Systematic reviewindependent cross-checkabstract checked I-LEG-108 standard review
Medicines and G6PD deficiency: what is the evidence?
Medications and glucose-6-phosphate dehydrogenase deficiency: an evidence-based review.
Overview
Youngster I et al.. Drug Saf 2010 · PMID 20701405 · DOI 10.2165/11536520-000000000-00000
Only seven medicines had solid evidence of causing haemolysis; many others were blamed wrongly.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Review drug safety in G6PD deficiency.
- How was the study done?
Literature review.
- How many people, animals or samples were studied?
Published reports to 2009.
- What was actually found?
Seven drugs clearly to avoid.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Most medicines are safe in normal doses, but a few must be avoided.
- What are the study's limitations?
Abstract only; older.
- What does it say about Elawady's specific claim?
Limits the aspirin/antibiotic part of C-LEG-05.
- Do the results apply to Germany and Europe?
Universal.
- What can explicitly not be concluded from this study?
It does not cover foods other than drugs.
Scientific in-depth review
1. Full reference
- Authors
- Youngster I et al.
- Journal
- Drug Saf
- Year
- 2010
- Identifier
- PMID 20701405 DOI 10.2165/11536520-000000000-00000
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref works API
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Not stated in abstract.
2. Research question
Which medications should be avoided in G6PD deficiency based on evidence?
3. Study design and population
- Study design
- Systematic review – Evidence-based literature review of medications in G6PD deficiency (MEDLINE, PubMed, Cochrane, textbooks to May 2009)
- Population
G6PD-deficient patients (literature)
- Country
International (authors in Israel)
- Period
Literature 1950-2009
- Sample size
Not applicable
- Inclusion and exclusion criteria
Studies and case reports on medication use and G6PD deficiency.
4. Methods and endpoints
- Exposure / intervention
Medications
- Comparator
Not applicable
- Endpoints
Haemolysis
- Statistical methods
Qualitative classification into three groups
5. Actual results
- Results
Solid evidence to prohibit only seven current medications: dapsone, methylthioninium chloride (methylene blue), nitrofurantoin, phenazopyridine, primaquine, rasburicase and tolonium chloride (toluidine blue); for other medications no evidence contravened use at normal therapeutic doses. Many drugs were probably wrongly cited because they were given during infection-related haemolysis.
- Absolute risks
Not applicable
- Authors' conclusion
Evidence-based global consensus on medication use is needed; many drugs have been wrongly blamed.
6. Strengths
- Explicit search of several sources
7. Weaknesses
- No formal quality appraisal described in abstract
- Abstract only
- Older (2009)
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Review methods only partly described in abstract.
9. Assessment of the statistical interpretation
Not applicable.
10. Relevance to the specific claim
Contradicts the broad statement that aspirin and antibiotics trigger haemolysis; only specific agents (two antimicrobials: dapsone, nitrofurantoin) are well supported.
11. Independent contrary findings
Hospital leaflets list more drugs (I-LEG-110).
12. Transferability to Germany and Europe
Universal.
13. Overall methodological judgement
Consistent with the later CPIC guideline (I-LEG-107).
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| 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
None specific.
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