Guideline / position statementindependent cross-checkabstract checked★ key study I-LEG-107 in-depth review
Which medicines are risky in G6PD deficiency (CPIC guideline)
Expanded Clinical Pharmacogenetics Implementation Consortium Guideline for Medication Use in the Context of G6PD Genotype.
Overview
Gammal RS et al.. Clin Pharmacol Ther 2023 · PMID 36049896 · DOI 10.1002/cpt.2735
Only a short list of medicines is high risk; aspirin at normal doses and most antibiotics are low risk, and no food other than fava beans is confirmed as a trigger.
Does the study support the specific claim? No · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Classify drugs by haemolysis risk.
- How was the study done?
Systematic review and expert grading.
- How many people, animals or samples were studied?
Published evidence on implicated drugs.
- What was actually found?
High risk: e.g. dapsone, rasburicase, primaquine; nitrofurantoin medium.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Most common medicines, including normal-dose aspirin, can be used; a few must be avoided.
- What are the study's limitations?
Evidence mainly case reports.
- What does it say about Elawady's specific claim?
Contradicts the claim that lentils, aspirin and antibiotics in general trigger haemolysis.
- Do the results apply to Germany and Europe?
Universal.
- What can explicitly not be concluded from this study?
It does not prove that rare reactions to other foods never occur.
Scientific in-depth review
1. Full reference
- Authors
- Gammal RS et al.
- Journal
- Clin Pharmacol Ther
- Year
- 2023
- Identifier
- PMID 36049896 DOI 10.1002/cpt.2735 · PMC10281211
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref works API
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
NIH (NIGMS, NHGRI) support; individual author declarations listed.
2. Research question
Which medications pose high, medium or low-to-no risk of acute haemolytic anaemia in G6PD deficiency?
3. Study design and population
- Study design
- Guideline / position statement – Clinical practice guideline (CPIC) based on a systematic literature review of drug-G6PD associations
- Population
People with G6PD deficiency (by genotype/phenotype)
- Country
International (CPIC)
- Period
Literature to about 2021
- Sample size
Not applicable
- Inclusion and exclusion criteria
Drugs implicated as unsafe by at least one source.
4. Methods and endpoints
- Exposure / intervention
Medications; fava beans and other foods discussed
- Comparator
Not applicable
- Endpoints
Acute haemolytic anaemia
- Statistical methods
Evidence grading; recommendation strength
5. Actual results
- Results
High risk (avoid): dapsone, methylene blue, pegloticase, primaquine at standard anti-relapse doses, rasburicase, tafenoquine, toluidine blue. Medium risk (caution): nitrofurantoin; medium-dose primaquine. Low-to-no risk (use normally): among others aspirin at <=1 g/day, chloramphenicol, ciprofloxacin, sulfamethoxazole. Text: 'Although some resources suggest that foods other than fava beans may cause AHA in G6PD deficiency, we were unable to confirm peer-reviewed evidence supporting the risk from other foods.' Favism 'can be fatal, mostly in children'.
- Absolute risks
Not applicable
- Authors' conclusion
Avoid high-risk drugs, use medium-risk drugs with caution, use low-to-no-risk drugs normally regardless of G6PD status.
6. Strengths
- Systematic evidence review with explicit grading
- Full text read (PMC)
7. Weaknesses
- Case-report-dominated evidence base
- Focus on drugs; food evidence only briefly addressed
8. Risk of bias
- Orienting tool
- AGREE-oriented (none formally applied)
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- low
- Rationale
Established guideline consortium; explicit methods.
9. Assessment of the statistical interpretation
Not applicable.
10. Relevance to the specific claim
Directly addresses the triggers named in C-LEG-05: no confirmed food trigger besides fava beans; aspirin at usual doses and most antibiotics are low risk; a few antimicrobials (dapsone, nitrofurantoin) are not.
11. Independent contrary findings
Some national/hospital lists (I-LEG-110) are more conservative (e.g. sulfonamides, quinolones).
12. Transferability to Germany and Europe
Universal pharmacology.
13. Overall methodological judgement
Highest-level current guidance on G6PD triggers; strongly limits C-LEG-05.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | low |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Evidence for many drugs remains sparse.
15. Linked fact checks
- In G6PD deficiency, haemolysis is triggered by merely smelling fava beans and by eating lentils, as well as by aspirin and antibiotics. – Studies contradicting or limiting the claim