Kamillosan Safety in G6PD Deficiency
Kamillosan (chamomile extract) can be used safely in patients with G6PD deficiency, as there is no evidence linking chamomile to hemolysis in G6PD-deficient individuals.
Evidence-Based Assessment
Medications Definitively Contraindicated in G6PD Deficiency
The following seven medications have solid evidence for causing hemolysis and must be avoided 1:
- Dapsone – potent oxidant causing methemoglobinemia and hemolysis 2, 3
- Methylene blue (methylthioninium chloride) – causes severe hemolytic anemia 2, 1
- Primaquine – contraindicated in severe deficiency 3
- Rasburicase – absolutely contraindicated 2
- Nitrofurantoin 1
- Phenazopyridine 1
- Tolonium chloride (toluidine blue) 1
Herbal and Dietary Supplements in G6PD Deficiency
A systematic review of herbal and dietary supplements found that only henna has evidence linking it to hemolysis in G6PD-deficient patients 4. The review specifically evaluated multiple herbal products and found no evidence of harm for vitamin C, vitamin E, vitamin K, Ginkgo biloba, and α-lipoic acid at therapeutic doses 4.
Chamomile (the active ingredient in Kamillosan) was not identified as causing hemolysis in any published case reports or studies 4.
Clinical Context
The confusion surrounding G6PD deficiency and medication safety stems from the fact that many compounds have been wrongly cited as causing hemolysis because they were administered during infection-related hemolytic episodes, rather than being the actual trigger 1. For medications not on the definitive contraindication list, there is no evidence to contravene their use in normal therapeutic doses 1.
Practical Recommendations
- Kamillosan can be used in G6PD-deficient patients without special precautions 1, 4
- Educate patients to recognize early signs of hemolysis: dark/reddish urine, sudden fatigue, pallor, jaundice, and abdominal or back pain 3, 5
- The risk of hemolysis varies by G6PD variant: Mediterranean (Gdmed) causes severe reactions, while African (GdA-) produces milder, self-limited hemolysis 3, 5
Common Pitfall to Avoid
Do not restrict all medications indiscriminately in G6PD-deficient patients based on outdated or anecdotal information 1. Over time, many compounds have been incorrectly labeled as dangerous, causing unnecessary patient distress and limiting therapeutic options 1. Stick to the evidence-based list of seven contraindicated medications unless new solid evidence emerges 1.