Effectiveness of hemodialysis in acute dapsone overdose—a case report

Thunga, Girish and Gnana Sam, Kishore and Patel, Dipish and Khera, Kanav and Sheshadri, Subha (2008) Effectiveness of hemodialysis in acute dapsone overdose—a case report. American Journal of Emergency Medicine, 26 (9). e1-e4.

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Abstract

The use of dapsone is increasing even though overdose is rarely reported and physicians must be aware of its toxicity and management. Mortality can occur due to methemoglobinemia and hemolytic anemia. Although activated charcoal and methylene blue are recommended, the use of hemodialysis is reported only in few studies. Literature on the kinetic profile indicates that 50% to 80% of dapsone is protein bound and indicates a possibility to dialyze the unbound form. This study describes a case of deliberate severe dapsone overdose with cyanosis, methemoglobinemia, and hemolytic anemia, which improved after repetitive hemodialysis. Dapsone is a synthetic sulfone, increasingly used in the treatment of a wide variety of dermatological disorders in the tropical world. Because of its increasing use for diseases other than leprosy, including dermatitis herpetiformis such as acne vulgaris, psoriasis, and Pneumocystis carinii pneumonia in acquired immunodeficiency syndrome, clinicians should be aware of its toxic potential [1]. Reports of acute toxicity and fatal dapsone overdose are rare in developing countries like India. Acute overdose of dapsone may occur due to either ccidental or intentional ingestion of the drug. Dapsone has been associated with a number of overdoses in children and adults in the United States and overseas, but acute overdose from dapsone intake is uncommon in Europe and Iran [2]. Continuous treatment with methylene blue and activated charcoal is recommended to curb the oxidative potential of dapsone during overdose [1]. The application of hemodialysis in the management of dapsone overdose has so far not been reported. Dapsone is 50% to 80% plasma protein bound [3], and the remaining is probably available in the free form for dialysis. Hematologic toxicities from drugs used in dermatology are infrequent but potentially life-threatening.

Item Type: Article
Subjects: Medicine > KMC Manipal > Medicine
Pharmacy > MCOPS Manipal > Pharmacy Practice
Depositing User: KMC Manipal
Date Deposited: 05 Jul 2011 09:41
Last Modified: 05 Jul 2011 09:41
URI: http://eprints.manipal.edu/id/eprint/542

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