Dapsone for Pneumocystis jirovecii pneumonia prophylaxis – applying theory to clinical practice with a focus on drug interactions

Carmela Emma Corallo; John Coutsouvelis; Susan Morgan; Orla Morrissey; Sharon Avery

doi:10.1515/dmpt-2019-0018

Article

Dapsone for Pneumocystis jirovecii pneumonia prophylaxis – applying theory to clinical practice with a focus on drug interactions

Carmela Emma Corallo , John Coutsouvelis , Susan Morgan , Orla Morrissey and Sharon Avery

Published/Copyright: July 20, 2020

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From the journal Drug Metabolism and Personalized Therapy Volume 35 Issue 3

Abstract

Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised individuals. The incidence can be as high as 80% in some groups but can be reduced to less than 1% with appropriate prophylaxis. HIV-infected patients with a low CD4 count are at the highest risk of PJP. Others at substantial risk include haematopoietic stem cell and solid organ transplant recipients, those with cancer (particularly haematologic malignancies), and those receiving glucocorticoids, chemotherapeutic agents, and other immunosuppressive medications. Trimethoprim-sulfamethoxazole is an established first-line line agent for prevention and treatment of PJP. However, in some situations, this medication cannot be used and dapsone is considered a suitable cost-effective second line agent. However, information on potential interactions with drugs commonly used in immunosuppressed patients is lacking or contradictory. In this this article we review the metabolic pathway of dapsone with a focus on interactions and clinical significance particularly in patients with haematological malignancies. An understanding of this process should optimise the use of this agent.

Keywords: adverse effects; dapsone; interactions; metabolism

Corresponding author: Carmela Emma Corallo, Alfred Health, Pharmacy, 55 Commercial Rd., Melbourne, Victoria, 3181, Australia, E-mail: c.corallo@alfred.org.au

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.

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Received: 2019-08-08

Accepted: 2020-05-14

Published Online: 2020-07-20

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Articles in the same Issue

https://doi.org/10.1515/dmpt-2019-0018

Keywords for this article

adverse effects; dapsone; interactions; metabolism