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ANTIINFECTIVES FOR SYSTEMIC USE › ANTIMYCOBACTERIALS › DRUGS FOR TREATMENT OF LEPRA › Drugs for treatment of lepra
dapsone and rifampicin
J04BA50
Forms & Strengths
- Dapsone: Oral tablets 25 mg, 100 mg
- Rifampicin: Oral capsules 150 mg, 300 mg
- Co-packaged multi-drug therapy blister packs for leprosy (MDT)
Adult Dosing
- Multibacillary leprosy: Rifampicin 600 mg once monthly supervised + Dapsone 100 mg daily self-administered, plus clofazimine, for at least 12 months
- Paucibacillary leprosy: Rifampicin 600 mg once monthly supervised + Dapsone 100 mg daily self-administered for 6 months
- Dermatitis herpetiformis (dapsone component): 50-300 mg daily titrated to clinical response
Pediatric Dosing
- Children 10-14 years (Multibacillary leprosy): Rifampicin 450 mg monthly + Dapsone 50 mg daily, plus clofazimine, for 12 months
- Children 10-14 years (Paucibacillary leprosy): Rifampicin 450 mg monthly + Dapsone 50 mg daily for 6 months
- Children under 10 years: Dapsone 1-2 mg/kg daily; Rifampicin 10-20 mg/kg daily or monthly per WHO guidelines
Indications
- Treatment of leprosy (Hansen's disease) in multibacillary (MB) and paucibacillary (PB) forms as multi-drug therapy (MDT)
- Suppression and treatment of dermatitis herpetiformis (dapsone)
Mechanism of Action
- Dapsone: Inhibits bacterial folic acid synthesis via competitive antagonism of dihydropteroate synthase
- Rifampicin: Inhibits bacterial DNA-dependent RNA polymerase, suppressing RNA synthesis
Contraindications
- Hypersensitivity to dapsone, rifampicin, sulfa drugs, or the rifamycin class
- Severe anemia prior to initiation
- G6PD deficiency (relative contraindication for dapsone due to severe hemolysis risk)
- History of rifampicin-induced hepatic injury
Adverse Reactions
- Hemolytic anemia (dose-dependent, especially in G6PD deficiency)
- Methemoglobinemia
- Hepatotoxicity (elevated transaminases, jaundice, hepatitis)
- Red-orange discoloration of body fluids (urine, sweat, tears due to rifampicin)
- Dapsone hypersensitivity syndrome (fever, rash, jaundice, eosinophilia)
- Gastrointestinal upset (nausea, vomiting, abdominal pain)
Drug Interactions
- Rifampicin is a potent CYP3A4 and P-glycoprotein inducer, significantly decreasing levels of oral contraceptives, anticoagulants, corticosteroids, and anti-retrovirals
- Probenecid decreases renal excretion of dapsone
- Trimethoprim increases plasma concentrations of both dapsone and trimethoprim
- Antacids may reduce absorption of rifampicin
Curated Content: Needs Vetting Before Put to Clinical Use