From the Guidelines
Clarithromycin can be given to a G6PD deficient patient, but with caution and monitoring for signs of hemolysis. The provided evidence does not directly address the safety of clarithromycin in G6PD deficient patients, but based on the general knowledge of the medication, it is not typically associated with hemolytic anemia in G6PD-deficient individuals 1. The standard dosing regimen for clarithromycin is typically 250-500 mg twice daily, with the duration depending on the infection being treated. Some key points to consider when prescribing clarithromycin to G6PD-deficient patients include:
- Monitoring for signs of hemolysis such as fatigue, pallor, jaundice, dark urine, or back/abdominal pain, although these complications are rare with this medication.
- Considering other potential contraindications such as QT prolongation risk, drug interactions (particularly with statins), and hepatic or renal impairment when prescribing.
- Being aware of potential interactions with other medications, such as rifampin, lopinavir-ritonavir, and efavirenz, which can affect clarithromycin levels 1. It's essential to weigh the benefits and risks of clarithromycin treatment in G6PD deficient patients and to closely monitor them for any adverse effects.
From the Research
G6PD Deficiency and Clarithromycin
- G6PD deficiency is a common enzymopathy that affects approximately 400 million people worldwide, causing red cells to be vulnerable to oxidative damage and hemolysis 2, 3, 4, 5.
- The deficiency can be triggered by various factors, including certain medications, infections, and ingestion of fava beans 2, 4, 5.
- There is no direct evidence in the provided studies that clarithromycin is harmful to G6PD deficient patients.
- However, studies have identified certain medications that should be avoided in individuals with G6PD deficiency, including dapsone, methylthioninium chloride, nitrofurantoin, phenazopyridine, primaquine, rasburicase, and tolonium chloride 3, 5.
- Clarithromycin is not listed as a medication that should be avoided in G6PD deficient patients in the provided studies 3, 5.
- It is essential to note that the lack of evidence does not necessarily mean that clarithromycin is safe for G6PD deficient patients, and caution should be exercised when prescribing medications to individuals with this deficiency.