• Paucibacillary leprosy (standard adult): Dapsone 100 mg daily + Rifampicin 600 mg monthly (supervised) - for 6 months.
• Multibacillary leprosy (standard adult): Dapsone 100 mg daily + Clofazimine 50 mg daily + Rifampicin 600 mg monthly + Clofazimine 300 mg monthly (supervised) - for 12 months.

Side Effects of Clofazimine

1. Skin and Mucocutaneous (Most Prominent)

• Skin discoloration - the most well-known and clinically significant cosmetic effect. The skin turns red to red-brown diffusely, with bluish to violet-brown pigmentation at lesional sites. This is due to drug deposits within fat and macrophages.
• Discoloration also affects the conjunctivae and cornea.
• Body fluids (urine, sweat, tears) can become discolored.
• Xerosis/ichthyosis (dry, scaly skin).
• The discoloration resolves gradually after stopping the drug, but it is a major reason patients refuse or discontinue treatment.

2. Gastrointestinal (Common)

• Abdominal pain, nausea, vomiting, diarrhea.
• At high doses (e.g., 300 mg/day used for recurrent ENL), GI effects can be significant and dose-limiting.
• Rare but serious: crystal deposition-related enteropathy (from drug crystals accumulating in intestinal macrophages).

3. Ocular

• Ocular irritation (conjunctival and corneal discoloration mentioned above also falls here).

4. Hepatic

• Elevated liver enzymes (hepatotoxicity) - especially with daily doses above 100 mg. Periodic LFTs are recommended in such cases.

5. Cardiac (Rare)

• Cardiac arrhythmias - rare, typically associated with electrolyte disturbances. A baseline electrolyte panel is recommended before starting therapy.

Key Monitoring Guidelines

Special Considerations

• Pregnancy/Lactation: Should be avoided - clofazimine concentrates in breast milk.
• Pharmacokinetics: Due to its extremely long serum half-life (~2 months) and storage in reticuloendothelial tissues and skin, side effects - especially discoloration - can persist long after the drug is stopped.
• Contraindication: Prior hypersensitivity reaction.