Salbutamol and Lagundi Safety in G6PD Deficiency
Both salbutamol (albuterol) and lagundi can be safely used in patients with G6PD deficiency, as neither medication appears on any list of contraindicated or high-risk drugs for this condition.
Medications Definitively Contraindicated in G6PD Deficiency
Based on the most rigorous evidence-based review, only seven medications are definitively contraindicated in G6PD-deficient patients 1, 2, 3:
- Dapsone - potent oxidant causing methemoglobinemia and hemolysis 4, 1
- Methylene blue (methylthioninium chloride) - can cause severe hemolytic anemia and may worsen methemoglobinemia paradoxically 4, 1, 5
- Nitrofurantoin 1, 3
- Phenazopyridine 3
- Primaquine - causes hemolytic anemia, contraindicated in severe deficiency 1, 5, 6
- Rasburicase 2, 3
- Tolonium chloride (toluidine blue) 3
Why Salbutamol is Safe
Salbutamol (albuterol) does not appear on any contraindicated or cautionary medication lists for G6PD deficiency in the comprehensive evidence-based reviews 1, 2, 3, 7. The most thorough systematic review concluded that medications not on the seven-drug contraindicated list can be given safely in normal therapeutic doses to G6PD-deficient patients 3.
Why Lagundi is Safe
Lagundi (Vitex negundo), a traditional herbal bronchodilator, is not listed among medications causing hemolysis in G6PD deficiency 1, 2, 3. As a plant-based medication without oxidative properties similar to the contraindicated drugs, it does not pose the same hemolytic risk.
Real-World Safety Data
A large real-world study of 31,962 G6PD-deficient patients found that only 0.2% experienced major hemolysis requiring hospitalization, with the vast majority (71.8%) caused by fava bean ingestion, not medications 7. This study demonstrated that many previously suspected medications were prescribed safely to thousands of G6PD-deficient patients 7.
Common Pitfalls to Avoid
- Do not confuse infection-related hemolysis with drug-induced hemolysis - many compounds have been wrongly cited as causing hemolysis when they were administered during infection-related hemolytic episodes 3
- Avoid unnecessary medication restrictions - over-cautious avoidance of safe medications can compromise patient care 3, 7
- The most common trigger is fava beans, not medications - patient education should emphasize dietary avoidance 7
Variant-Specific Considerations
The severity of G6PD deficiency varies by genetic variant 1, 5:
- Mediterranean variant (B-) - typically causes more severe reactions 1, 5
- African variant (A-) - usually causes milder, self-limited hemolysis 1
However, this variant difference is relevant primarily for the seven contraindicated medications, not for salbutamol or lagundi 1.
Clinical Monitoring Recommendations
While salbutamol and lagundi are safe, monitor all G6PD-deficient patients for signs of hemolysis when starting any new medication 2: