ld be treated prior to initiation of therapy and hemoglobin monitored. hemolysis and methemoglobin may be poorly tolerated by patients with severe cardiopulmonary disease. cutaneous reactions, especially bullous, include exfoliative dermatitis and are probably one of the most serious, though rare, complications of sulfone therapy. they are directly due to drug sensitization. such reactions include toxic erythema, erythema multiforme, toxic epidermal necrolysis, morbilliform and scarlatiniform reactions, urticaria and erythema nodosum. if new or toxic dermatologic reactions occur, sulfone therapy must be promptly discontinued and appropriate therapy instituted. leprosy reactional states, including cutaneous, are not hypersensitivity reactions to dapsone and do not require discontinuation. see special section.

in order to reduce secondary dapsone resistance, the who expert committee on leprosy and the usphs at carville, la, recommended that dapsone should be commenced in combination with one or more anti-leprosy drugs. in the multidrug program dapsone should be maintained at the full dosage of 100 mg daily without interruption (with corresponding smaller doses for children) and provided to all patients who have sensitive organisms with new or recrudescent disease or who have not yet completed a two year course of dapsone monotherapy. for advice and other drugs, the usphs at carville, la (1- 800-642-2477) should be contacted. before using other drugs consult appropriate product labeling. in bacteriologically negative tuberculoid and indeterminate disease, the recommendation is the coadministration of dapsone 100 mg daily with six months of rifampin 600 mg daily. under who, daily rifampin may be replaced by 600 mg rifampin monthly, if supervised. the dapsone is continued until all signs of clinical activity are controlled - usually after an additional six months. then dapsone should be continued for an additional three years for tuberculoid and indeterminate patients and for five years for borderline tuberculoid patients. in lepromatous and borderline lepromatous patients, the recommendation is the co-administration of dapsone 100 mg daily with two years of rifampin 600 mg daily. under who daily rifampin may be replaced by 600 mg rifampin monthly, if supervised. one may elect the concurrent administration of a third anti-leprosy drug, usually either clofazamine 50-100 mg daily or ethionamide 250-500 mg daily. dapsone 100 mg daily is continued 3-10 years until all signs of clinical activity are controlled with skin scrapings and biopsies negative for one year. dapsone should then be continued for an additional 10 years for borderline patients and for life for lepromatous patients. secondary dapsone resistance should be suspected whenever a lepromatous or borderline lepromatous patient receiving dapsone treatment relapses clinically and bacteriologically, solid staining bacilli being found in the smears taken from the new active lesions. if such cases show no response to regular and supervised dapsone therapy within three to six months or good compliance for the past 3-6 months can be assured, dapsone resistance should be considered confirmed clinically. determination of drug sensitivity using the mouse footpad method is recommended and, after prior arrangement, is available without charge from the usphs, carville, la. patients with proven dapsone resistance should be treated with other drugs.

osy reactional state. body as a whole: in addition to the warnings and adverse effects reported above, additional adverse reactions include: nausea, vomiting, abdominal pains, pancreatitis, vertigo, blurred vision, tinnitus, insomnia, fever, headache, psychosis, phototoxicity, pulmonary eosinophilia, tachycardia, albuminuria, the nephrotic syndrome, hypoalbuminemia without proteinuria, renal papillary necrosis, male infertility, drug-induced lupus erythematosus and an infectious mononucleosis-like syndrome. in general, with the exception of the complications of severe anoxia from overdosage (retinal and optic nerve damage, etc.) these adverse reactions have regressed off drug. to report suspected adverse reactions, contact rising pharmaceuticals, inc. at 1-866-562-4597 or fda at 1-800-fda-1088 or www.fda.gov/medwatch .

inistration (50 - 100 mg) in leprosy patients will provide blood levels in excess of the usual minimum inhibitory concentration even for patients with a short dapsone half-life.