Deliberate self-poisoning with dapsone. A case report and summary of relevant pharmacology and treatment.

We report the case of a 14-year-old girl who deliberately ingested 8-9 g of dapsone and presented with severe methaemoglobinaemia and altered mental status. Prompt treatment with repeated doses of methylene blue and organ support brought about control of the methaemoglobinaemia and averted organ failure.

Investigations into the haemolytic effects of dapsone therapy in leprosy patients.

Investigations into the haemolytic effects of dapsone therapy were carried out in forty four leprosy patients admitted to the Sacred Heart Leprosy Centre, Kumbakonam. They received weight based dapsone dosages varying from 1.3-3.3 mg/kg body weight. Blood levels and urinary Dapsone/creatinine ratio were assessed at 1 day, 7 days and 30 days of Dapsone treatment. At the same points of time, haematological observations were also carried out. Serum bilirubin as well as blood mathaemoglobin were also examined. The findings showed a reduction in Hb levels at 30 days observation in a good proportion of cases on 100 mg. In one case (child) weighing 15 kg and receiving 50 mg dapsone increased mathaemoglobin was observed. It is suggested that dapsone dosage be regulated to body weight and preferably not to exceed 1.5 mg/kg body weight.

Leprosy, liver and jaundice.

Nine patients of leprosy, 5 BL and 4 LL who developed jaundice during the course of disease were investigated. Two LL patients developed jaundice during ENL reaction. There was slight hepatomegaly in 5 patients and moderate splenomegaly in 3 only. There was significant alterations in liver enzymes and serum bilirubin in all patients. The abnormalities of the enzymes levels persisted for abnormally long periods even when the serum bilirubin had come down and the patients had become asymptomatic. Blood for HBsAg and anti-HAV IgM was negative in all the patients except one in whom HBsAg was positive. Drugs could not be implicated as the cause of jaundice, all patients maintained recovery even after restarting antileprosy drugs. The possibility of non A, non B viruses producing hepatitis during the course of disease is brought out. Course of prolonged jaundice in leprosy is compared with other diseases which could result in a similar situation.

The effect of clofazimine on liver function tests in lepra reaction (ENL).

Twenty patients with suspected DDS resistance and repeated attacks of lepra reactions were selected for the study. Clofazimine was administered in different doses over a period of 12 months. Elevated levels of transaminases and Alkaline phosphatase prior therapy attained values to near normalcy. Progressive fall in serum Bilirubin and Proteins with normal A/G ratio at the end of therapy was also observed. Clofazimine by its anti-inflammatory and antibacterial action could inhibit the process of liver damage and happened to have minimal deleterious effect on liver by studying the liver function tests.

In vivo and in vitro drug metabolism in patients with leprosy.

Plasma antipyrine and chloramphenicol clearance was studied in 23 patients of leprosy and 12 control subjects. Drug metabolising enzymes (aminopyrine N-demethylase and bilirubin UDP-glucuronyl transferase) were estimated in liver biopsy samples of twelve patients and ten controls. A significant decrease in drug clearance and drug metabolising enzymes was observed. However, no significant correlation could be obtained between drug half lives and drug metabolising enzymes or with any of the liver function tests in these patients. The findings indicate that drug metabolism is impaired in leprosy patients.

Dapsone haemolysis in leprosy. A preliminary report.

Fifty one patients with leprosy from the Urban Leprosy Centre, attached to the Department of Dermatology and Venereology, Goa Medical College on treatment with Dapsone were studied from the point of view of development of haemolysis related to the drug. The findings are described and discussed. Anaemia developed in 60.7 percent of the patients during the course of treatment. It was mild and well compensated. The haemolytic effect of dapsone was related to the dose and duration of the treatment, being more manifested in doses above 50 mg daily.

[Hepatic function in the clinical spectrum of Hansen's disease]. / La función hepática a través del espectro clínico de la hanseniasis.

The liver function was studied in 100 hanseniasis patients. They were classified in the following 10 groups: quiescent LL (20 patients), quiescent BL (13 patients), quiescent BB (7 patients), quiescent BT (9 patients), quiescent TT (12 patients), reactional LL (12 patients), reactional BL (10 patients), reactional BB (7 patients), reactional BT (5 patients), reactional TT (5 patients); a comparison was made with a control group (10 healthy individuals). It was found a hyperproteinemia with high levels of globulin and normal levels of albumin in the serum of all clinical forms, and a typical pattern of "light damage hepatic cells" with raised in the enzymatic activity of GOT, GPT and alkaline phosphatase with no changes in turbidity tests and bilirrubinemia, in all reactional patients. The physiopathology of this problem and the types III and IV hypersensitivity phenomena are discussed.

Long-term clinical toxicity studies with clofazimine (B663) in leprosy.

Fifty-one leprosy patients receiving long-term clofazimine have undergone systematic clinical laboratory testing in a search for any toxicity secondary to the drug. In approximately 220 patient-years of observation and in analyzing approximately 40,000 test results, no statistically significant changes in the direction of abnormality have been observed in SGOT, thymol turbidity, serum globulins, uric acid, alkaline phosphatase, white blood cell count or differential, hematocrit, hemoglobin, BUN, serum creatinine, serum cholesterol, serum albumin, serum potassium, serum calcium, stool for occult blood, routine urinalysis, or reticulocyte count. Statistically significant changes toward abnormality were found in fasting blood sugar and total serum bilirubin. These statistically significant changes in the direction of abnormality were of a small magnitude, were not associated with related clinical signs or symptoms, and do not seem to be of major clinical significance. Despite the accumulation of relatively massive amounts of the drug in various tissues, clofazimine appears remarkably free of serious or life-threatening toxicity clinically. Although the skin and gastrointestinal side effects of clofazimine limit its usefulness, on the evidence to date, its advantages outweigh its disadvantages in those leprosy patients for whom it is indicated.