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Dapsone-induced methemoglobinemia in renal transplant recipients: more prevalent than previously thought

N Mitsides1, D Green, R Middleton

  • 1Nephrology Department, Salford Royal NHS Foundation Trust, Salford, UK.

Transplant Infectious Disease : an Official Journal of the Transplantation Society
|November 13, 2013
PubMed
Abstract

Insights

Dapsone use in renal transplant patients led to a high prevalence of drug-induced methemoglobinemia (MHb), causing significant hospitalizations. This highlights concerns regarding dapsone

Area of Science:

  • Nephrology
  • Pharmacology
  • Hematology

Background:

  • Pneumocystis pneumonia (PCP) outbreak necessitated dapsone use as second-line prophylaxis in a nephrology unit.
  • Dapsone is a common cause of drug-induced methemoglobinemia (MHb), with poorly described prevalence in renal transplant recipients.
  • Renal excretion of dapsone suggested a potentially higher MHb rate in this population.

Purpose of the Study:

  • To describe demographics, risk factors, and presenting features of MHb in renal transplant patients on dapsone.
  • To investigate the prevalence of MHb in renal transplant recipients receiving dapsone chemoprophylaxis.

Main Methods:

  • Twenty-six renal transplant recipients on dapsone for PCP chemoprophylaxis were monitored.
  • Patients with normal glucose-6-phosphate dehydrogenase levels were included.
  • Characteristics of patients who developed MHb were compared to identify risk factors.

Main Results:

  • A high prevalence of MHb (46%) was observed in patients receiving dapsone.
  • Half of MHb cases were asymptomatic, with a significant mean hemoglobin drop.
  • MHb correlated strongly with length of hospital stay, leading to admissions.

Conclusions:

  • The study reports the highest known prevalence of MHb associated with dapsone use.
  • Dapsone treatment resulted in significant hospitalizations among renal transplant recipients.
  • Concerns are raised regarding the safety of dapsone for chemoprophylaxis in this patient group.
Keywords:
Pneumocystis pneumoniachemoprophylaxishemolytic anemiaimmunosuppression

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