Clofazimine in recurrent or chronic or steroid dependent type 2 leprosy reaction

Leprosy Mailing List – September 2^nd, 2010

Ref.:    Clofazimine in recurrent or chronic or steroid dependent type 2 leprosy reaction.

From:  H K Kar, New Delhi, India

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Dear Dr Noto,

We agree with Dr Romero (LML Aug. 29^th, 2010) that clofazimine is a very good drug for management of recurrent or chronic or steroid dependent type 2 leprosy reaction. However, we prefer to give a longer duration of clofazimine (CLF) with gradual tapering in steroid dependent cases.

e.g.

CLF 300mg daily daily  for 3 months followed by 200 mg for 3 months followed by 100mg daily as long as symtoms persist

plus
prednisolone in dose of 30 mg daily for 2 weeks followed by 25 mg daily 2 weeks followed by 20 mg for 2weeks followed by 15 mg daily for 2 weeks followed by 10 mg daily for 2 weeks followed by 5 mg daily for 2 weeks, then stop.

Majority of cases respond to this regimen  if thalidomide is not available or if not affordable.

Side effects with high dose of  CLF when given for a longer period like chronic abdominal pain, diarrhoea and rarely partial or complete bowel obstruction may develop.  In that case  the drug should be stopped immediately.  Gradually decreasing the dose of CLF should prevent these complications.

Fortunately this drug is available separately for use in reaction in India. 

Reference:
Management of leprosy reactions in IAL Text book of Leprosy. 1st edition (2010) edited by H K Kar and Bhushan Kumar, published by Jaypee brothers medical publishers (P) LTD, chapter 30; page:395.                               

(E-mail: jaipee(at)jaypeebrothers.com,  Website:www.jaypeebrothers.com)

telephone:+91-11-23272143, Fax: 91-11-23276490

Regards.

Dr (Prof.) H K Kar
Consultant & HOD
Department of Dermatology, STD & Leprosy
P.G.I.M.E.R. and Dr Ram Manohar Lohia Hospital
Baba Kharag Singh Marg
New Delhi-110001

India