G6PD Deficiency Drug Avoidance — FRCA Final MCQ

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HardGeneral AnaesthesiaG6PD Deficiency Drug AvoidanceFRCA Final

A 40-year-old woman with G6PD deficiency requires GA for cholecystectomy. Which perioperative drug should be avoided?

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Correct answer: C — Prilocaine

Prilocaine's metabolite o-toluidine causes methaemoglobinaemia. G6PD-deficient patients are especially vulnerable — cannot regenerate reduced glutathione. Additionally methylene blue (standard MetHb antidote) is ineffective in G6PD deficiency as it requires NADPH from the hexose monophosphate shunt.

Reference: BNF – 2025 – G6PD deficiency: drugs to avoid