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Dapsone-induced methemoglobinemia

K E Ward1, M W McCarthy

  • 1School of Pharmacy, University of Pittsburgh, PA, USA.

The Annals of Pharmacotherapy
|June 2, 1998
PubMed
Summary
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Dapsone prophylaxis for Pneumocystis pneumonia (PCP) can cause methemoglobinemia, even at therapeutic doses. Clinicians should monitor for this rare but serious adverse effect in transplant patients.

Area of Science:

  • Pharmacology
  • Critical Care Medicine
  • Transplant Medicine

Background:

  • Dapsone is used for Pneumocystis pneumonia (PCP) prophylaxis, particularly in immunocompromised patients.
  • Transplant recipients often require PCP prophylaxis due to immunosuppression.
  • Alternative PCP prophylaxis is sometimes necessary due to intolerance or contraindications.

Observation:

  • A 69-year-old liver and kidney transplant recipient developed dyspnea and hypoxemia.
  • The patient was receiving dapsone for PCP prophylaxis after prior intolerance to other agents.
  • Methemoglobinemia was diagnosed as the cause of the patient's symptoms.

Findings:

  • Dapsone therapy, even at therapeutic doses, can induce methemoglobinemia.
  • This adverse effect can occur in patients with a history of organ transplantation.

Related Experiment Videos

  • Intravenous methylene blue and activated charcoal were administered for treatment.

    • Implications:

    • Increased awareness of dapsone-induced methemoglobinemia is crucial for clinicians.
    • Prompt evaluation for methemoglobinemia is recommended in transplant patients with unexplained dyspnea and hypoxemia.
    • This case highlights the importance of considering drug-induced toxicity in complex patient populations.