The Drug-Induced Respiratory Disease Website
Known since the 1940s (PMID 18883450). Comprehensive list of causal drugs and chemicals available at PMID 1564446. Methemoglobin is the oxidized (Fe3+) species of hemoglobin (Fe2+). Patients present with slate-grey cyanosis, low SpO2, normal SaO2 and PaO2. Normally, methemoglobin is <1%. Levels above 40% can be life-threatening, producing pulmonary edema, cardiovascular collapse (PMID 17122537) CNS disturbances and death. Management includes i.v. methylene blue. A possible rebound increase in MeHb upon treatment requires close monitoring. Excess methylene blue can also produce methemoglobinemia. Guidelines: PMID 34467556.
Publications
Dapsone-Induced Methemoglobinemia in a Woman With Multiple Myeloma Without Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency.
Cureus 2024 Jun;16;e63249 — 2024 Jun — e63249
Detection of methaemoglobinaemia in a COVID-19 patient on dapsone.
BMJ case reports 2024 Jan 09;17; — 2024 Jan 09
Efficacy of dual intracerebroventricular and intravitreal gene therapy in sheep prompts the first clinical trial to treat CLN5 Batten disease.
Frontiers in pharmacology 2023;14;1212235 — 2023 — 1212235
Methemoglobinemia With Dapsone Prophylaxis in a Patient With Minimal Change Disease.
Cureus 2022 Jun;14;e26393 — 2022 Jun — e26393
Methylene Blue Infusion to Treat Severe Dapsone-Induced Methemoglobinemia in a Pediatric Patient.
Cureus 2021 Oct;13;e18853 — 2021 Oct — e18853
A Case of Dapsone-induced Mild Methemoglobinemia with Dyspnea and Cyanosis.
Acta dermatovenerologica Croatica : ADC 2020 Dec;28;249-250 — 2020 Dec — 249-250
Unusual cause of persistent dyspnea in a patient with nephrotic syndrome: dapsone-induced methemoglobinemia.
CEN case reports 2021 Jan 08;; — 2021 Jan 08
A case of dapsone-induced methaemoglobinaemia.
Clinical medicine (London, England) 2020 Sep;20;519-521 — 2020 Sep — 519-521
A case of DAPSONE INDUCED METHEMOGLOBINEMIA.
Journal of pharmaceutical policy and practice 2019;12;22 — 2019 — 22
Dapsone-induced Methemoglobinemia in a Patient of Leprosy.
Indian journal of dermatology 2015 Jan-Feb;60;108 — 2015 Jan-Feb — 108
Mitsides N, Green D, Middleton R, New D, Lamerton E, Allen J, Redshaw J, Chadwick PR, Subudhi CP, Wood G
Dapsone-induced methemoglobinemia in renal transplant recipients: more prevalent than previously thought.
Transplant infectious disease : an official journal of the Transplantation Society 2014 Feb;16;37-43 — 2014 Feb — 37-43
Dapsone-induced methemoglobinemia: a primer for clinicians.
The Annals of pharmacotherapy 2011 Sep;45;1103-15 — 2011 Sep — 1103-15
Symptomatic-low grade methemoglobinemia because of dapsone: a multiple hit hypothesis.
American journal of therapeutics 2013 Nov-Dec;20;e729-32 — 2013 Nov-Dec — e729-32
Case files of the medical toxicology fellowship at Banner Good Samaritan Medical Center in Phoenix, AZ: methemoglobinemia following dapsone exposure.
Journal of medical toxicology : official journal of the American College of Medical Toxicology 2011 Jun;7;139-46 — 2011 Jun — 139-46
Case records of the Massachusetts General Hospital: Case 7-2011: a 52-year-old man with upper respiratory symptoms and low oxygen saturation levels.
The New England journal of medicine 2011 Mar 10;364;957-66 — 2011 Mar 10 — 957-66
Dapsone-induced methemoglobinemia: a dose-related occurrence?
Cancer 2011 Aug 01;117;3485-92 — 2011 Aug 01 — 3485-92
Dyspnea in a lung transplant recipient.
Respiratory care 2010 May;55;626-9 — 2010 May — 626-9
Pathophysiologic mechanisms, diagnosis, and management of dapsone-induced methemoglobinemia.
The Journal of the American Osteopathic Association 2010 Jan;110;16-20 — 2010 Jan — 16-20
Dapsone-induced hemolytic anemia in lung allograft recipients.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2008 Nov;27;1198-202 — 2008 Nov — 1198-202
Dapsone induced methemoglobinemia : Intermittent vs continuous intravenous methylene blue therapy.
Indian journal of pediatrics 2008 Mar;75;245-7 — 2008 Mar — 245-7
Methemoglobinemia associated with dapsone therapy in a child with pneumonia and chronic immune thrombocytopenic purpura.
Journal of pediatric hematology/oncology 2006 Jun;28;395-8 — 2006 Jun — 395-8
Presentation of dapsone-induced methemoglobinemia in a patient status post small bowel transplant.
Journal of clinical anesthesia 2005 Nov;17;568-70 — 2005 Nov — 568-70
Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals.
Medicine 2004 Sep;83;265-73 — 2004 Sep — 265-73
Dapsone-induced methemoglobinemia in pediatric oncology patients: case examples.
Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses 2001 Sep-Oct;18;224-8 — 2001 Sep-Oct — 224-8
[Respiratory insufficiency caused by dapsone-induced methemoglobinemia].
Ugeskrift for laeger 2001 Jan 01;163;39-40 — 2001 Jan 01 — 39-40
Blue and breathless.
Hospital medicine (London, England : 1998) 1999 Jul;60;530 — 1999 Jul — 530
Acute dapsone intoxication: a pediatric case report.
Pediatric emergency care 1997 Apr;13;127-9 — 1997 Apr — 127-9
Drug-induced methaemoglobinaemia. Treatment issues.
Drug safety 1996 Jun;14;394-405 — 1996 Jun — 394-405
Safrin S, Finkelstein DM, Feinberg J, Frame P, Simpson G, Wu A, Cheung T, Soeiro R, Hojczyk P, Black JR
Comparison of three regimens for treatment of mild to moderate Pneumocystis carinii pneumonia in patients with AIDS. A double-blind, randomized, trial of oral trimethoprim-sulfamethoxazole, dapsone-trimethoprim, and clindamycin-primaquine. ACTG 108 Study
Annals of internal medicine 1996 May 01;124;792-802 — 1996 May 01 — 792-802
Methemoglobinemia provoked by malarial chemoprophylaxis in Vietnam.
The New England journal of medicine 1968 Nov 21;279;1127-31 — 1968 Nov 21 — 1127-31
Respiratory insufficiency from dapsone-induced methemoglobinemia.
AIDS (London, England) 1991 Nov;5;1392-3 — 1991 Nov — 1392-3