Safe Cough and Cold Medications for Children with G6PD Deficiency
Most over-the-counter cough and cold medications are safe for children with G6PD deficiency, as only seven medications are definitively contraindicated in this condition, and common cold remedies are not among them. 1, 2
Medications That Are Safe to Use
Analgesics and Antipyretics
- Ibuprofen is safe for children with G6PD deficiency, with extremely low reported incidence of hemolysis (approximately 1/100,000 affected children per year in population studies, and 1/100 million per year in FDA adverse reaction databases). 3
- Acetaminophen (paracetamol) can be used safely as no evidence contraindicates its use in G6PD-deficient patients. 2
Cough Suppressants and Pain Medications
- Codeine and codeine derivatives are safe and have not been shown to cause hemolytic crises in G6PD-deficient patients. 4
Antibiotics (if bacterial infection develops)
- Cephalexin and other cephalosporins are safe, with standard dosing of 75-100 mg/kg/day divided into 3-4 doses, and no special restrictions for G6PD-deficient patients. 5
- Amoxicillin and most beta-lactam antibiotics have no evidence contraindicating their use. 2
Medications to Absolutely Avoid
Only seven medications are definitively contraindicated in G6PD deficiency: 1, 2
- Dapsone
- Methylthioninium chloride (methylene blue)
- Nitrofurantoin
- Phenazopyridine
- Primaquine
- Rasburicase
- Tolonium chloride (toluidine blue)
None of these are typically found in pediatric cough and cold preparations.
Important Clinical Considerations
Variant-Specific Risk
- The Mediterranean variant (Gdmed) causes more severe reactions than the African variant (GdA-), which typically produces milder, self-limited hemolysis. 1
- Mediterranean variants are found predominantly in men from Mediterranean regions, India, and Southeast Asia, while the African variant (GdA-) affects 10-15% of Black individuals. 1
Monitoring Recommendations
When using any medication in a G6PD-deficient child, monitor for signs of hemolysis: 6, 5
- Jaundice
- Dark urine
- Fatigue
- Pallor
Common Pitfall to Avoid
Do not confuse infection-related hemolysis with medication-induced hemolysis. Many medications have been wrongly cited as causing hemolysis because they were administered during infection-related hemolytic episodes. 2 In a real-world study of 31,962 G6PD-deficient patients, 71.8% of major hemolytic episodes were caused by fava bean ingestion and 8.5% by infections, with only 4.2% potentially medication-related. 7
Practical Algorithm for Medication Selection
For fever and pain:
- First-line: Ibuprofen or acetaminophen 3
- Alternative: Codeine-containing preparations if needed for cough 4
If bacterial infection suspected:
- Use cephalexin, amoxicillin, or other beta-lactams without concern 5, 2
- Avoid nitrofurantoin (one of the seven contraindicated medications) 1, 2
For symptomatic relief:
- Standard decongestants and antihistamines have no evidence contraindicating their use 2