Version July 2025
| Medicines and other substances likely to be UNSAFE in moderate to severe G6PD deficiency* |
| Medications |
| Chlorpropamide |
| Dabrafenib |
| Dapsone (diaminodiphenyl sulfone) |
| Fluoroquinolones (ciprofloxacin, moxifloxacin, norfloxacin, ofloxacin)¶ |
| Methylene blue (methylthioninium chloride)Δ |
| Nalidixic acid◊ |
| Nitrofurantoin, nifuratel, and nitrofurazone (nitrofural)◊ |
| Phenazopyridine (pyridium) |
| Primaquine and tafenoquine |
| Rasburicase and pegloticase |
| Sulfonylureas (eg, glipizide, glyburide [glibenclamide]) |
| Chemical exposures and foods |
| Fava beans |
| Henna compounds (black and red Egyptian) |
| Naphthalene (mothballs, lavatory deodorant, garden pesticide) |
| Phenylhydrazine |
| "RUSH" (isobutyl nitrite, amyl nitrite) |
| Medicines that are PROBABLY SAFE given in usual therapeutic doses in G6PD deficiency*; NOTE: some of these were previously considered unsafe; safety in Class I variants is generally not known |
| Acetaminophen (Tylenol, Paracetamol) |
| Aminophenazone, dipyrone, and metamizole (NSAIDs)◊ |
| Antazoline (antihistamine) |
| Antipyrine (phenazone) |
| Ascorbic acid (vitamin C) |
| Aspirin (acetylsalicylic acid) |
| Benzhexol (Artane) |
| Chloramphenicol |
| Chloroquine and hydroxychloroquine |
| Colchicine |
| Clotrimazole |
| Diphenhydramine (Benadryl) |
| Isoniazid |
| Levodopa (L-Dopa) and levodopa-carbidopa |
| Para-aminosalicylic acid |
| Para-aminobenzoic acid (PABA) |
| Phenylbutazone |
| Phenytoin |
| Probenecid (Benemid) |
| Procainamide (Pronestyl) |
| Pyrimethamine (Daraprim) |
| Quinine |
| Streptomycin |
| Sulfa-containing drugs§ (sulfacetamide, sulfadiazine, sulfamethoxazole [Gantanol], trimethoprim-sulfamethoxazole, sulfamethoxypyridazine [Kynex], sulfanilamide, sulfisoxazole [Gantrisin]) |
| Tiaprofenic acid |
| Trimethoprim |
| Tripelennamine (Pyribenzamine) |
| Vitamin K |
G6PD: glucose-6-phosphate deficiency; NSAIDs: nonsteroidal antiinflammatory drugs.
* Applies to Class I, II, and III G6PD variants. However, note that there is marked variability in reports. This list is based on evidence supporting a clear association with drug-induced hemolysis. Individual characteristics (ie, degree of G6PD deficiency, dose, presence of infection) will determine actual safety or injury. Medicines known to be unsafe in G6PD deficiency that are no longer in clinical use are excluded from this list. In cases where the patient truly requires the medication and G6PD status is unknown, it may be appropriate to administer and monitor closely.
¶ Levofloxacin is not listed because some cases of hemolytic anemia with levofloxacin have been associated with a positive Coombs test or other possible causes of hemolysis.
Δ Methylene blue is a component of some combination urinary tract products.
◊ Not available in the United States.
§ Sulfamethoxazole is widely used. Some cases of hemolysis in individuals with G6PD deficiency have been reported. Use with caution.
