Precautions in G6PD Deficiency

Key Medications to Avoid

The American College of Physicians recommends that individuals with G6PD deficiency avoid specific oxidant medications that can trigger hemolysis, and undergo G6PD testing before starting potentially harmful drugs 1
For P. vivax or P. ovale malaria requiring radical cure, primaquine should only be used after G6PD testing, as recommended by the Infectious Diseases Society of America 2, 3
The Centers for Disease Control and Prevention suggests that for those with intermediate G6PD deficiency and non-Mediterranean variants, weekly primaquine may be considered with close monitoring for hemolysis 3

The American Academy of Family Physicians recommends mandatory screening for G6PD deficiency upon entry into healthcare, before starting therapy with any oxidant drug, and especially in individuals with predisposing racial or ethnic backgrounds 1
Qualitative screening is recommended for initial assessment, as suggested by the Clinical Infectious Diseases journal 1
Quantitative G6PD testing is required before tafenoquine administration, as recommended by the Clinical Microbiology and Infection journal 3

The African variant of G6PD deficiency is found in 10-15% of Black men and women, and is associated with milder hemolysis, according to the Clinical Infectious Diseases journal 1
The Mediterranean variant of G6PD deficiency can cause life-threatening hemolysis, and requires stricter avoidance of oxidant medications, as reported by the American Journal of Hematology 4

Baseline testing before initiating treatment should include complete blood count with hemoglobin determination, as recommended by the Clinical Infectious Diseases journal 1
Ongoing monitoring during therapy should include blood examinations, particularly blood cell counts and hemoglobin, as suggested by the American Journal of Hematology 4

Immediate discontinuation of any potentially hemolytic medication is recommended if signs of hemolysis occur, such as back or abdominal pain, as reported by the American Journal of Hematology 4

First-degree relatives of patients with hereditary methemoglobinemia should be tested for G6PD deficiency, as recommended by the American Journal of Hematology 4