The use of cimetidine to reduce dapsone-dependent methaemoglobinaemia in dermatitis herpetiformis patients

Br J Clin Pharmacol. 1992 Sep;34(3):244-9. doi: 10.1111/j.1365-2125.1992.tb04131.x.

Abstract

1. We have attempted to reduce dapsone-dependent methaemoglobinaemia formation in six dermatitis herpetiformis patients stabilised on dapsone by the co-administration of cimetidine. 2. In comparison with control, i.e. dapsone alone, methaemoglobinaemia due to dapsone fell by 27.3 +/- 6.7% and 26.6 +/- 5.6% the first and second weeks after commencement of cimetidine administration. The normally cyanotic appearance of the patient on the highest dose of dapsone (350 mg day-1), underwent marked improvement. 3. There was a significant increase in the trough plasma concentration of dapsone (2.8 +/- 0.8 x 10(-5)% dose ml-1) at day 21 in the presence of cimetidine compared with control (day 7, 1.9 +/- 0.6 x 10(-5)% dose ml-1, P less than 0.01). During the period of the study, dapsone-mediated control of the dermatitis herpetiformis in all six patients was unchanged. 4. Trough plasma concentrations of monoacetyl dapsone were significantly increased (P less than 0.05) at day 21 (1.9 +/- 1.0 x 10(-5)% dose ml-1) compared with day 7 (1.6 +/- 0.9 x 10(-5)% dose ml-1:control). 5. Over a 12 h period, 20.6 +/- 8.9% (day 0) of a dose of dapsone was detectable in urine as dapsone hydroxylamine. Significantly less dapsone hydroxylamine was recovered from urine at day 14 (15.0 +/- 8.4) in the presence of cimetidine, compared with day 0 (control: P less than 0.05). 6. The co-administration of cimetidine may be of value in increasing patient tolerance to dapsone, a widely used, effective, but comparatively toxic drug.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cimetidine / pharmacology
  • Cimetidine / therapeutic use*
  • Dapsone / adverse effects*
  • Dapsone / analogs & derivatives
  • Dapsone / pharmacokinetics
  • Dapsone / therapeutic use
  • Dermatitis Herpetiformis / complications
  • Dermatitis Herpetiformis / drug therapy*
  • Drug Therapy, Combination
  • Drug Tolerance
  • Female
  • Humans
  • Male
  • Methemoglobinemia / chemically induced*
  • Methemoglobinemia / drug therapy
  • Middle Aged

Substances

  • Cimetidine
  • Dapsone
  • monoacetyldapsone