Medications to Avoid Safe to take But only in normal therapeutic doses [!!!] G6PD Deficiency Reference Guide Analgesics / Antipyretics acetanilid, acetophenetidin (phenacetin), (Quoted from Ernest Beutler, M.D., “Glucose-6- amidopyrine (aminopyrine) *, Phosphate Dehydrogenase Deficiency,” in Eryth- What is G6PD Deficiency? antipyrine *, aspirin *, phenacetin, rocyte disorders: Anemias due to increased destruc- probenicid, pyramidone tion of erythrocytes with enzyme deficiencies, p. 598.) Glucose-6-phosphate dehydrogenase likely to be affected by this condition than (G6PD) deficiency is the most common are females. Genetic testing is available to Miscellaneous Acetaminophen (paracetamol, Tylenol, human enzyme deficiency; it affects an identify a deficiency in G6PD in both alpha-methyldopa, ascorbic acid *, Tralgon, hydroxyacetanilide), estimated 400 million people worldwide. males and females. dimercaprol (BAL), hydralazine, Acetophenetidin (phenacetin), G6PD deficiency is also known as It is very important to tell any doctor or mestranol, methylene blue, nalidixic acid, Acetylsalicylic acid (aspirin) *, “favism,” since G6PD deficient individu- other health professional (such as nurse or naphthalene, niridazole, Aminopyrine (Pyramidon, amidopyrine) *, als are also allergic to fava beans. pharmacist) that you have G6PD Defi- phenylhydrazine, toluidine blue, Antazoline (Antistine), G6PD deficiency is a genetic condition ciency to avoid a possible harmful reaction trinitrotoluene, urate oxidase, vitamin Antipyrine *, that is inherited in an X-linked recessive to treatments they might prescribe. K * (water soluble), pyridium, quinine * Ascorbic acid (vitamin C) *, fashion. This means that males are more Benzhexol (Artane), Antimalarials Chloramphenicol, chloroquine *, hydroxychloroquine, Chlorguanidine (Proguanil, Paludrine), What happens if you have G6PD Deficiency? mepacrine (quinacrine), pamaquine, Chloroquine *, Colchicine, pentaquine, primaquine, quinine *, Diphenhydramine (Benadryl), Hemolytic anemia and prolonged neonatal natured, thus destroying its function as the quinocide Isoniazid, L-Dopa, Menadione sodium bisulfite (Hykinone), jaundice are the two major problems asso- principle oxygen carrying molecule. ciated with G6PD deficiency. Both of these In normal cells, NADPH would play a Cytotoxic / Antibacterial Menapthone, p-Aminobenzoic acid, problems are directly related to the inability role in removing these harmful oxidants chloramphenicol, co-trimoxazole, Phenylbutazone, Phenytoin, of specific cell types to regenerate a mol- from the cell. Among the drugs contra-in- furazolidone, furmethonol, nalidixic acid, Probenecid (Benemid), ecule called nicotinamide adenine dinucle- dicated for G6PD deficient individuals are neoarsphenamine, nitrofurantoin, Procain amide hydrochlonde (Pronestyl) *, otide phosphate in its reduced form aspirin and most anti-malarial drugs; for- nitrofurazone, para-aminosalicylic acid Pyrimethamine (Daraprim), Quinidine *, Quinine *, (NADPH); this reaction is normally cata- tunately, G6PD deficient individuals are re- lyzed by the G6PD enzyme. Aside from sistant to malarial infection. Treatments for Cardiovascular Drugs Streptomycin, neonatal jaundice, hemolytic anemia can hemolytic anemia include nasal oxygen, procainamide *, quinidine * Sulfacytine, Sulfadiazine, Sulfaguanidine, only arise when a person with G6PD Defi- bed rest, human haptoglobin products, ciency is exposed to certain chemicals; oth- folic acid, and blood transfusions. Sulfonamides / Sulfones Sulfamerazine, erwise, they live a normal life. Neonatal jaundice (a yellowing of the dapsone, sulfacetamide, Sulfamethoxypyridazine (Kynex), Hemolytic anemia is the decreased abil- mucous membranes and other body tissues sulfamethoxypyrimidine, sulfanilamide, Sulfisoxazole (Gantrisin), ity of red blood cells to transport oxygen at birth) is a common condition in all new- sulfapyridine, sulfasalazine, sulfisoxazole Trimethoprim, Tripelennamine (pyribenzamine), throughout the body; consequently, if you borns, but when it persists, G6PD defi- Vitamin K *. are having a hemolytic crisis, you will prob- ciency is suspected. The newborn becomes Miscellaneous to Avoid ably feel tired and out of breath, and may jaundiced as a result of decreased activity have a dark colored urine. Certain oxida- of G6PD in the liver. This can be a poten- Fava Beans * These drugs appear in both lists. Most tive drugs, infections, or fava beans (and the tially serious problem as it can cause severe (Few also avoid red wine, all legumes, prefer to avoid them altogether. If you pollen from the fava bean plant) can cause do take these, please remember to take neurological complications. Jaundiced ba- blueberries [and yogurts containing these], only normal therapeutic doses. this. When any one of these agents enters bies are placed under special lights, called soya products, tonic water, camphor). the red blood cell, hemoglobin becomes de- bili-lights, to alleviate the jaundice. Frequently Asked Questions What are the symptoms of hemolytic anemia? Am I having a reaction? How do I get G6PD Deficiency? You will begin to feel tired, short of breath, have an irregular heart beat, and may have a G6PD Deficiency is an inherited condition; therefore, you can not get it from being in dark orange urine. contact with someone who has G6PD Deficiency. Since it is inherited, there is no cure. Can I donate blood if I have G6PD Deficiency? What are the chances of passing it on to my kids? No! Currently the Red Cross does not accept G6PD deficient blood. If the father is G6PD Deficient and the mother is not affected: • Having a girl who is G6PD Deficient (0%) How would you call fava beans in other languages? • Having a boy who is G6PD Deficient (0%) Arabic: Foolle; • Having a girl who is a carrier (no clinical symptoms) of G6PD Deficiency (100%) Catalan: Fava; If the father is G6PD Deficient and the mother is a carrier: Chinese: Tzan-Doo; • Having a girl who is G6PD Deficient (50%) Dutch: Tuinboon; • Having a girl who is a carrier (50%) Farsi (Persian): Ba-ghe-Leh; • Having a boy who is G6PD Deficient (50%) English: Fava or Broad Bean; If the father is unaffected and the mother is a carrier: French: Fève; • Having a girl who is G6PD Deficient (0%) German: Favabohnen (Fava bean), Dicke Bohnen (thick bean), Saubohnen (sow bean); • Having a girl who is a carrier (50%) Greek: Koukia (“Fava” is an appetizer made from dried fava beans); • Having a boy who is G6PD Deficient (50%) Italian: Fava (pl. fave); Malay: Kacang Kuda; Spanish: Haba; Turkish: Bakla (“Fava” is an appetizer made from dried fava beans); Healthy Carrier Deficient Healthy Deficient Carrier Urdo (Pakistan and India): Lobhiya, Rajma, Jheam. XY (X)X (X)Y XX (X)Y (X)X [Excerpted from the Favism & G6PD Deficiency Forum]

For a more thorough discourse, go to: http://www.rialto.com/g6pd http://www.rialto.com/favism X(X) XX (X)Y XY (X)X (X)X XY XY (X)(X) (X)X (X)Y XY http://www.rialto.com/cgibin/htz?favforum.hts (discussion of common issues) 25% 25% 25% 25% 25% 25% 25% 25% 25% 25% 25% 25% You may also join our mailing list where you can exchange opinions and consult with other members (http://www.rialto.com/favism/newslist.htm). Drawing from P. Marradi et al., “The Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency: A Review”, Medico e Bambino 8 (1993), 538-42.

Written by Ramez Ethnasios (G6PD Site; [email protected]) Edited and Set by Chanan Zass (Favism Site; [email protected])

What precautions can I take to ensure my health living with While all effort has been made to ensure that the information offered here is correct and up-to-date, neither the G6PD Deficiency? authors of included content, nor the Favism Site and G6PD Deficiency Site their employees, affiliates, agents and Do not take any of the medications listed in this brochure (or medications similar to third party information providers warrant that the information is accurate and complete. Under no circumstances

shall the above be liable for any direct, indirect, incidental, special or consequential damages that result from the 1999 3, June them) without consulting a physician. Also avoid fava beans (and the plant). Always tell use of said information, nor shall they be liable for errors or omissions. any health provider you see that you have G6PD Deficiency (and give them this list). The purpose of this brochure is to offer the reader a background information on favism and G6PD Deficiency. No recommendation brought herein should be followed without prior consultation with your physician.