From the Research
Benzodiazepines are not known to trigger hemolysis in patients with Glucose-6-phosphate dehydrogenase (G6PD) deficiency and are generally considered safe for these patients. According to the most recent and highest quality study available, 1, benzodiazepines do not appear to cause hemolytic crises in G6PD-deficient patients. This study, published in 2024, found that medications such as nitrofurantoin, ciprofloxacin, and sulfamethoxazole can be prescribed safely to G6PD-deficient patients, and there is no evidence to suggest that benzodiazepines pose a risk.
Key Points
- Benzodiazepines work through enhancing GABA neurotransmission in the central nervous system, rather than through oxidative mechanisms that would affect red blood cell metabolism 2.
- G6PD deficiency causes vulnerability to oxidative stress because affected individuals cannot generate sufficient NADPH to maintain glutathione in its reduced form, which is necessary to protect red blood cells from oxidative damage 3.
- The most effective management strategy is to prevent hemolysis by avoiding oxidative stressors, and benzodiazepines are not considered oxidative stressors 2.
- Other studies, such as 4 and 5, also support the safety of benzodiazepines in G6PD-deficient patients, but 1 is the most recent and highest quality study.
Recommendations
- Benzodiazepines can be prescribed to G6PD-deficient patients without special precautions related to hemolysis risk.
- Common benzodiazepines like diazepam, lorazepam, alprazolam, and clonazepam are safe for use in G6PD-deficient patients.
- Clinicians should be aware of the medications that can cause hemolytic crises in G6PD-deficient patients, such as certain antimalarials, sulfonamides, and nitrofurantoin, and avoid their use when possible.