From the FDA Drug Label
- 7 Hemolytic Anemia Associated with G6PD Deficiency
Hemolysis has been reported in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Monitor for hemolytic anemia as this can occur, particularly in association with other drugs that cause hemolysis.
Key Points:
- Hemolysis has been reported in patients with G6PD deficiency.
- Monitor for hemolytic anemia, especially when used with other drugs that cause hemolysis. The use of Plaquenil (hydroxychloroquine) in patients with G6PD deficiency requires careful monitoring due to the risk of hemolytic anemia 1.
From the Research
Hydroxychloroquine (Plaquenil) can be used safely in patients with G6PD deficiency, as evidenced by the most recent study in 2022 2, which found no cases of hemolysis in G6PD-deficient patients exposed to hydroxychloroquine.
Key Points
- The American College of Rheumatology does not recommend routine G6PD screening before starting hydroxychloroquine therapy, as hydroxychloroquine has a low risk of causing hemolysis in G6PD-deficient individuals 2.
- Standard hydroxychloroquine dosing (typically 200-400 mg daily) can be used in these patients, with close monitoring during the initial treatment period for signs of hemolysis such as fatigue, pallor, jaundice, or dark urine.
- Laboratory tests including complete blood count, reticulocyte count, haptoglobin, and bilirubin can be checked if there are concerns about a potential hemolytic reaction.
- The safety of hydroxychloroquine in G6PD deficiency is particularly important since this medication is commonly used for autoimmune conditions like lupus and rheumatoid arthritis, which require long-term treatment.
Considerations
- Other antimalarials such as primaquine and tafenoquine have a higher risk of causing hemolysis in G6PD-deficient individuals and should be avoided 3.
- G6PD deficiency is a common genetic disorder that affects approximately 400 million people worldwide, and it is essential to recognize the potential for G6PD deficiency in patients to avoid triggers that result in harmful clinical manifestations 4.
- The most recent study in 2022 2 provides the strongest evidence for the safety of hydroxychloroquine in G6PD deficiency, and its findings should be prioritized in clinical decision-making.