Clofazimine is an antimycobacterial agent primarily used for the treatment of leprosy, including dapsone-resistant leprosy and leprosy accompanied by erythema nodosum.
Precautions for Clofazimine Administration
Administration in Special Populations
Pregnant Women: Animal studies have shown that clofazimine may cause delayed skull ossification in fetuses, as well as increased rates of miscarriage and stillbirth. The risks and benefits of using clofazimine during pregnancy must be weighed. If its use is deemed necessary, patients must be fully informed of the associated risks. Reliable contraceptive measures should be used during treatment and for 4 months after discontinuing the medication.
Lactating Women: Clofazimine can be excreted in breast milk, leading to skin discoloration in breastfed infants.
Patients with Hepatic or Renal Impairment: Patients with severe renal impairment should use clofazimine with caution. Patients with hepatic impairment (Child-Pugh Class A, B, or C) should avoid using it unless the benefits clearly outweigh the risks.
Patients with Concurrent HIV Infection: No dose adjustment is required, and the therapeutic effect of clofazimine is not affected by HIV infection status.
Drug Interactions
Clofazimine may inhibit CYP3A4/5 metabolic enzymes, increasing the blood concentration and toxicity risk of drugs metabolized via this pathway.
Concomitant use with drugs that prolong the QT interval (e.g., bedaquiline) may produce an additive effect, increasing the risk of torsades de pointes (a type of ventricular tachycardia).
When used together with these drugs, close monitoring of the electrocardiogram (ECG) and clinical responses is necessary.
Monitoring During Clofazimine Administration
Pre-Treatment Assessment
Conduct a detailed medical history review, with special attention to a history of gastrointestinal diseases, heart diseases, and mental illnesses.
Pregnancy testing is mandatory for women of childbearing age.
Perform a baseline ECG to assess the QT interval.
Conduct tests to evaluate hepatic and renal function.
Assess and document the patient’s skin condition.
Monitoring During Treatment
Gastrointestinal Monitoring: 40–50% of patients may experience symptoms such as abdominal pain, diarrhea, nausea, and vomiting. Persistent abdominal pain requires immediate medical attention to rule out the possibility of intestinal obstruction.
Cardiac Monitoring: Regular ECGs should be performed to monitor the QT interval, especially when the dose exceeds 100mg per day or when clofazimine is used concomitantly with other QT-prolonging drugs. If QTcF (Fridericia-corrected QT interval) ≥ 500ms or significant ventricular arrhythmias occur, the medication should be discontinued immediately.
Skin Monitoring: 75–100% of patients will experience discoloration of the skin and body fluids (e.g., tears, sweat, urine). The skin condition should be evaluated regularly, with attention to associated dryness, ichthyosis-like changes, or pruritus.
Psychological Monitoring: Skin discoloration may lead to depression or even suicidal ideation. The patient’s mental state should be assessed regularly to identify signs that require intervention in a timely manner.
Laboratory Monitoring: Regularly check liver function, blood glucose, and blood potassium levels. Be alert to possible eosinophilia and accelerated erythrocyte sedimentation rate.
