7 Things You Should Avoid If You Have G6PD Deficiency

Glucose 6 phosphate dehydrogenase (G6PD) deficiency is an inherited type of hemolytic anemia, a form of anemia that occurs when the red blood cells are broken down faster than usual (this is called hemolysis). In G6PD deficiency this occurs because you make a reduced amount of G6PD, an enzyme that protects the red blood cell from damage.

Fortunately, most people with G6PD deficiency do not have problems on a daily basis. However, there are certain medications or foods that increase the rate of red blood cell breakdown.

Let's review some of the common things that can cause problems in this blood disorder. 

1

Antibiotics

Woman's fingers holding a red and white pill capsule

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People with G6PD deficiency can tolerate most antibiotics but should be aware of a select few that can initiate significant red blood cell breakdown leading to anemia. Antibiotics referred to as "sulfa" drugs should be avoided. These antibiotics are typically used to treat skin or urinary tract (bladder) infections. The most common form of these antibiotics goes by the brand names Septra or Bactrim (sulfamethoxazole-trimethoprim).

The "quinolone" antibiotics should also be avoided. The two most common antibiotics in this group are Cipro (ciprofloxacin) and Levaquin (levofloxacin). These antibiotics are commonly used in adults to treat urinary tract infections and pneumonia. Other antibiotics that should be avoided include nitrofurantoin and dapsone. Fortunately, there are many antibiotics that people with G6PD deficiency can take safely.

Make sure to discuss your condition with your physician if you have G6PD deficiency and require antibiotic therapy.

2

Malaria Medications

Mosquito landed on a white pill

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Primaquine, a medication used to treat or prevent malaria, can trigger hemolytic crises in people with G6PD deficiency. Because of this possible complication, it is recommended that people be tested for G6PD deficiency prior to taking primaquine. This includes breastfeeding infants whose mothers take primaquine. Fortunately, other medications used to treat malaria are tolerated by most people with G6PD deficiency.

3

Medications Used in Cancer Treatment

Nurse preparing intravenous medication

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Rasburicase is a medication used to treat tumor lysis syndrome, a medical complication of hematologic cancers like leukemia, should not be used in people with G6PD deficiency. Because of this risk, it is recommended that people be tested prior to receiving rasburicase.

Similarly, doxorubicin, a type of chemotherapy used to treat multiple types of cancer, can trigger red blood cell breakdown in people with certain types of G6PD deficiency.

4

Aspirin

Aspirin pills scattered on white tabletop

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Aspirin, commonly used to treat pain or inflammation, should be avoided. Some people take aspirin daily as part of their treatment regimen.

When avoiding aspirin, it is important to remember that it is found in many over-the-counter medications like Anacin, Bufferin, Ecotrin, Excedrin, BC Powders and Goody's Powders. It is also found in Pepto-Bismol. In general other over the counter pain relievers like acetaminophen or ibuprofen are tolerated without issues.

5

Mothballs

Woman putting moth balls between towels

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Yes, people still use mothballs. Mothballs can contain a chemical known as naphthalene which can trigger hemolysis in people with G6PD deficiency. Naphthalene can also be found in fumigants, particularly those used to keep snakes away.

Naphthalene is a vapor given off by these products so exposure may come from inhaling the vapor or ingesting them.

6

Henna

Hand with Henna

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There are case reports published indicating henna (used for temporary tattoos or hair dye) has triggered hemolytic crises in people with G6PD deficiency.

Newborns under the age of 2 months appear to be more susceptible to this reaction.

7

Fava Beans

Raw shelled beans in a bowl
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G6PD deficiency, and particularly the most severe forms, is also called favism. This is because the ingestion of fava beans (also known as broad beans) can trigger hemolytic attacks in patients with G6PD deficiency.

Some suggest that all legumes (such as peas, lentils, or peanuts) be avoided, but whether or not this is actually needed is unknown.

A Word From Verywell

If you have G6PD deficiency, it doesn't mean you cannot take medications. You should be aware of common medications to avoid. This is not a complete list of items that people with G6PD deficiency should avoid. There are other medications that only cause red cell breakdown if taken in high doses. Others only trigger problems in specific types of G6PD deficiency.

Make sure you discuss all your new medications with your physician to make sure they are not contraindicated for people with G6PD deficiency.

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Article Sources

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  4. Chung WP, Hsu YT, Chen YP, Hsu HP. Treatment of a patient with breast cancer and glucose 6-phosphate dehydrogenase deficiency: A case reportMedicine (Baltimore). 2019;98(13):e14987. doi:10.1097/MD.0000000000014987

  5. Feghaly J, Al Hout AR, Mercieca Balbi M. Aspirin safety in glucose-6-phosphate dehydrogenase deficiency patients with acute coronary syndrome undergoing percutaneous coronary interventionBMJ Case Rep. 2017;2017:bcr2017220483. doi:10.1136/bcr-2017-220483

  6. Raupp P, Hassan JA, Varughese M, Kristiansson B. Henna causes life threatening haemolysis in glucose-6-phosphate dehydrogenase deficiencyArch Dis Child. 2001;85(5):411–412. doi:10.1136/adc.85.5.411