Is there a list of drugs that can be safely given in the presence of glucose-6-phosphate dehydrogen

Fråga: Is there a list of drugs that can be safely given in the presence of glucose-6-phosphate dehydrogenase deficiency (G6PD-D)?

A 12-year-old Kurd boy with G6PD-D has got a cold with a cough. His pediatrician intends to prescribe a safe antibiotic and a safe cough medicine.

Sammanfattning: To avoid hemolytic episodes infections ought to be treated and drugs listed as non-safe should not be given. Antibiotics that are not considered safe include nitrofurantoin, nalidixic acid and chloramphenicol. Other antibiotics that do not contain sulfa/sulfones appear safe as do all anti-cough drugs registered in Sweden.

Svar: Two previous Drugline documents that dealt with this issue will be enclosed with this answer. They contain general information about the deficiency as well as a thorough drug list (1,2).

Theoretically, drugs at risk to cause hemolysis in patients with G6PD-D are oxidant compounds and drugs that have a direct inhibitory effect on the enzyme (3).

Antibiotics that are not considered safe include nitrofurantoin, nalidixic acid and chloramphenicol. Sulfa compounds are generally considered a risk, but some older drugs that contain sulfa could be given (2).

A Medline search has not revealed any more recent relevant articles on the subject. To our knowledge there is no major centre of research or information concerning G6PD-D in Sweden (3,4).

Infections could precipitate hemolytic crisis (5). 1 Drugline nr 05954 (year 1987)
2 Drugline nr 08270 (year 1990)
3 Personal communication with Dr Gunnar Ronquist, Department of Clinical Chemistry, Akademiska Hospital, Uppsala
4 Personal communication with the Department of Clinical Genetics, Karolinska Hospital, Stockholm

5 d´Arcy PF, Griffin JP: Iatrogenic diseases. 1986; 3rd ed: 62-63