Dapsone therapy for malaria during pregnancy - Maternal and fetal outcomes

Brabin, Bernard, Eggelte, T. A., Parise, M. and Verhoeff, Francine H. (2004) 'Dapsone therapy for malaria during pregnancy - Maternal and fetal outcomes'. Drug Safety, Vol 27, Issue 9, pp. 633-648.

Full text not available from this repository.

Abstract

The need to consider using dapsone in pregnant women for its antimalarial activity is becoming greater in areas where Plasmodium falciparum resistance to chloroquine and pyrimethamine-sulfadoxine is rapidly increasing. Dapsone in combination with other antimalarials might provide a valuable alternative for both treatment and prophylaxis. This review assesses the clinical pharmacology of dapsone and its adverse drug reactions in relation to haemolysis, glucose-6-phosphate dehydrogenase (G6PD) deficiency, blood dyscrasias and methaemoglobinaemia. Studies are summarised reporting its use in leprosy, dermatological and other conditions, and malaria, in relation to maternal and infant outcomes. A total of 924 pregnancies were identified during which dapsone therapy was taken. Only limited data are available and this precludes a meaningful quantitative benefit-risk analysis.
Mild degrees of haemolysis consistently occur with continued therapy, although adverse effects may be less likely with intermittent treatment, as most reported adverse effects have occurred with long-term use of dapsone. There are a number of gaps in knowledge where more data are needed. These include no data on pharmacokinetics in pregnancy and whether these are altered with co-administration of chlorproguanil. Potential complications in women with severe anaemia are unknown and there is no information on haemolytic effects in women or the fetus with G6PD deficiency. The use of dapsone in HIV-infected women in malarious areas could carry increased risks because of the immunosuppressive actions of the drug. Trials of dapsone therapy in pregnancy should be considered in malarious areas where there is good reason for its deployment. Controlled trials have provided data on maternal tolerance, and dapsone in combination with other antimalarial drugs can offer clear benefit in terms of improved birthweight. The use of dapsone combinations should be considered when no good alternative is available and the threat of malaria is the greater risk.

Item Type:	Article
Uncontrolled Keywords:	idiopathic thrombocytopenic purpura dermatitis-herpetiformis falciparum-malaria herpes gestationis hemolytic-anemia induced methemoglobinemia antimalarial-drugs leprosy patients n-hydroxylation human-milk
Subjects:	QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 256 Antimalarials QV Pharmacology > QV 38 Drug action. QV Pharmacology > Toxicology > General Toxicology > QV 600 General works QX Parasitology > Protozoa > QX 135 Plasmodia WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria WQ Obstetrics > Pregnancy Complications > WQ 256 Infectious diseases
Faculty: Department:	Groups (2002 - 2012) > Child & Reproductive Health Group
Depositing User:	Martin Chapman
Date Deposited:	01 Mar 2012 11:57
Last Modified:	06 Feb 2018 13:03
URI:	https://archive.lstmed.ac.uk/id/eprint/2145

Statistics

View details

Actions (login required)

Edit Item