Does a single dose of Maxolon (Metoclopramide) affect Glucose-6-phosphate dehydrogenase (G6PD) deficiency?

From the FDA Drug Label

In patients with G6PD deficiency who experience metoclopramide-induced methemoglobinemia, methylene blue treatment is not recommended

• Maxalon (metoclopramide) may affect patients with G6PD deficiency by increasing the risk of methemoglobinemia.
• A single dose of Maxalon may still pose this risk, although the label does not specifically address single-dose effects. 1

From the Research

Maxalon (metoclopramide) is generally considered safe for patients with G6PD deficiency, and a single dose is unlikely to trigger hemolysis in G6PD-deficient individuals. This is because metoclopramide does not appear on most lists of medications that should be avoided in this condition, as seen in studies such as 2 which found that many medications previously thought to be risky for G6PD-deficient patients were actually prescribed safely. Metoclopramide works by blocking dopamine receptors and enhancing acetylcholine release in the digestive tract to improve motility and reduce nausea and vomiting. Unlike certain antibiotics, antimalarials, and other medications that can cause oxidative stress to red blood cells, metoclopramide's mechanism of action does not typically generate the oxidative byproducts that would trigger hemolysis in G6PD-deficient patients.

Some key points to consider:

• G6PD deficiency is a common enzyme defect that can lead to hemolysis in response to certain medications or infections, as discussed in 3 and 4.
• The risk of hemolysis varies by mutation status and the oxidative stressor, as seen in 5 and 6.
• However, metoclopramide is not typically considered a risky medication for G6PD-deficient patients, and its use is not contraindicated in this population.
• As with any medication, individual responses can vary, and patients with severe G6PD deficiency should inform their healthcare providers about their condition before taking any medication.
• If any unusual symptoms like dark urine, fatigue, or yellowing of the skin occur after taking Maxalon, medical attention should be sought immediately.