Dapsone

Brand Names: Dapsone

Clinical Names: 4,4'diaminodiphenyl-sulphone (DDS), Dapsone

Summary

generic name: Dapsone, 4,4'diaminodiphenyl-sulphone (DDS)

trade name: Dapsone®

type of drug: Antibiotic.

used to treat: Leprosy; dermatitis herpetiformis.

overview of interactions:
• nutrient affecting drug toxicity: Vitamin E




Interactions

nutrient affecting drug toxicity: Vitamin E

• mechanism: Dapsone is strongly oxidative in a way that damages the membranes of red cells and results in hemolysis.

• research: In several trials, individuals, with leprosy or dermatitis herpetiformis, taking Dapsone were given 800 IU of vitamin E for periods ranging from four weeks to three months. In one study of patients with dermatitis herpetiformis, Vitamin E therapy was followed by vitamin C therapy, and then combined vitamins E and C. This study concluded that the vitamin C had exerted no beneficial effect but that oral administration of 800 units of vitamin E daily for 4 weeks confers partial protective effect against dapsone-induced hemolysis in patients with dermatitis herpetiformis.
(Kelly JW, et al. Arch Dermatol 1984 Dec;120(12):1582-1584; Prussick R, et al. Arch Dermatol 1992 Feb;128(2):210-213; Lardo MM, et al. Medicina (B Aires) 1997;57(2):150-154.)

• nutritional support: The clinical significance of vitamin E to counter the adverse effects of Dapsone remains somewhat inconclusive. However, supplementation of 800 IU would provide many other potential benefits for such individuals beyond the anti-oxidant effect indicated in these studies.

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Do not rely solely on the information in this article.

The information presented in Interactions is for informational and educational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, case reports, and/or traditional usage with sources as cited in each topic. The results reported may not necessarily occur in all individuals and different individuals with the same medical conditions with the same symptoms will often require differing treatments. For many of the conditions discussed, treatment with conventional medical therapies, including prescription drugs or over-the-counter medications, is also available. Consult your physician, an appropriately trained healthcare practitioner, and/or pharmacist for any health concern or medical problem before using any herbal products or nutritional supplements or before making any changes in prescribed medications and/or before attempting to independently treat a medical condition using supplements, herbs, remedies, or other forms of self-care.


References

Kelly JW, Scott J, Sandland M, Van der Weyden MB, Marks R. Vitamin E and dapsone-induced hemolysis. Arch Dermatol 1984 Dec;120(12):1582-1584.
Abstract: Sixteen patients, each receiving 100 mg of dapsone per day, were studied for evidence of hemolysis. Vitamin E (dl-alpha tocopherol acetate), 800 mg/day, was then administered for up to three months, and dapsone therapy was continued at the same dose. Hemolysis factors were reexamined immediately prior to cessation of vitamin E therapy. No substantial change was demonstrable for levels of hemoglobin, reticulocyte count, and haptoglobin at the end of vitamin E therapy, despite a significant rise in serum vitamin E levels. Erythrocyte survival measured in four patients before and at the end of vitamin E therapy also showed no substantial change. Erythrocyte Heinz body count, however, fell in nine of 15 patients studied, and none showed an increase in this measurement while receiving vitamin E. We conclude that in patients receiving dapsone at 100 mg/day, vitamin E therapy at 800 mg/day does not substantially ameliorate the hemolytic effect of this drug.

Lardo MM, Diaz NB, Artaza JR, Carbia CD, Nazer R, Valdez R. [Vitamin E as protective agent against hemolysis in leprosy patients under dapsone treatment]. Medicina (B Aires) 1997;57(2):150-154. [Article in Spanish]
Abstract: Dapsone (4,4'diaminodiphenyl-sulphone) commonly used in the treatment of patients who suffer from leprosy, is a strongly oxidative drug, producing damage to the red cell membrane. This study investigated whether Vitamin E would have a protective effect on the red cell membrane from oxidant damage caused by Dapsone in patients with leprosy. We have studied 16 patients for 4 months, divided into two groups. Group 1 (n = 7) dapsone (DDS): 100 mg/day; Group 2 (n = 9) dapsone: 100 mg/day in addition with Vitamin E: 800 U/day. We did not include patients with low levels of Glucose-6-Phosphate Dehydrogenase (G-6-PD) because of their sensibility to this drug. At the beginning of the treatment we determined the level of G-6-PD. All patients showed a normocytic normochromic anemia with a decrease in Haptoglobine levels (below 5 mg/dl). Statistical analyses showed that reticulocyte counts did not present significant differences between groups all through evolution. As for methemoglobin (Hi) we observed in Group 1 an increase between the first and the fourth month, which was not seen in group 2. Statistical analyses of the results suggest that oral Vitamin E confers partial protective effect and does not correct the hemolysis parameters produced by Dapsone treatment except for Hi levels which were more sensitive to the oxidant damage.

Prussick R, Ali MA, Rosenthal D, Guyatt G. The protective effect of vitamin E on the hemolysis associated with Dapsone treatment in patients with dermatitis herpetiformis. Arch Dermatol 1992 Feb;128(2):210-213.
Abstract: OBJECTIVE--This study looked at whether oral vitamin C and vitamin E would protect the erythrocyte from oxidant damage caused by dapsone in patients with dermatitis herpetiformis. DESIGN--Fifteen consecutive patients with dermatitis herpetiformis taking dapsone therapy received, in addition, 800 U/d of vitamin E for 4 weeks; then 1000 mg of vitamin C per day for 4 weeks, and, finally, combined vitamin E and vitamin C therapy for 4 weeks. Hemolysis indexes were assessed at baseline and after each 4-week period. RESULTS--Statistical analysis of the results suggests that oral administration of 800 units of vitamin E daily for 4 weeks confers partial protective effect against dapsone-induced hemolysis in patients with dermatitis herpetiformis. CONCLUSION--Partial protection against dapsone-induced hemolysis by orally administered vitamin E, if confirmed as being clinically relevant by further trials, may allow clinicians to continue dapsone therapy orally in patients who develop significant hemolysis. Prophylactic vitamin E to minimize potential hemolysis at the initiation of dapsone therapy may also be appropriate.