lCAUTIONSAnaemia (treat severe anaemia before starting)
.avoid in Acute porphyrias p. 603.cardiac disease.G6PD
deficiency.pulmonary disease.susceptibility to
haemolysis
lINTERACTIONS→Appendix 1 : dapsone
lSIDE-EFFECTSAgranulocytosis.appetite decreased.
haemolysis.haemolytic anaemia.headache.hepatic
disorders.hypoalbuminaemia.insomnia.lepra reaction.
methaemoglobinaemia.motor loss.nausea.peripheral
neuropathy.photosensitivity reaction.psychosis.severe
cutaneous adverse reactions (SCARs).skin reactions.
tachycardia.vomiting
SIDE-EFFECTS, FURTHER INFORMATIONSide-effects are
dose-related.
If dapsone syndrome occurs (rash with fever and
eosinophilia)—discontinue immediately (may progress to
exfoliative dermatitis, hepatitis, hypoalbuminaemia,
psychosis and death).
lPREGNANCYFolic acid p. 574 (higher dose) should be
given to mother throughout pregnancy; neonatal
haemolysis and methaemoglobinaemia reported in third
trimester.
lBREAST FEEDINGHaemolytic anaemia; although
significant amount in milk, risk to infant very small unless
infant is G 6 PD deficient.
lPATIENT AND CARER ADVICE
Blood disordersOn long-term treatment, patients and their
carers should be told how to recognise signs of blood
disorders and advised to seek immediate medical attention
if symptoms such as fever, sore throat, rash, mouth ulcers,
purpura, bruising or bleeding develop.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Tablet
CAUTIONARY AND ADVISORY LABELS 8
▶Dapsone (Non-proprietary)
Dapsone 50 mgDapsone 50 mg tablets| 28 tabletP£ 38. 04 DT =
£ 38. 04
Dapsone 100 mgDapsone 100 mg tablets| 28 tabletP£ 97. 39
DT = £ 95. 15
Pentamidine isetionate
lINDICATIONS AND DOSE
Treatment ofPneumocystis jirovecii(Pneumocystis
carinii) pneumonia (specialist use only)
▶BY INTRAVENOUS INFUSION
▶Child: 4 mg/kg once daily for at least 7 – 10 days
Prophylaxis ofPneumocystis jirovecii(Pneumocystis
carinii) pneumonia (specialist use only)
▶BY INHALATION OF NEBULISED SOLUTION
▶Child 5–17 years: 300 mg every 4 weeks, alternatively
150 mg every 2 weeks, using suitable equipment—
consult product literature
Visceral leishmaniasis (specialist use only)
▶BY DEEP INTRAMUSCULAR INJECTION
▶Child 1–17 years: 3 – 4 mg/kg once daily on alternate
days, maximum total of 10 injections, course may be
repeated if necessary
Cutaneous leishmaniasis (specialist use only)
▶BY DEEP INTRAMUSCULAR INJECTION
▶Child 1–17 years: 3 – 4 mg/kg 1 – 2 times a week until
condition resolvesTrypanosomiasis (specialist use only)
▶BY DEEP INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INFUSION
▶Child 1–17 years: 4 mg/kg once daily or on alternate days
for a total of 7 – 10 injectionslUNLICENSED USENot licensed for prevention of
pneumocystis pneumonia in children.
lCAUTIONSAnaemia.bradycardia.coronary heart disease.
history of ventricular arrhythmias.hyperglycaemia.
hypertension.hypoglycaemia.hypokalaemia.
hypomagnesaemia.hypotension.leucopenia.risk of
severe hypotension following administration.
thrombocytopenia
lINTERACTIONS→Appendix 1 : pentamidine
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonDizziness.hypoglycaemia (can
be severe and sometimes fatal).hypotension (can be
severe and sometimes fatal).local reaction.nausea.rash.
taste altered
▶Rare or very rareQT interval prolongation
▶Frequency not knownPancreatitis acute (can be severe and
sometimes fatal)
SPECIFIC SIDE-EFFECTS
▶Common or very common
▶When used by inhalationCough.dyspnoea.respiratory
disorders
▶With parenteral useAcute kidney injury.anaemia.
azotaemia.electrolyte imbalance.flushing.haematuria.
hyperglycaemia.leucopenia.localised pain.myopathy.
syncope.thrombocytopenia.vomiting
▶Rare or very rare
▶With parenteral useArrhythmia (can be severe and
sometimes fatal).pancreatitis (can be severe and
sometimes fatal)
▶Frequency not known
▶When used by inhalationAngioedema.appetite decreased.
bradycardia.fatigue.renal failure
▶With parenteral useArrhythmias.perioral hypoaesthesia.
sensation abnormal.Stevens-Johnson syndrome
lPREGNANCYManufacturer advises avoid unless essential.
lBREAST FEEDINGManufacturer advises avoid unless
essential—no information available.
lHEPATIC IMPAIRMENTManufacturer advises caution.
lRENAL IMPAIRMENT
Dose adjustmentsReduce intravenous dose for
pneumocystis pneumonia if creatinine clearance less than
10 mL/minute: inlife-threatening infection,use 4 mg/kg
once daily for 7 – 10 days, then 4 mg/kg on alternate days to
complete course of at least 14 doses; inless severe infection,
use 4 mg/kg on alternate days for at least 14 doses.
lMONITORING REQUIREMENTS
▶Monitor blood pressure before starting treatment, during
administration, and at regular intervals, until treatment
concluded.
▶Carry out laboratory monitoring according to product
literature.
lDIRECTIONS FOR ADMINISTRATIONPatient should be lying
down when receiving drug parenterally. Direct intravenous
injection should be avoided whenever possible andnever
given rapidly; intramuscular injections should be deep and
preferably given into the buttock. Forintravenous infusion,
reconstitute 300 mg with 3 – 5 mL Water for Injections
(displacement value may be significant), then dilute
required dose with 50 – 250 mL Glucose 5 %orSodium
Chloride 0. 9 %; give over at least 60 minutes.
Powder for injection (dissolved in water for injection)
may be used for nebulisation.BNFC 2018 – 2019 Pneumocystis pneumonia 381
Infection5