What common drugs are contraindicated in patients with glucose-6-phosphate dehydrogenase deficiency?📝📝📝

In recent years, broad beans and their products have become a favorite
snack for many people. However, some children will experience physical discomfort such as fever, chills, headache, dizziness, fatigue, abdominal pain or vomiting after eating these foods, and even dark yellow urine or jaundice. If children have the above symptoms after eating broad beans and their products for the first time, they may have glucose-6-phosphate dehydrogenase deficiency. 

What is glucose-6-phosphate dehydrogenase deficiency?

Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency) is also called favism. Human red blood cell membranes have an enzyme called glucose-6-phosphate dehydrogenase (G6PD). It is involved in the process by which red blood cells metabolize glucose. In the process, it produces a substance that protects red blood cells from being damaged by oxides. If people eat oxidative foods or drugs in the absence of G6PD, red blood cells will be easily destroyed by them and acute hemolysis will occur. Since most patients developed acute hemolysis within 48 hours of eating fresh broad beans or their products, G6PD deficiency is also known as favism.

What are the clinical manifestations of glucose-6-phosphate dehydrogenase deficiency?

In patients with G6PD deficiency, the onset is generally acute. Its incubation period can range from 2 hours to 15 days, but is generally 1 to 2 days. 

1. Prodromal symptoms include fever, dizziness, abdominal pain, nausea, vomiting, fatigue, and general malaise, which generally last for 1 to 2 days.
2. The manifestations of acute intravascular hemolytic anemia include rapid onset of jaundice, pale complexion, and dark yellow urine. Some patients also develop spleen and liver enlargement.
3. Severely ill patients may experience convulsions, lethargy, coma, severe anemia, acute renal failure, shock, and systemic failure.

What are the main causes of Glucose-6-Phosphate Dehydrogenase Deficiency?

1. Eating broad beans and their products, contacting broad bean pollen.
2. Nursing mothers ate fava beans and their products, or were exposed to broad bean pollen.
3. Taking medicines (such as antipyretic analgesics, some antimalarial drugs, or sulfonamides, etc.).
4. Infections: Viral infections (eg, flu, typhoid, mumps, pneumonia, hepatitis, etc.).

G6PD deficiency is most common in children under 5 years of age, and is more common in men than women. It is an inherited blood disorder. Therefore, it cannot be cured, but it can be prevented.

Why does glucose-6-phosphate dehydrogenase deficiency occur mainly in children?

Some studies suggest that it may be due to poor digestion, abnormal intestinal permeability and the easy entry of broad bean protein into children's bodies. In addition, some studies have pointed out that with the growth of children's age, the enzymes, liver, spleen and various physiological functions will gradually improve. At the same time, the human body will neutralize broad beans and some oxidative substances, so it will inhibit the pathogenesis of G6PD deficiency. 

Moreover, people with G6PD deficiency generally stop eating broad beans or other oxidative substances after they develop it in childhood. As a result, the incidence of G6PD deficiency in young and old is reduced.

What foods and drugs are contraindicated in patients with Glucose-6-Phosphate Dehydrogenase Deficiency?

Food: Broad beans and their products. Broad bean products include soy sauce, bean paste and other condiments. In terms of oxidative capacity, fresh fava beans will be stronger than cooked fava beans. In patients with favism, fresh fava beans will almost certainly cause hemolysis. In addition, broad bean pollen will almost certainly cause severe hemolysis in patients. Therefore, they should avoid visiting fava bean fields during the fava bean harvest season.

Mothballs: Naphthalene contained in mothballs can also cause acute hemolysis in patients with favism. Therefore, mothballs are prohibited in the patient's wardrobe. Once the clothes come into contact with mothballs, they must be exposed to the sun before the patient can wear them.

Topical medicines: The external use of salicylic acid and some Chinese herbal oils should also be prohibited by patients.

Traditional Chinese medicines: Patients should avoid using traditional Chinese medicines such as pearl powder, Sichuan lotus, bezoar, winter plum blossom, honeysuckle, and their proprietary Chinese medicines.

Medicines: Patients with favism should avoid self-medication and inform their doctor when seeking medical treatment. Patients with favism should try to avoid the following drugs:

• Antidiabetic drugs: such as glimepiride, gliclazide, glyburide, glipizide, etc.
• Antipyretic analgesics: such as aminopyrine, aspirin, acetaminophen, etc.
• Antimicrobial drugs: chloramphenicol, streptomycin, ciprofloxacin, moxifloxacin, levofloxacin, furazolidone, chloroquine, primaquine, etc.
• Vitamins: such as vitamin C, vitamin K1, vitamin K3, vitamin K4.
• Others: isosorbide nitrate, hydroxychloroquine, sulfasalazine, etc.
• In addition, levodopa, dopamine, phenytoin, diphenhydramine, chlorpheniramine, colchicine, and doxorubicin also have a lower risk.