title: Complications related to dapsone use for Pneumocystis jirovecii pneumonia prophylaxis in solid organ transplant recipients.
abstract: Dapsone, used for prevention of Pneumocystis jirovecii infections, has been reported to cause hemolytic anemia and methemoglobinemia; its tolerability in solid organ transplant recipients is not well described. We investigated dapsone-related adverse events in patients undergoing solid organ transplantation from 1999 to 2004. Transplant providers identified patients for the investigators who then reviewed the patients' hospital and outpatient records. Sixteen solid organ transplant recipients fit case definitions for dapsone-related hemolytic anemia (n = 11) or methemoglobinemia (n = 5). Median time from event to dapsone discontinuation was 15 days; all patients improved after drug discontinuation. G6PD enzyme activity was normal in all patients whose test results were available. Dapsone may be associated with hemolytic anemia or methemoglobinemia, even with normal G6PD levels. These events are often not promptly recognized, and drug discontinuation is delayed. Dapsone-related hemolytic anemia or methemoglobinemia should be considered in solid organ transplant recipients with unexplained anemia or hypoxia.
authors.affiliation: Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. ingi.lee@uphs.upenn.edu
authors.forename: Ingi
authors.initials: I
authors.lastname: Lee
authors.forename: Todd D
authors.initials: TD
authors.lastname: Barton
authors.forename: Simin
authors.initials: S
authors.lastname: Goral
authors.forename: Alden M
authors.initials: AM
authors.lastname: Doyle
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom
authors.forename: Donna
authors.initials: D
authors.lastname: Chojnowski
authors.forename: Kathleen
authors.initials: K
authors.lastname: Korenda
authors.forename: Emily A
authors.initials: EA
authors.lastname: Blumberg
mesh_terms: D000328:Adult; D000368:Aged; D000743:Anemia, Hemolytic / Q000139:chemically induced; D000890:Anti-Infective Agents / Q000009:adverse effects; D019072:Antibiotic Prophylaxis; D003622:Dapsone / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008708:Methemoglobinemia / Q000139:chemically induced; D008875:Middle Aged; D016377:Organ Transplantation; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control*; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies
chemical_list: D000890:Anti-Infective Agents; D003622:Dapsone