What is your opinion about Dapsone/ Bactrim?

In a liver transplant recipient (underlying disease HCV but SVR since 2004) with no history of EBV or CMV would you discontinue Bactrim or Dapsone at some point? If so, at what point and are there any criteria that must be met before  discontinuation is appropriate? I am 9 years out and still take Dapsone daily.
Thank you,
Mike

[Thomas D Schiano, MD]

all transplant programs do something different.  there are no real good studies to define these things.  at our center we discontinue bactrim after 3 months and patients seem to do just fine.

[mikesimon]

Thank You.
From what I have learned most centers discontinue Bactrim or Dapsone at some point. Mine doesn't and I can see slight hemolytic anemia from Dapsone in my labs- Male with hemoglobin of 12.3 to 12.8 and slightly below normal RBC. I am diabetic and I think my HbA1c is lower than it really would be if my RBCs lived a normal life - mine is 4 to 4.5, I don't think my A1c is reliable. I saw the same thing to a much greater degree when I was treating HCV and developed hemolytic anemia due to Ribavirin.
Mike

[Thomas D Schiano, MD]

i agree with you completely.  I frankly think that it can be discontinued--speak to the transplant team about this. you make a good point about the glycosylated hemoglobin level.

[mikesimon]

Thank you so much Doctor. I intend to raise this issue with my team soon.
Mike