Co-Amoxiclav is Safe in G6PD Deficiency
Co-amoxiclav (amoxicillin-clavulanic acid) can be safely used in patients with G6PD deficiency, as it is not among the medications known to cause hemolysis in these patients.
Medications Actually Contraindicated in G6PD Deficiency
The evidence clearly identifies only seven medications that are definitively contraindicated in G6PD deficiency 1, 2, 3:
- Dapsone - a potent oxidant causing methemoglobinemia and hemolysis 1
- Methylthioninium chloride (methylene blue) - causes severe hemolytic anemia 1
- Primaquine - contraindicated in severe deficiency 1
- Rasburicase 2, 3
- Nitrofurantoin 3
- Phenazopyridine 3
- Tolonium chloride (toluidine blue) 3
Why Co-Amoxiclav is Not on This List
After thorough review of the medical literature, co-amoxiclav does not appear on any evidence-based list of medications that cause hemolysis in G6PD-deficient patients 3. The comprehensive 2010 systematic review found that many compounds have been wrongly cited as causing hemolysis simply because they were administered during infection-related hemolytic episodes, when the infection itself was the actual trigger 3.
Clinical Implications
- No special precautions are needed when prescribing co-amoxiclav to G6PD-deficient patients beyond standard indications 3
- The antibiotic can be used at normal therapeutic doses without concern for hemolysis 3
- Infections themselves can trigger hemolysis in G6PD deficiency, making appropriate antibiotic treatment (including co-amoxiclav when indicated) actually beneficial 4, 5
Important Caveats
While co-amoxiclav is safe, clinicians should still:
- Monitor for signs of hemolysis (jaundice, dark urine, fatigue, pallor) when starting any medication in G6PD-deficient patients, as this is good general practice 2
- Remember that the underlying infection being treated may itself trigger hemolysis, independent of the antibiotic used 3, 4
- Be aware that G6PD deficiency severity varies by genetic variant, with Mediterranean variants (Gdmed) causing more severe reactions than African variants (GdA-) 1, 2