“We changed and gave the clofazimine with a meal”

Leprosy Mailing List – November 3^rd, 2011 

Ref.:   “We changed and gave the clofazimine with a meal”.

From: G Warren, Sydney, Australia

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Dear Dr Noto,

Thank you for publishing that letter and picture by Dr Peton.  He does not mention what antileprosy medication the patient was on. -  was it multi-drug therapy (MDT)?  Was the patient on clofazimine – at what dose and for how long?

My comments are that in the early days we often used to use clofazimine as monotherapy (when doing the initial drug trials) and we used to give a dose of oil with each dose as initially recommended.  But we often gave it in 200 or 300m mgms daily.  Yes, it did produce a very dark skin in the Chinese patients.  A few of the patients did complain of abdominal discomfort if they did not take the oil. 

One patient was actually admitted to the major govt hospital and operated on for a suspected abdominal problem as he complained of persistent gastric discomfort.  From Memory (this was about 1970) they found very heavy pigmentation with clofazimine in the mucosa of the ileum and colon which were apparently very dark in colour (No I did not see it nor do I have a photo- good on you for getting the record).  But no evidence of gastric ulceration or other regular cause of gastric discomfort.  From that incident we changed and gave the clofazimine with a meal and had no further similar complaints.

Sometime in the 1980s an article appeared stating that clofazimine caused diarrhoea and similar problems but the case written up also had amoebic dysentery!  No we (treating literally hundreds of patients and doing regular path testing) found that clofazimine causes very few if any complications other than the discolouration of skin that fades within about a year of discontinuation.  But we did find that many of the biochemical abnormalities present (eg poor liver and kidney function) initially were corrected within the first year.- oh yes we treated any obvious abnormalities such as anaemia and parasites! 

I am sorry I cannot quote the publications concerned now-  but would be interested as to the symptoms of the patient he speaks about and recommend the clofazimine be given with his meals and or oil, in future.

Yours sincerely,

Grace Warren

Previously superintendent Hong Kong leprosarium 1960-75 and

Adviser for The Leprosy Mission In Asia for 1975-1994.