Monitoring and Prevention of Side Effects

Before therapy with dapsone is started, a complete blood cell count with differential white count should be obtained. Also, the glucose-6-phosphate dehydrogenase and methemoglobin levels should be tested, since hemolysis and methemoglobinemia are well-known dapsone-dependent side effects. Once therapy has been initiated, the complete blood cell count should be obtained weekly for the first month and then, if stable, every 2 weeks for another 2 months. Thereafter, the complete blood cell count should be done periodically. Serum creatinine and liver enzyme levels should also be measured before therapy starts and should be frequently monitored thereafter (Katz 1999, Lang 1979). To minimize the risk of side effects, the lowest effective dose of dapsone (generally 100 mg/day) should not be exceeded (Duna and Cash 1995, Lo et al. 1989). In addition, concomitant administration of drugs associated with hemolysis and blood dyscrasias, such as sulfonamides, isoniazid, aspirin, ibuprofen, and primaquine, should be avoided (Zhu and Stiller 2001).

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