal haemolysis and methaemoglobinaemia reported..

Dapson is almost completely absorbed from GIT with peak plasma concentration occurring

from 1-8hrs after dose .-Steady concentration are obtained after 8 days

of treatment,- The plasma half- life 10-50hrs(average28hrs).

-About 50-80%Dapson is bound to plasma proteins.

-70-85%of the dose is excreted in the urine of which about 20% is unchanged and small amounts are found in feces.

1-Usual Adult Dose for Leprosy –Lepromatous

:50 to 100 mg orally once a day for 2-5 years2-Usual Adult Dose for Leprosy -- Tuberculoid:

100 mg orally once a day for 6 months. Rifampin is additionally recommended to reduce the incidence of dapsone resistance. If the disease relapses, this regimen should be repeated.

3-Usual Adult Dose for Dermatitis Herpetiformis:50 mg orally once a day continued on a life-long basis.

Dosage may be advanced to 300 mg/day. Dosage reduction to a minimum maintenance level as soon as possible is

recommended

-Usual Adult Dose for Pneumocystis Pneumonia 4 100mg orally once a day for 14 to 21 days. Used in

combination with trimethoprim…5-Usual Adult Dose for Pneumocystis Pneumonia

Prophylaxis.. 100mg orally twice a week. Therapy should be

continued on a life-long basis. 6-Usual Adult Dose for Toxoplasmosis -Prophylaxis. 1oo mg orally twice a week continued on a life-long

basis7-Usual Pediatric Dose for leprosy

1to 2 mg/kg (up to 100 mg) orally once a day

8-Usual Pediatric Dose for Pneumocystis PneumoniaProphylaxis:

>1 month:2 mg/kg/day (up to 100 mg) orally once a day. Alternate dosing:> 1 month: 4 mg/kg orally once weekly. Maximum dose = 200 mg

9-Usual Pediatric Dose for Toxoplasmosis -- Prophylaxis:more1 month:

2 mg/kg/day (or 15 mg/m2) orally once a day. Maximum dose = 25 mg .

Dapsone should be administered as part of combination therapy for prophylaxis of toxoplasmosis

If you miss a dose of dapsone, take it as soon as possible.However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.Do not double dose

Seek emergency medical attention if an overdose is suspected.

Symptoms of a dapsone overdose may include nausea, vomiting, excitation, seizures, and bluish skin color, sudden vision change ,sudden loss of vision.

Avoid prolonged exposure to sunlight.Dapsone may increase the sensitivity of the skin to sunlight and sunburn may be more likely to occur.

If exposure to the sun is unavoidable, wear a sunscreen and protective clothing .

1-Amprenavir: plasma concentration of dapsone

possibly increased by amprenavir ..2-Probencid:excretion of dapsone reduced by

probenecid (increased risk of side-effects) . 3-Certain concomitant medications (such as rifampin,

anticonvulsants, St. John’s wort) may increase the formation of dapsone hydroxylamine, a metabolite of dapsone associated with hemolysis. With oral dapsone treatment, folic acid antagonists such as pyrimethamine havebeen noted to possibly increase the likelihood of hematologic reactions.4-Trimethoprim: plasma concentration of both drugs

may increase when dapsone given withtrimethoprim

5-This medication may decrease the effectiveness of

combination-type birth control pills. This can result in pregnancy. You may need to use an additional form of reliable birth control while using this medication .

6-Dapsone should be taken two hours before ortwo hours after ddI. ddI tablets contain abuffer that can decrease the absorption ofdapsone and reduce its effectiveness

7-Delaviridine and Saquinavir could lessen the effects of Dapsone ,so Dapsone dose may have to be increased if patients are also on these medication.

8-Dapsone can be harmful to liver, so any medication are also harmful to liver could make that worse.Ziudovuodine and pyrimethamine are some of thse.

Topical Benzoyl PeroxideTopical application of ACZONER followed by benzoyl peroxide in subjects with acnevulgaris resulted in a temporary local yellow or orange discoloration of the skin and facial hair

Store the medicine in a closed container at room temperature between 68-77degreeF(20-25 degree C), away from heat, moisture, and direct light, Keep

from freezing..