Herbal Supplements and G6PD Deficiency Interaction
Based on the available evidence, the herbal supplement combination you listed (Tongkat Ali, Maca Root, Horny Goat Weed, Tribulus, American Ginseng, and Asian Ginseng) can likely be used safely in patients with G6PD deficiency, as there is no documented evidence linking these specific supplements to hemolytic crises in G6PD-deficient individuals.
Evidence-Based Assessment
Documented Safety Profile of Herbal Supplements in G6PD Deficiency
A systematic review of herbal and dietary supplements in G6PD deficiency found that only henna had evidence linking it to hemolysis, while most other herbal products showed insufficient evidence to contravene their use at therapeutic doses 1
The review specifically found no evidence of harm for commonly used supplements including vitamin C, vitamin E, vitamin K, Ginkgo biloba, and α-lipoic acid in G6PD-deficient patients 1
None of the six herbal ingredients in your supplement formulation (Eurycoma longifolia/Tongkat Ali, Maca root, Epimedium/Horny Goat Weed, Tribulus terrestris, American Ginseng, or Asian Ginseng) appear in any published lists of contraindicated substances for G6PD deficiency 1, 2
Definitively Contraindicated Medications (For Context)
The evidence establishes only seven medications with solid evidence for prohibition in G6PD deficiency 3, 4, 5, 2:
- Dapsone 3, 4, 2
- Methylene blue (methylthioninium chloride) 4, 5, 2
- Primaquine 4, 5, 2
- Rasburicase 5, 2
- Nitrofurantoin 2
- Phenazopyridine 2
- Tolonium chloride (toluidine blue) 2
Your herbal supplement combination is not among these contraindicated substances.
Clinical Reasoning
Why These Supplements Are Likely Safe
The comprehensive evidence-based review concluded that many compounds have been wrongly cited as causing hemolysis because they were administered during infection-related hemolytic episodes, not because the compounds themselves triggered hemolysis 2
For all medications and supplements not on the definitive contraindication list, the review found no evidence to contravene their use in normal therapeutic doses in G6PD-deficient patients 2
A specific systematic review of herbal and dietary supplements found that insufficient evidence exists to contravene the use of most herbal products at therapeutic doses in G6PD-deficient subjects 1
Important Caveats
Fava beans remain the only food with conclusive clinical evidence linking consumption to hemolytic anemia risk in G6PD deficiency 6
The severity of potential reactions varies by G6PD variant—the Mediterranean variant (Gdmed) causes more severe reactions than the African variant (GdA-) 4, 5
Patients should still monitor for signs of hemolysis (jaundice, dark urine, fatigue, pallor) when starting any new supplement, particularly if they have the Mediterranean variant 5
Practical Recommendations
Screening is recommended before starting any new therapy in patients of Mediterranean, African, Indian, or Southeast Asian descent to confirm G6PD status 3, 4
If hemolysis occurs while taking these supplements, discontinue immediately and seek medical evaluation, though this would be unexpected based on current evidence 5
Patients should be educated to avoid the seven definitively contraindicated medications listed above, as these pose genuine hemolytic risk 3, 4, 2
Avoid testing during acute illness or hemolytic episodes, as G6PD levels may be falsely elevated due to young reticulocytes having higher enzyme activity 3, 5