From the Research
For fever in a patient with G6PD deficiency, acetaminophen (Tylenol) is the safest first-line option, typically given at a dose of 325-650 mg every 4-6 hours, not exceeding 3,000-4,000 mg per day in adults, as supported by the most recent and highest quality study 1. When treating fever in patients with G6PD deficiency, it is essential to consider the potential risks of hemolytic anemia associated with certain medications.
- Acetaminophen is recommended as the first-line treatment for fever in G6PD-deficient patients.
- Ibuprofen can also be used safely at 200-400 mg every 4-6 hours for adults, with children receiving 5-10 mg/kg every 6-8 hours.
- Aspirin and certain other medications like sulfonamide antibiotics, nitrofurantoin, and primaquine should be avoided, as they can trigger hemolytic anemia in G6PD-deficient patients, as reported in a case study 2. The study by 1 provides reassurance that many medications previously thought to be risky for G6PD-deficient patients can be prescribed safely, but it is crucial to prioritize caution and choose medications with a well-established safety profile, such as acetaminophen. It is also important to ensure adequate hydration and monitor for signs of hemolysis, such as dark urine, jaundice, fatigue, or shortness of breath, and to discontinue the medication and seek medical attention immediately if these symptoms develop. The safety of aspirin in G6PD-deficient patients is still a topic of debate, with some studies suggesting that low-dose aspirin may be safe 3, while others report cases of late-onset hemolysis and subsequent major bleeding events 2. However, given the potential risks, it is recommended to avoid aspirin and opt for safer alternatives, such as acetaminophen, for treating fever in patients with G6PD deficiency.