Co-amoxiclav is Safe in G6PD Deficiency
Co-amoxiclav (amoxicillin/clavulanic acid) can be used safely in patients with G6PD deficiency at normal therapeutic doses, as penicillins are not among the contraindicated medications and have not been associated with hemolytic reactions in G6PD-deficient patients. 1
Evidence-Based Medication Classification in G6PD Deficiency
Definitively Contraindicated Medications (Avoid Completely)
Only seven medications have solid evidence for causing hemolysis and should be strictly avoided 1, 2:
- Dapsone 3, 1
- Methylthioninium chloride (methylene blue) 3, 1
- Nitrofurantoin 1, 2
- Phenazopyridine 1, 2
- Primaquine 3, 1
- Rasburicase 1, 2
- Tolonium chloride (toluidine blue) 2
Co-amoxiclav Safety Profile
Penicillins, including amoxicillin (the primary component of co-amoxiclav), are explicitly listed as safe medications that can be used in normal therapeutic doses in G6PD-deficient patients. 1 This is supported by:
- A comprehensive evidence-based review found no evidence contraindicating penicillin use in G6PD deficiency 2
- Real-world data from over 31,962 G6PD-deficient patients showed that many previously suspected medications were prescribed safely without causing hemolysis 4
- The major causes of hemolytic crises in G6PD deficiency are fava beans (71.8% of cases), infections (8.5%), and only rarely medications (4.2%) 4
Clinical Implications
When to Screen for G6PD Deficiency
Screen patients before starting oxidant drugs if they have predisposing backgrounds 3, 5:
- Mediterranean descent
- African descent
- Indian descent
- Southeast Asian descent
Common Pitfall to Avoid
Many medications have been wrongly cited as causing hemolysis because they were administered during infection-related hemolytic episodes, not because the drug itself caused hemolysis. 2 This historical confusion has led to unnecessarily restrictive medication lists that are not evidence-based.
Monitoring Recommendations
While co-amoxiclav is safe, monitor for signs of hemolysis when starting any new medication in G6PD-deficient patients 1:
- Jaundice
- Dark urine
- Acute anemia
- Elevated indirect bilirubin