Fansidar Danger, Again *****

In previous issues (#42, #43) we discussed the dangers and benefits of fansidar, one of several preventive treatments for pneumocystis. Recently we heard of two more cases of serious reactions to this drug. One happened to a friend of this writer, who used fansidar because he was unable to obtain aerosol pentamidine in San Diego. He had not realized that fansidar must be stopped if a skin rash occurs, and almost died as a result.
We repeat the following warning from the Physician's Desk Reference, which also includes other precautions. This part of the warning is printed twice in all caps, and set off in separate boxes for additional emphasis.
"FATALITIES ASSOCIATED WITH THE ADMINISTRATION OF FANSIDAR HAVE OCCURRED DUE TO SEVERE REACTIONS, INCLUDING STEVENS- JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS. FANSIDAR
PROPHYLAXIS SHOULD BE DISCONTINUED AT THE FIRST APPEARANCE OF SKIN RASH, IF A SIGNIFICANT REDUCTION IN THE COUNT OF ANY FORMED BLOOD ELEMENTS IS NOTED, OR UPON THE OCCURRENCE OF
ACTIVE BACTERIAL OR FUNGAL INFECTIONS."
Persons with AIDS or ARC may be more likely to have these reactions than other people. (Fansidar is usually used as a preventive for malaria.)
Use of this drug may be justified in some cases. But patients should make sure to get the warnings from their physicians--or look them up themselves in the Physician's Desk Reference, usually available in public libraries.
Fansidar seems to be used infrequently in San Francisco, as aerosol pentamidine prophylaxis is more available here.