Leprosy
mailing list – March 1st, 2006
Ccn: all.
Ref.:
Clofazimine and ENL.
From: G Warren, Sidney, Australia.
Dear All,
Regarding
the extra Clofazimine 300mgms for ENL (S D Ghate, LML Feb. 27th, 2006) I was
the original one who in 1966 realized that this was an effective
method of treating ENL and its use often eliminated the need for the
more dangerous drugs of Prednisolone and Thalidomide, Lepr Review Vol
39, 61-66. 1968.
It is obvious that if the patient is taking the 300
regularly he is taking the 50mgms that is needed for MDT.
I have never seen an article stating that the 300mgms
meant that the 50mgms included in the MDT pack did not need to be
taken. It is obvious that
the 300mgms caps include the 50mgms, so the fact of omitting the
separate cap is rarely stated. One
usually only lists the dose the patient is taking Not the ones they do
not take.
One word of warning, do not give 300mgms daily for more
than 2-3 months as some patients do develop undesirable intestinal
symptoms of the 300mgms. It takes 6-8 weeks to build up the
maximum anti-inflammatory effect, and is slowly excreted, and
so once that is achieved the dose can be reduced slowly adjusting
tranquilisers as needed as these patients are often emotionally
and psychologically unstable because of having leprosy. This instability triggers
episodes of ENL.
Also look for any other medical problem especially
infections or endocrine problems (e.g. diabetes -- these are often the
trigger factors that produced the ENL in the first place) and treat
those. Until they are controlled the ENL will not be.
Grace Warren.
