From the Guidelines
Patients with G6PD deficiency should avoid medications that can trigger hemolytic anemia, but many medications are generally safe to use, including acetaminophen, most antibiotics like penicillins, cephalosporins, and erythromycin, most antihypertensives, and most pain relievers, as recommended by recent guidelines 1.
Safe Medications
- Acetaminophen (Tylenol) is preferred over NSAIDs for fever or pain, though most NSAIDs are considered low-risk, with the exception of those that may exacerbate G6PD deficiency, such as aspirin in patients with G6PD deficiency 1.
- Safe antibiotics include amoxicillin, cephalexin, azithromycin, and ciprofloxacin.
- Most antihypertensives and pain relievers are also safe to use.
Medications to Avoid
- Patients should avoid high-risk medications such as rasburicase, primaquine, dapsone, methylene blue, nitrofurantoin, and sulfonamide antibiotics (like sulfamethoxazole), as they can trigger hemolytic anemia in G6PD deficient patients 1.
- The severity of G6PD deficiency varies by genetic variant, with Mediterranean variants typically being more severe than African variants.
Important Considerations
- Patients should always inform healthcare providers about their G6PD status before receiving any new medication, and should carry medical identification indicating their condition.
- When in doubt about a specific medication, consulting with a healthcare provider familiar with G6PD deficiency is recommended.
- It is essential to consider the potential risks and benefits of each medication, as well as the individual patient's specific condition and genetic variant, to ensure safe and effective treatment.
From the FDA Drug Label
Hemolysis In glucose-6-phosphate dehydrogenase deficient individuals, hemolysis may occur. This reaction is frequently dose-related.
The FDA drug label does not provide a list of safe medications for patients with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency. It only mentions that sulfamethoxazole and trimethoprim can cause hemolysis in G6PD deficient individuals, but does not provide information on alternative medications that are safe to use in these patients 2.
From the Research
Medications Safe for G6PD-Deficient Patients
- Benzodiazepines, codeine/codeine derivatives, propofol, fentanyl, and ketamine were found to be safe for G6PD-deficient patients and do not cause hemolytic crises 3
- Medications that can probably be given safely in normal therapeutic dosages to individuals with G6PD deficiency include those where evidence does not contravene their use, although the specific medications are not listed 4
- Medications where no evidence at all was found to contravene their use in G6PD-deficient patients are also considered safe, but again the specific medications are not listed 4
Medications to be Avoided
- Seven medications that should be avoided in individuals with G6PD deficiency are: dapsone, methylthioninium chloride (methylene blue), nitrofurantoin, phenazopyridine, primaquine, rasburicase, and tolonium chloride (toluidine blue) 4
- Aspirin use is controversial, but low-dose aspirin administration has been shown to be safe in G6PD-deficient patients 5
Real-World Evidence
- A real-world study found that medications such as nitrofurantoin, ciprofloxacin, glibenclamide, ofloxacin, phenazopyridine, sulfamethoxazole/cotrimoxazole, sulfasalazine, hydroxychloroquine, glimepiride, mesalazine, and sulfacetamide have been prescribed safely to G6PD-deficient patients 6
- Dual antiplatelet therapy containing low-dose aspirin has been used safely in G6PD-deficient patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents 5