Is Cetirizine Safe for G6PD Deficiency?
Yes, cetirizine is safe for individuals with G6PD deficiency—there is no evidence contraindicating its use, and it does not appear on any list of medications known to cause hemolysis in G6PD-deficient patients.
Evidence-Based Medication Safety in G6PD Deficiency
Definitively Contraindicated Medications
The medications that must be avoided in G6PD deficiency are well-established and limited to seven specific drugs:
- Dapsone (potent oxidant causing methemoglobinemia and hemolysis) 1, 2, 3
- Methylthioninium chloride (methylene blue) 2, 3
- Nitrofurantoin 3
- Phenazopyridine 3
- Primaquine 2, 3
- Rasburicase 4, 3
- Tolonium chloride (toluidine blue) 3
Cetirizine Safety Profile
Cetirizine, an antihistamine, does not appear on any contraindicated or cautionary medication lists for G6PD deficiency. 3
A comprehensive evidence-based review examining medications and G6PD deficiency found solid evidence to prohibit only the seven medications listed above, concluding that "regarding all other medications, our review found no evidence to contravene their use in normal therapeutic doses to G6PD-deficient patients" 3
A large real-world study of 31,962 G6PD-deficient patients demonstrated that many previously suspected medications were prescribed safely without causing hemolysis 5
Clinical Implications
Safe Medication Use
Antihistamines like cetirizine can be used without restriction in G6PD-deficient patients for allergic conditions 3
The most effective management strategy is preventing hemolysis by avoiding only the documented oxidative stressors listed above 6
Common Pitfalls to Avoid
Do not unnecessarily restrict medications that lack evidence of causing hemolysis—this causes patient distress and limits therapeutic options 3
Many compounds have been wrongly cited as causing hemolysis because they were administered during infection-related hemolytic episodes, not because the drug itself caused hemolysis 3
When to Screen for G6PD Deficiency
Screening is strongly recommended before starting any of the seven contraindicated medications, particularly in patients of Mediterranean, African, Indian, or Southeast Asian descent 2, 7
- Qualitative screening is sufficient for initial assessment 2, 7
- Quantitative testing may be needed for borderline cases (30-70% activity) 7
Monitoring Considerations
While cetirizine itself requires no special monitoring in G6PD deficiency, clinicians should educate patients to recognize signs of hemolysis if they develop concurrent infections or are exposed to oxidative stressors:
In summary, cetirizine poses no hemolytic risk and can be prescribed with confidence to patients with G6PD deficiency.