Aczone, Diaminodiphenyl sulfone, DDS, and generics
Antibiotic, sulfone derivative

C	2	Yes	Yes	No
Key

• Tabs: 25, 100 mg
• Oral suspension: 2 mg/mL
• Topical gel (Aczone and generics): 5%, 7.5% (60, 90 g); contains methylparaben

Dosing

• Pneumocystis jiroveci (formerly carinii) treatment:
  • Child and adult: 2 mg/kg/24 hr PO once daily ( max. dose: 100 mg/24 hr) with trimethoprim 15 mg/kg/24 hr PO ÷ TID × 21 days
• P. jiroveci (formerly carinii) prophylaxis (first episode and recurrence):
  • Child ≥1 mo: 2 mg/kg/24 hr PO once daily; max. dose: 100 mg/24 hr. Alternative weekly dosing: 4 mg/kg/dose PO Q7 days; max. dose: 200 mg/dose
  • Adult: 100 mg/24 hr PO ÷ once daily–BID as monotherapy; OR 50 mg PO once daily with pyrimethamine 50 mg PO Q7 days and leucovorin 25 mg PO Q7 days; other combination regimens with pyrimethamine and leucovorin may be used (see https://www.aidsinfo.gov)
• Toxoplasma gondii prophylaxis (prevent first episode):
  • Child ≥1 mo: 2 mg/kg/24 hr ( max. dose: 25 mg/24 hr) PO once daily with pyrimethamine 1 mg/kg/24 hr ( max. 25 mg/dose) PO once daily and leucovorin 5 mg PO Q3 days
  • Adolescent and adult: 50 mg PO once daily with pyrimethamine 50 mg PO Q7 days and leucovorin 25 mg PO Q7 days; other combination regimens with pyrimethamine and leucovorin may be used (see https://www.aidsinfo.gov)
• Leprosy (see http://www.who.int/en/ for the WHO latest recommendations, including combination regimens such as rifampin ± clofazimine):
  • Child: 1–2 mg/kg/24 hr PO once daily; max. dose: 100 mg/24 hr
  • Adult: 100 mg PO once daily
• Acne vulgaris (topical gel; reevaluate patient if no improvement after 12 wk of therapy):
  • 5% gel (≥12 yr old): Apply small amount (pea size) of topical gel onto clean, acne-affected areas BID.
  • 7.5% gel (≥9 yr old): Apply small amount (pea size) of topical gel onto clean, acne-affected areas once daily.

Notes

• Patients with HIV, glutathione deficiency, or G6PD deficiency may be at increased risk for developing methemoglobinemia. Side effects include hemolytic anemia (dose related), agranulocytosis, methemoglobinemia, aplastic anemia, nausea, vomiting, hyperbilirubinemia, headache, nephrotic syndrome, and hypersensitivity reaction (sulfone syndrome). Cholestatic jaundice, hepatitis, peripheral neuropathy, and suicidal intent have been reported with systemic use.
• Didanosine, rifabutin, and rifampin decrease dapsone levels. Trimethoprim increases dapsone levels. Pyrimethamine, nitrofurantoin, primaquine, and zidovudine increase risk for hematological side effects.
• Oral suspension may not be absorbed as well as tablets.
• TOPICAL USE: Dry skin, erythema, and peeling of the skin may occur. Use of topical gel, followed by benzoyl peroxide for acne, has resulted in temporary local discoloration (yellow/orange) of the skin and facial hair. Avoid use of topical gel in G6PD deficiency or congenital/idiopathic methemoglobinemia.