Omeprazole Safety in G6PD Deficiency
Omeprazole is safe to use in patients with G6PD deficiency—there is no evidence that proton pump inhibitors cause hemolysis in this population.
Medications Definitively Contraindicated in G6PD Deficiency
Only seven medications have solid evidence for causing hemolysis and should be avoided 1:
- Dapsone 2, 3, 1
- Methylthioninium chloride (methylene blue) 2, 3, 1
- Primaquine 2, 3, 1
- Rasburicase 2, 1
- Nitrofurantoin 1
- Phenazopyridine 1
- Tolonium chloride (toluidine blue) 1
Why Omeprazole Is Safe
Omeprazole and other proton pump inhibitors are not listed among medications that cause hemolysis in G6PD deficiency 1. The comprehensive evidence-based review examining all medications and G6PD deficiency found no evidence contraindicating the use of proton pump inhibitors in normal therapeutic doses 1.
A large real-world study of 31,962 G6PD-deficient patients identified only 71 cases (0.2%) of major hemolysis requiring hospitalization over 12 years, with 71.8% caused by fava beans, 8.5% by infections, and only 4.2% possibly medication-related (nitrofurantoin, phenazopyridine, and an unspecified "pain killer")—notably, no proton pump inhibitors were implicated 4.
Common Pitfall to Avoid
Many medications have been wrongly cited as causing hemolysis because they were administered during infection-related hemolytic episodes 1. Over time, this has led to unnecessarily restrictive medication lists that cause patient distress and limit therapeutic options 1.
Clinical Approach When Prescribing Any Medication
When starting any new medication in a G6PD-deficient patient, monitor for signs of hemolysis including 2:
- Jaundice
- Dark urine (hemoglobinuria)
- Fatigue
- Back or abdominal pain
- Anemia
The Mediterranean variant (Gdmed) causes more severe, potentially life-threatening hemolysis compared to the African variant (GdA-), which typically produces milder, self-limited reactions 3, 5.