From the Guidelines
Patients with Glucose-6-phosphate dehydrogenase (G6PD) deficiency can generally take Plaquenil (hydroxychloroquine) safely, but caution is advised due to the potential risk of hemolysis. The risk of hemolysis in G6PD-deficient patients taking hydroxychloroquine is considered low, as stated in the kdigo 2024 clinical practice guideline for the management of lupus nephritis 1. However, it is essential to note that the guideline recommends measuring G6PD levels in men, especially those of African, Asian, or Middle Eastern origin, before starting hydroxychloroquine therapy. Key points to consider include:
- Theoretical concerns about hemolysis exist, but clinical experience has shown that hydroxychloroquine rarely triggers hemolytic episodes in G6PD-deficient patients.
- Baseline G6PD testing may be considered in high-risk populations, though it is not universally required.
- Patients should be monitored for signs of hemolysis, such as fatigue, jaundice, or dark urine, particularly during the initial weeks of therapy.
- The safety profile of hydroxychloroquine in G6PD deficiency is related to its relatively low oxidative stress on red blood cells compared to other antimalarials. In contrast, another study 1 states that hydroxychloroquine is contraindicated in persons with glucose-6-phosphate dehydrogenase deficiency, highlighting the importance of careful consideration and consultation with a healthcare provider before initiating therapy. Ultimately, the decision to prescribe hydroxychloroquine to a patient with G6PD deficiency should be made on a case-by-case basis, taking into account the individual's specific circumstances and the potential benefits and risks of therapy.
From the FDA Drug Label
- 7 Hemolytic Anemia Associated with G6PD Deficiency
Hemolysis has been reported in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Monitor for hemolytic anemia as this can occur, particularly in association with other drugs that cause hemolysis.
Patients with G6PD deficiency should be monitored for hemolytic anemia when taking Plaquenil (hydroxychloroquine), as hemolysis has been reported in these patients.
- Key points:
- Hemolysis can occur in patients with G6PD deficiency taking hydroxychloroquine.
- Monitor for hemolytic anemia, especially when used with other drugs that cause hemolysis. It is recommended to exercise caution when prescribing Plaquenil to patients with G6PD deficiency and to closely monitor them for signs of hemolytic anemia 2.
From the Research
G6PD Deficiency and Plaquenil (Hydroxychloroquine) Use
- Patients with Glucose-6-phosphate dehydrogenase (G6PD) deficiency can be concerned about taking certain medications, including Plaquenil (hydroxychloroquine), due to the risk of hemolytic anemia.
- According to a study published in 2010 3, there is no evidence to contravene the use of hydroxychloroquine in normal therapeutic doses in G6PD-deficient patients.
- A more recent study from 2022 4 found no evidence of hemolysis in G6PD-deficient patients exposed to hydroxychloroquine, with over 500 months of cumulative exposure time.
- Other studies 5, 6, 7 discuss the role of G6PD in hemolytic and nonhemolytic disorders, treatment strategies, and potential pharmacological pathways, but do not specifically address the use of hydroxychloroquine in G6PD-deficient patients.
Key Findings
- Hydroxychloroquine is not listed as a medication that should be avoided in individuals with G6PD deficiency 3.
- The package insert for hydroxychloroquine recommends careful use in patients with G6PD deficiency, but the American College of Rheumatology does not recommend routine testing for G6PD prior to initiation of hydroxychloroquine 4.
- The available evidence suggests that hydroxychloroquine can be used safely in G6PD-deficient patients, but more research is needed to confirm this finding.