Which medications should be avoided in patients with G6PD deficiency to prevent hemolytic crises?

Medications to avoid in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency to prevent hemolytic crises include certain antibiotics, antimalarials, and other oxidative drugs. Specifically, sulfonamides, nitrofurantoin, dapsone, and chloramphenicol are commonly implicated antibiotics that should be avoided due to their oxidative potential triggering hemolysis NICE CG143. Antimalarial drugs such as primaquine and other 8-aminoquinolines are also contraindicated as they can precipitate hemolytic episodes in G6PD-deficient individuals NICE CG143. Additionally, certain analgesics like high-dose aspirin and some nonsteroidal anti-inflammatory drugs (NSAIDs) may pose risks and should be used cautiously or avoided NICE CG143. Other agents including methylene blue and some quinolones have been reported to induce hemolysis and are generally avoided in this population Elyassi & Rowshan 2025.

UK guidelines emphasize avoiding these known oxidative drugs to prevent hemolytic crises, recommending alternative medications when possible NICE CG143. Recent literature supports these recommendations and further highlights the importance of perioperative medication review to exclude oxidative agents, as even commonly used drugs in hospital settings can trigger hemolysis in G6PD deficiency Elyassi & Rowshan 2025. This integrated approach ensures patient safety by minimizing exposure to hemolysis-inducing medications.