Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Allied Health Professions, Wayne State University, Detroit, MI, USA.
Ann Pharmacother. 2011 Sep;45(9):1103-15. doi: 10.1345/aph.1Q139. Epub 2011 Aug 18.
To present a comprehensive review of dapsone-induced methemoglobinemia and its management.
Literature retrieval was accessed through MEDLINE (1966-March 2011), Cochrane Library, and EMBASE, using the terms dapsone and methemoglobinemia.
All case reports, small case series, and randomized controlled trials published in English were evaluated. Because of the absence of comprehensive updates on this topic since 1996, publications between 1997 and March 2011 were included in this review.
Between 1997 and March 2011, the majority of publications describing methemoglobinemia associated with dapsone use reported this adverse effect at therapeutic doses. Excluding overdose situations, 18 described symptomatic dapsone-associated methemoglobinemia and clinical presentation ranging from cyanosis to dyspnea. In almost all of the accounts, patients had a concurrent event such as anemia or pneumonia, suggesting an interplay between these comorbidities and the onset of symptomatic methemoglobinemia. Delayed hemolytic anemia was seen in patients with high methemoglobin levels at presentation. Management in most cases consisted of administration of methylene blue. Overall, most reports described a successful outcome, and no mortality resulted from methemoglobinemia associated with therapeutic use.
Clinicians should recognize methemoglobinemia as an adverse effect associated with dapsone use and the potential factors that precipitate it. They should also know how to promptly and effectively manage this event.
全面综述氨苯砜诱导的高铁血红蛋白血症及其治疗方法。
通过 MEDLINE（1966 年至 2011 年 3 月）、Cochrane 图书馆和 EMBASE 检索文献，检索词为氨苯砜和高铁血红蛋白血症。
评估了所有以英文发表的个案报告、小病例系列和随机对照试验。由于自 1996 年以来该主题缺乏全面更新，因此纳入了 1997 年至 2011 年 3 月发表的文献。
1997 年至 2011 年 3 月间，大多数描述与氨苯砜使用相关的高铁血红蛋白血症的出版物报告了这种不良反应发生在治疗剂量时。排除过量情况，18 例报告了与氨苯砜相关的高铁血红蛋白血症和临床症状，从发绀到呼吸困难。在几乎所有病例中，患者都同时存在贫血或肺炎等其他疾病，表明这些合并症与症状性高铁血红蛋白血症的发生之间存在相互作用。在有高高铁血红蛋白血症水平的患者中，出现迟发性溶血性贫血。在大多数情况下，治疗方法包括亚甲蓝的应用。总体而言，大多数报告描述了成功的结果，没有因治疗性使用氨苯砜引起的高铁血红蛋白血症导致死亡。
临床医生应认识到高铁血红蛋白血症是氨苯砜使用的一种不良反应及其潜在的促发因素。他们还应知道如何迅速有效地治疗这种疾病。
