G6pd Deficiency 613h4g
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Feeding and Caring for Babies with G6PD Deficiency or Favism Feeding your G6PD Deficient Baby By far the best milk for a baby with G6PD Deficiency is breast milk. The mother should avoid ALL contraindicated substances while breast feeding and also during pregnancy. See below. Unfortunately, not all mothers can breast feed, which can complicate matters for a G6PD Deficient baby. We have researched every baby formula we know about and ALL of them have contraindicated substances in them. Usually either soy or ascorbic acid or both. If you are unable to breast feed your baby we recommend fresh goat's milk as an alternative. You may supplement with vitamins, but unless specifically told to do so by a physician, we suggest moderation. More is not better. Natural (not man made) vitamin C is much better than ascorbic acid. Introduce solid foods as soon as your physician will allow it. The following website has some good information about goat's milk and also a recipe for home made formula. Goat's milk for babies If you are unable to get fresh goat's milk, canned goat's milk will work. If neither of them are available the next best would be fresh cow's milk and then evaporated (NOT CONDENSED) cow's milk. Evaporated milk should be diluted with water. Another possibility for milk for your baby is rice milk. One good thing about it is if you can't find it at the store, you can make your own. There are tons of rice milk recipes on the net. You will probably have to supplement with calcium and other vitamins though. Solid foods for G6PD Deficient Babies The best solid foods for your baby are those that you prepare yourself. If purchasing baby food from the store, be sure to check the ingredients carefully for soy products. Many times soy is disguised as lecithin or vegetable broth. To prepare baby food yourself, put food that you cook in a blender. It is a bit more trouble, but the food will be much better for your baby. Some Good First Foods For G6PD Deficient Babies First foods should be a single ingredient and can be given as soon as six months old. Ask your doctor for verification. Homemade foods are MUCH better and you have control over the ingredients. Salt and sugar should never be added to baby foods. Here's some examples. Rice cereal has been a staple first food for a long time. To make it, simply grind organic whole grain rice in a blender or food processor and thin with some breast milk or goat's milk. Avocados and bananas are also great first foods and they are simple to prepare and contain folate, which they need for blood production. Just remove the meat and mash with a fork. Add breast milk or goat's milk to thin or rice cereal to thicken.
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Pears, yams/sweet potatoes and winter squash are prepared by steaming or baking until tender and then processing in a blender or food processor. Add a bit of breast milk or goat's milk to thin or rice cereal to thicken. Be sure to cool to warm before serving. Apple can be made into applesauce by peeling, coring and cutting into chunks. Just cover with water and boil until soft. Be sure to stir often and do not use aluminum pans. Drain, reserving water, and puree. Add some of he reserved water to thin or rice cereal to thicken. Serve lightly warm. Canned applesauce can also be used if it contains only apples or apples and water and nothing else. Pregnant and Nursing Mothers and G6PD Deficiency It is very important that you avoid ALL contraindicated substances while pregnant with or nursing a potentially G6PD Deficient baby. Be sure to eat lots of antioxidants as well. What to look for at birth Many times G6PD Deficient babies develop jaundice (yellow skin) shortly after birth. This condition can cause brain damage (or kernicterus) if severe enough and not treated. The usual treatment is placing the baby under special lights. Jaundice can be caused by hemolysis as well as other conditions. G6PD Deficiency What is G6PD deficiency? G6PD deficiency is an inherited condition. If someone is G6PD deficient their body does not produce enough of the enzyme glucose-6-phosphate dehydrogenase (G6PD). G6PD helps red blood cells to function properly. G6PD also protects red blood cells from certain substances that are harmful to the body. If a person with G6PD deficiency is exposed to these substances, their red blood cells can be damaged or destroyed. G6PD deficiency can be serious if it is not diagnosed. Otherwise, with proper care and the right precautions, a child with G6PD deficiency can live a normal and active life. What causes G6PD deficiency? G6PD deficiency is ed on from parent to child. A child inherits it from one or both parents. It can neither be prevented or provoked. However, the symptoms of G6PD deficiency can be triggered by certain medicine, foods, and substances. Read more on symptoms and triggers below. How common is G6PD deficiency? G6PD deficiency is the most common known enzyme deficiency in humans. An estimated 400 million people around the world are affected.
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In the Philippines, around 1 in 50 children are G6PD deficient. G6PD deficiency is more common in boys than in girls. How is G6PD deficiency diagnosed? G6PD deficiency is tested through a simple blood pricking procedure. If you are pregnant or have just given birth, the Department of Health and your doctor will strongly advise you to participate in the Newborn Screening Program. It is a heelprick procedure that tests for five congenital (or inherited) conditions, including G6PD deficiency. Because it is quite common among Filipinos, your baby should be tested for G6PD deficiency as soon as possible. Newborn screening is available in many health institutions including hospitals, lying-in centers, rural health units and health centers. If your baby is delivered at home, you may bring him to the nearest health institution that offers newborn screening. Besides the Newborn Screening Program, you or your child can be tested in one of the G6PD Confirmatory Centers. You can also ask your doctor to refer you to a testing center near you. It may take several tests to completely confirm if your child is affected with G6PD deficiency. Can G6PD deficiency be cured? There is no known cure for G6PD deficiency. It is a lifelong condition that cannot be outgrown. However, a child with G6PD deficiency can live an active, healthy and normal life as long as he is able to avoid the substances that can trigger G6PD deficiency symptoms. What are the symptoms of G6PD deficiency? If your child is G6PD deficient, he will have no symptoms unless he is exposed to one of the harmful substances that can trigger the breakdown of red blood cells. Your child's symptoms will depend on what the harmful substance was and how much of it he was exposed to. In milder cases, your child may not even show any symptoms.
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In more serious cases, hemolysis (or hemolytic anemia) -- the accelerated destruction of red blood cells -- may happen. If so, he may have these symptoms: • pale skin (among darker skinned children, check the lips and tongue for paleness) • fatigue • shortness of breath • rapid heart rate • jaundice (yellowing of skin and eyes) especially among newborns • dark, tea-colored urine If your child is showing these symptoms, take him to the nearest hospital Emergency Room immediately. He may need hospitalization and medical care. When the trigger has been removed or treated, the symptoms usually resolve themselves within a few weeks. What are the triggers that cause G6PD deficiency symptoms? The foods and drugs that can trigger hemolysis are known as oxidative substances. These triggers may come in the form of: • an illness, such as a bacterial or viral infection • some painkillers and fever-reducing medication • some antibiotics (particularly those with "sulf" in the generic name) • some anti-malarial medicine (particularly those with "quine" in the generic name) • some chemicals and substances like menthol and moth balls • some food and drinks like flava beans, legumes and soya These triggers should not be eaten, ingested, touched or inhaled. The Newborn Screening Reference Center has provided a comprehensive list of food, medicine and substances to avoid.
How do I care for my G6PD deficient child? The best thing you can do to protect your child from triggers. Make sure he is not exposed to triggers for hemolysis in the food, drink and medicines he is given. Stay well-informed about the food and medicines which contain oxidative substances. Keep your list of symptom triggers (oxidative substances) in a convenient place. Make several copies: one to carry with you, one for a permanent place in your home, and several others to readily give out when necessary. Always double-check food, beverage, and medicine labels
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against the list. Make sure that your relatives, caregivers and health care providers know that they have to be careful about your child's condition. Brief everyone who will be caring, feeding, and treating your child about G6PD deficiency. Provide them with a list of oxidative substances to avoid. Tell them about the symptoms to watch out for. Teach them to be vigilant about avoiding exposing your child to possible symptom triggers. Take your child to his pediatrician for regular health-care maintenance checkups to keep him healthy and free from infection. She will monitor your child's levels of red blood cells. She may also prescribe diet supplements such as iron and folic acid. Do not ignore infections and persistent fever. If your child is sick, bring him at once to his pediatrician. Your pediatrician can give you more information about caring for your child. She may also refer you to a group if one is operating in your area. In Manila, the Institute of Human Genetics (of the National Institute of Health) at the U.P.-Philippine General Hospital conducts regular activities designed to spread awareness about G6PD deficiency and other genetic illnesses. You may also get in touch with the National Institute of Health for your concerns. As your child grows up, talk to him about G6PD deficiency. Honestly explain what the condition is about as simply and gently as you can. Let him know that he can be just like his friends as long as he takes care to avoid the food, drink, medicine and substances that may make him sick.
http://www.babycenter.com.ph/a1043402/g6pd-deficiency#ixzz2LrINjLI4 G6PD Medicines to avoid Contraindicated Vs. Allergy G6PD Deficiency does not cause individuals to be allergic to the substances below as commonly believed. An allergy causes itchy eyes, runny nose, etc. whereas in a person with G6PD Deficiency these substances cause red blood cells to burst (hemolysis) and can lead to hemolytic anemia. G6PD Deficiency Drugs to Avoid and Other Contraindicated Substances Low Risk drugs, medicine, foods and other substances below MAY be safe at normal theraputic doses. People with Class 1 G6PD Deficiency (ie: Mediterranean variant among others) may still react to low risk substances. Consult with your physician before using any of these substances.
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We try our best to keep this list up to date, but the constant influx of new drugs, medicines and research makes this task quite difficult. To be safe the following classes of drugs, medicines and other substances should be avoided if at all possible. 1. 2. 3. 4. 5. 6. 7. 8.
NSAIDS (Asprin, Ibuprophen) Tylenol Quinolones Drugs metabolized through the liver or known to cause blood or liver related problems or hemolysis Sulfa drugs Petrochemically derived substances (This is a long list and gets longer every year. Many artificial foods, dyes and vitamins are included in this list.) Moth Balls and anything containing naphthalene. Artificial Food Coloring (Methylene and Toluidine blue)
When in doubt, the safest course of action is to avoid the substance. If you react to something not on this list, avoid that substance in the future. Watch carefully for hemolysis signs at all times. To learn more about a substance (including information links, synonyms, notes, etc), click on the substance name. To just see a list of synonyms, click on the Synonym link. Acetaminophen
Analgesics / Antipyretics
C8H9NO2
Low Risk - Synonyms
N-(4-hydroxyphenyl)acetamide
Antazoline
Antihistamine
C17H19N3
Low Risk - Synonyms
N-benzyl-N-(4,5-dihydro-1H-imidazol-2-ylmethyl)aniline Acetanilid
Analgesics
C8H9NO
High Risk - Synonyms
N-phenylacetamide
Antipyrine
Analgesics / Antipyretics
C11H12N2O
Low Risk - Synonyms
2,3-DIMETHYL-1-PHENYL-3-PYRAZOLIN-5-ONE Acetylphenylhydrazine
Antimicrobial
C8H10N2O
High Risk - Synonyms
1-Acetyl-2-phenylhydrazine, Acetylphenylhydrazine
Ascorbic Acid
Vitamin
C6H8O6
Low Risk - Synonyms
(R)-3,4-dihydroxy-5-((S)- 1,2-dihydroxyethyl)furan-2(5H)-one Aminophenazone
Analgesics
C13H17N3O
High Risk - Synonyms
4-dimethylamino-1,5-dimethyl-2-phenyl-pyrazol-3-one
Aspirin
Anti Inflammatory
C9H8O4
High Risk - Synonyms
7|Page 2-acetyloxybenzoic acid
Astemizole
Antihistamine
C28H31FN4O
Low Risk - Synonyms
1-[(4-fluorophenyl)methyl]-N-[1-[2-(4-methoxyphenyl)ethyl]-4 piperidyl]-benzoimidazol-2-amine
Beta-Naphthol
Miscellaneous
C10H8O
High Risk - Synonyms
2-Naphthol
Celebrex
Sulfa Drug
C17H14F3N3O2S
High Risk - Synonyms
4-[5-(4-methylphenyl)- 3-(trifluoromethyl)-1H-pyrazol-1-yl] benzenesulfonamide
Colchicine
Anti Inflammatory
C22H25NO6
Low Risk - Synonyms
(S)-N-(5,6,7,9-tetrahydro-1,2,3,10-tetramethoxy-9-oxobenzo[a ] heptalen-7-yl) acetamide
Dapsone
Sulfones
C12H12N2O2S
High Risk - Synonyms
4-(4-aminophenyl)sulfonylaniline
Dimercaprol
Miscellaneous
C3H8OS2
High Risk - Synonyms
2,3-Dimercaptopropanol
Diphenhydramine
Antihistamine
C17H21NO
Low Risk - Synonyms
2-benzhydryloxy-N,N-dimethyl-ethanamine Chloramphenicol
Antibacterial
C11H12C12N2O5
High Risk - Synonyms
2,2-dichloro-N-[1,3-dihydroxy-1-(4-nitrophenyl)-propan-2-yl] acetamide
Dopamine
Anti-epileptic
C8H11NO2
Low Risk - Synonyms
4-(2-aminoethyl)benzene-1,2-diol Chloroquine
Antimalarials
C18H26ClN3
High Risk - Synonyms
Doxorubicin
Chemotherapeutic
N'-(7-chloroquinolin-4-yl)-N,N-diethyl-pentane-1,4-diamine
C27H29NO11
High Risk - Synonyms
Ciprofloxacin
Quinolones
10-(4-amino-5-hydroxy-6-methyl-oxan-2-yl)oxy-6,8,11-t rihydroxy-8-(2-hydroxyacetyl)-1-methoxy-9,10-dihydro-7H-tetr acene-5,12-dione
C17H18FN3O3
High Risk - Synonyms
1-cyclopropyl-6-fluoro-4-oxo-7-piperazin-1-yl-quinoline-3-ca rboxylic acid
Ethanol
Disinfectants
C2H6O
High Risk - Synonyms
8|Page Ethanol
C13H18O2
Low Risk - Synonyms
2-[4-(2-methylpropyl)phenyl]propanoic acid Furazolidone
Antibiotics
C8H7N3O5
High Risk - Synonyms
3-[(5-nitro-2-furyl)methylideneamino]oxazolidin-2-one
Isobutyl Nitrite
Miscellaneous
C4H9NO2
High Risk - Synonyms
Nitrous acid, 2-methylpropyl ester Furosemide
Diuretic
C12H11ClN2O5S
High Risk - Synonyms
4-chloro-2-(furan-2-ylmethylamino)-5-sulfamoylbenzoic acid
Isoniazid
Antibiotics
C6H7N3O
Low Risk - Synonyms
pyridine-4-carbohydrazide Gadopentetate dimeglumine
Contrast Agent
C28H54GdN5O20
High Risk - Synonyms
Lamotrigine
Antidepressants
2-[bis[2-[carboxymethyl-(2-oxido-2-oxoethyl)amino]ethyl]amin o]acetate; gadolinium(+3) cation; (2R,3R,4R,5S)-6methylaminohexane-1,2,3,4,5-pentol
C9H7Cl2N5
High Risk - Synonyms
Glucosulfone
Miscellaneous
Levofloxacin
Anti-bacterial
C24H34N2Na2O18S3
High Risk - Synonyms
C36H42F2N6O9
High Risk - Synonyms
Glyburide
Antidiabetic Agent
(-)-(S)-9-fluoro-2,3-dihydro-3-methyl-10-(4-methyl-1-piperaz inyl)-7-oxo-7Hpyrido[1,2,3-de]-1,4 benzoxazine-6-carboxylic acid hemihydrate
C32H28ClN3O5S
High Risk - Synonyms
5-chloro-N-[2-[4-(cyclohexylcarbamoylsulfamoyl)phenyl]ethyl] 2-methoxy-benzamide
Henna
Miscellaneous
C10H6O3
High Risk - Synonyms
4-hydroxynaphthalene-1,2-dione
Ibuprofen
Analgesics / Antipyretics
6-(2,3-dichlorophenyl)-1,2,4-triazine-3,5-diamine
Lisinopril
Antihypertensive Agents
C21H31N3O5
Low Risk - Synonyms
(2S)-1-[(2S)-6-amino-2-{[(1S)-1-carboxy-3-phenylpropyl]amino }hexanoyl]pyrrolidine-2-carboxylic acid
Magnevist
Contrast Agent
C28H54GdN5O20
Low Risk - Synonyms
2-[bis[2-[carboxymethyl-(2-oxido-2-oxoethyl)amino]ethyl]amin o]acetate; gadolinium(+3) cation; (2R,3R,4R,5S)-6-
9|Page methylaminohexane-1,2,3,4,5-pentol
1-carbamimidamido-N,N-dimethylmethanimidamide
Mefloquine
Anitmalarials
Methylene Blue
Miscellaneous
C17H16F6N2O
High Risk - Synonyms
C16H18ClN3S
High Risk - Synonyms
[2,8-bis(trifluoromethyl)quinolin-4-yl]-piperidin-2-ylmethan ol
3,7-Bis(dimethylamino)phenazathionium chloride
Menadiol Sodium Sulfate (Vitamin k4 sodium sulfate)
Miscellaneous
Mirtazapine
Antidepressant
C17H19N3
Low Risk - Synonyms
C11H8Na2O8S2
High Risk - Synonyms 1,2,3,4,10,14b-hexahydro-2-methylpyrazino[2,1-a]pyrido[2,3-c ][2]benzazepine
Menadione
Miscellaneous
C11H8O2
High Risk - Synonyms
2-methylnaphthalene-1,4-dione
Moxifloxacin
Anti-bacterial
C21H24FN3O4
High Risk - Synonyms
1-cyclopropyl-7-[(1S,6S)-2,8-diazabicyclo[4.3.0]non-8-yl]-6fluoro-8-methoxy-4-oxo-quinoline-3-carboxylic acid Menadione sodium Bisulfite Miscellaneous (Vitamin K3 sodium bisulfite) C11H8O2NaHSO3
Nalidixic Acid
Antibacterial
C12H12N2O3
High Risk - Synonyms
High Risk - Synonyms
1-ethyl-7-methyl-4-oxo-[1,8]naphthyridine-3-carboxylic acid Menthol
Miscellaneous
C10H20O
High Risk - Synonyms
2-(2-Propyl)-5-methylcyclohexanol
Naphthalene
Miscellaneous
C10H8
High Risk - Synonyms
Naphthalene Mesalazine
Anti Inflammatory
C7H7NO3
High Risk - Synonyms
5-amino-2-hydroxy-benzoic acid
Nimesulide
Anti-Inflammatory Agents
C13H12N2O5S
High Risk - Synonyms
N-[4-nitro-2-(phenoxy)phenyl]methanesulfonamide Metformin
Antidiabetic
C4H11N5
High Risk - Synonyms
Niridazole
Miscellaneous
10 | P a g e C6H6N4O3S
High Risk - Synonyms
1-(5-Nitro-2-thiazolyl)-2-imidazolinone
Pefloxacin
Anti-Infective
C17H20FN3O3
High Risk - Synonyms
1-ethyl-6-fluoro-7-(4-methylpiperazin-1-yl)-4-oxo-quinoline- 3carboxylic acid Nitrofurantoin
Cytotoxic / Antibacterial
C8H6N4O5
High Risk - Synonyms Pentaquine
Antimalarials
C18H27N3O
High Risk - Synonyms
1-[(5-nitro-2-furyl)methylideneamino]imidazolidine-2,4-dione
Nitrofurazone
Cytotoxic / Antibacterial
C6H6N4O4
High Risk - Synonyms
1-amino-N-[(5-nitro-2-furyl)methylideneamino]methanamide
Norfloxacin
Antibiotics
C16H18FN3O3
Low Risk - Synonyms
1-ethyl-6-fluoro-4-oxo-7-piperazin-1-yl-1H-quinoline-3-carbo xylic acid
1,5-Pentanediamine, N-(6-methoxy-8-quinolinyl)-N'-(1methylethyl)-
Phenacetin
Analgesics
C10H13NO2
High Risk - Synonyms
N-(4-ethoxyphenyl)ethanamide
Phenazopyridine
Miscellaneous
C11H11N5
High Risk - Synonyms
3-phenyldiazenylpyridine-2,6-diamine Oxidase, Urate
Miscellaneous
C1521H2381N417O461S7
High Risk - Synonyms Phenylbutazone
Anti-inflammatory
C19H20N2O2
Low Risk - Synonyms
Aspergilus urate oxidase
4-butyl-1,2-diphenyl-pyrazolidine-3,5-dione Pamaquine
Antimalarials
C42H45N3O7
High Risk - Synonyms Phenylhydrazine
Miscellaneous
C6H8N2
High Risk - Synonyms
N,N-diethyl-N'-(6-methoxyquinolin-8-yl)pentane-1,4-diamine
Phenylhydrazine Para-Aminobenzoic Acid
Miscellaneous
C7H7NO2
Low Risk - Synonyms Phenytoin
Anticonvulsants
C15H12N2O2
Low Risk - Synonyms
4-Aminobenzoic Acid
11 | P a g e 5,5-diphenylimidazolidine-2,4-dione
C20H24N2O2
Low Risk - Synonyms
(2-ethenyl-4-azabicyclo[2.2.2]oct-5-yl)-(6-methoxyquinolin-4 -yl)methanol Primaquine
Antimalarials
C15H21N3O
High Risk - Synonyms Quinine
Antimalarials
C20H24N2O2
Low Risk - Synonyms
N-(6-methoxyquinolin-8-yl)pentane-1,4-diamine
Probenecid
Analgesics / Antipyretics
C13H19NO4S
High Risk - Synonyms
4-[(dipropylamino)sulfonyl] benzoic acid
Procainamide
Cardiovascular Drugs
C13H21N3O
Low Risk - Synonyms
(2-ethenyl-4-azabicyclo[2.2.2]oct-5-yl)-(6-methoxyquinolin-4 -yl)methanol
Stibophen
Miscellaneous
C12H4Na5O16S4Sb
High Risk - Synonyms
2-(2-Oxido-3,5-Disulphonatophenoxy)-1,3,2,Benzodioxastibole4-6-Disulphonate
4-amino-N-(2-diethylaminoethyl)benzamide
Proguanil C11H16ClN5
Streptomycin
Anti-bacterial
C21H39N7O12
Low Risk - Synonyms
Antimalarial Low Risk - Synonyms
5-(2,4-diguanidino-3,5,6-trihydroxy-cyclohexoxy)-4-[4,5-dihy droxy-6-(hydroxymethyl)-3-methylamino-tetrahydropyran-2-yl]o xy-3-hydroxy-2-methyl-tetrahydrofuran-3-carbaldehyde
1-(4-chlorophenyl)-2-(N'-propan-2-ylcarbamimidoyl)guanidine
Pyrimethamine
Antimalarials
C12H13ClN4
Low Risk - Synonyms
Sulfacetamide
Sulfonamides / Sulfones
C8H10N2O3S
High Risk - Synonyms
N-acetyl-4-amino-benzenesulfonamide
5-(4-chlorophenyl)-6-ethyl-pyrimidine-2,4-diamine
Quinacrine C23H3OClN3 O
Sulfonamides / Sulfones
C12H14N4O3S
Low Risk - Synonyms
Antimalarials High Risk - Synonyms
N'-(6-chloro-2-methoxy-acridin-9-yl)-N,N-diethyl-pentane-1,4 diamine
Quinidine
Sulfacytine
Antiarrhythmic Agents / Antimalarials
4-amino-N-(6-methoxy-2-methylpyrimidin-4-yl)benzenesulfonami de
Sulfadiazine
Sulfonamides / Sulfones
C10H10N4O2S
Low Risk - Synonyms
12 | P a g e 4-amino-N-pyrimidin-2-yl-benzenesulfonamide
C6H8N2O2S
High Risk - Synonyms
4-aminobenzenesulfonamide Sulfadimidine
Sulfonamides / Sulfones
C12H14N4O2S
High Risk - Synonyms
4-amino-N-(4,6-dimethylpyrimidin-2-yl)benzenesulfonamide
Sulfapyridine
Sulfonamides / Sulfones
C11H11N3O2S
High Risk - Synonyms
4-amino-N-pyridin-2-ylbenzenesulfonamide Sulfafurazole
Sulfonamides / Sulfones
C11H13N3O3S
High Risk - Synonyms
4-amino-N-(3,4-dimethyl-1,2-oxazol-5-yl)benzenesulfonamide
Sulfasalazine
Sulfonamides / Sulfones
C18H14N4O5S
High Risk - Synonyms
2-hydroxy-5-[4-(pyridin-2-ylsulfamoyl)phenyl]diazenyl-benzoi c acid Sulfaguanidine
Miscellaneous
C7H10N4O2S
Low Risk - Synonyms Sulfathiazole
Cytotoxic / Antibacterial
C9H9N3O2S2
High Risk - Synonyms
4-Amino-N-(diaminomethylene)benzenesulfon Amide
4-amino-N-(1,3-thiazol-2-yl)benzenesulfonamide Sulfamerazine
Sulfonamides / Sulfones
C11H12N4O2S
Low Risk - Synonyms Sulfonylurea
Antidiabetic Agents
C21H27N5O4S
Low Risk - Synonyms
4-amino-N-(4-methylpyrimidin-2-yl)benzenesulfonamide
Sulfamethoxazole
Sulfonamides / Sulfones
C10H11N3O3S
High Risk - Synonyms
4-amino-N-(5-methyloxazol-3-yl)-benzenesulfonamide
Sulfamethoxypyridazine
Sulfonamides / Sulfones
C11H12N4O3S
Low Risk - Synonyms
1-cyclohexyl-3-[[p-[2-(5-methylpyrazinecarboxamido)ethyl]phe nyl] sulfonyl]urea
Sulfoxone
Antibacterial
C14H16N2O6S3
High Risk - Synonyms
[4-[4-(sulfinomethylamino)phenyl]sulfonylphenyl]aminomethane sulfinic acid
4-Amino-N-(6-methoxy-3-pyridazinyl)-benzenesulfonamide
Sulfanilamide
Tamsulosin
Sulfonamides
C20H28N2O5S
High Risk - Synonyms
Chemotherapeutic 5-[2-[2-(2-ethoxyphenoxy)ethylamino]propyl]-2-methoxy-benzen esulfonamide
13 | P a g e C14H18N4O3 Tiaprofenic Acid
Anti Inflammatory
C14H12O3S
Low Risk - Synonyms
2-[5-(benzoyl)thiophen-2-yl]propanoic acid
Toluidine Blue
Miscellaneous
C15H16N3SCl
High Risk - Synonyms
Low Risk - Synonyms
5-[(3,4,5-trimethoxyphenyl)methyl]pyrimidine-2,4-diamine
Trinitrotoluene
Miscellaneous
C7H5N3O6
High Risk - Synonyms
2-methyl-1,3,5-trinitrobenzene
3-Amino-7-(dimethylamino)-2-methylphenothiazin-5-ium Chloride
Tripelennamine
Antihistaminic
C16H21N3
Low Risk - Synonyms
N-benzyl-N',N'-dimethyl-N-pyridin-2-yl-ethane-1,2-diamine Trihexyphenidyl
Antiparkinson Agents
C20H31NO
Low Risk - Synonyms Vitamin K1
Miscellaneous
C31H46O2
Low Risk - Synonyms
1-cyclohexyl-1-phenyl-3-(1-piperidyl)propan-1-ol
Phytomenadione Trimethoprim
Antimalarials / Antibacterial
G6PD Deficiency Food To Avoid
Some of the foods commonly eaten around the world can cause people with G6PD Deficiency tohemolyze. Some of these foods can be deadly (like fava beans). Some others can cause low level hemolysis, which means that red blood cells die, but not enough to cause the person to go to the hospital. Low level hemolysis over time can cause other problems, such as memory dysfunction, overworked spleen, liver, kidney and heart, and iron overload. Even though a G6PD Deficient person may not have a crises when consuming these foods, they should be avoided.
Fava Beans and other legumes This list contains every legume we could find, but there may be other names for them that we do not know about. Low level hemolysis is very hard to detect and can cause other problems, so we recommend the avoidance of all legumes.
Sulfites
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and foods containing them. Sulfites are used in a wide variety of foods, so be sure to check labels carefully.
Menthol and foods containing it. This can be difficult to avoid as tooth paste, candy, breath mints, mouth wash and many other products have menthol added to them. Mint from natural mint oils is alright to consume.
Artificial blue food coloring other artificial food color can also cause hemolysis. Natural food color such as found in foods like turmeric or grapes is okay.
Ascorbic acid Artificial ascorbic acid commonly put in food and vitamins can cause hemolysis in Large doses and should be avoided. It is put into so many foods that you can be getting a lot ofAscorbic Acid without realizing it. See Ascorbic Acid for more information about iron absorbtion and ascorbic acid.
Vitamin K This is from drugbank: "Menadione (vitamin K3), which is not used as a nutritionalsupplemental form of vitamin K for humans, has been reported to cause adverse reactions, including hemolytic anemia. Large doses have also been reported to cause brain damage. Vitamin K istered to newborns with G6PD Deficiency has been known to cause adverse outcomes including hemolytic anemia, neonatal brain or liver damage, or neonatal death in some cases."
Tonic water
(contains quinine, a contraindicated drug which causes hemolysis in G6PDD people).
Bitter Gourd and Garden Egg Bitter Gourd is also known as Bitter Mellon. These are common foods in some parts of Africa and Asia.
Some Chinese herbs
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particularly Rhizoma Coptidis (huang lien), Calculus Bovis (neu huang), Flos Chimonanthi Praecocis (leh mei hua), Flos Lonicerae (kam ngan fa) and Margarita oranything containing them. Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive hereditary disease characterised by abnormally low levels of glucose-6-phosphate dehydrogenase (abbreviated G6PD or G6PDH), a metabolic enzyme involved in the pentose phosphate pathway, especially important in red blood cellmetabolism. Individuals with the disease may exhibit nonimmune hemolytic anemia in response to a number of causes, most commonly infection or exposure to certain medications or chemicals. G6PD deficiency is closely linked to favism, a disorder characterized by a hemolytic reaction to consumption of broad beans, with a name derived from the Italian name of the broad bean (fava). The name favism is sometimes used to refer to the enzyme deficiency as a whole, although this is misleading as not all people with G6PD deficiency will react to consumption of broad beans. G6PD deficiency is the most common human enzyme defect. The most common medical problem associated with glucose-6-phosphate dehydrogenase deficiency is hemolytic anemia, which occurs when red blood cells are destroyed faster than the body can replace them. This type of anemia leads to paleness, yellowing of the skin and whites of the eyes (jaundice), dark urine, fatigue, shortness of breath, and a rapid heart rate. In people with glucose-6-dehydrogenase deficiency, hemolytic anemia is most often triggered by bacterial or viral infections or by certain drugs (such as some antibiotics and medications used to treat malaria). Hemolytic anemia can also occur after eating fava beans or inhaling pollen from fava plants (a reaction called favism). Favism may be formally defined as a haemolytic response to the consumption of broad beans. All individuals with favism show G6PD deficiency. However, not all individuals with G6PD deficiency show favism. For example, in a small study of 757 Saudi men, more than 42% showed G6PD deficiency, but none reported symptoms of favism, despite fava in the diet.[2] Favism is known to be more prevalent in infants and children, and G6PD genetic variant can influence chemical sensitivity. Other than this, the specifics of the chemical relationship between favism and G6PD are not well understood. Symptoms Dark urine Enlarged spleen Paleness Rapid heart rate Shortness of breath Yellow skin color (jaundice) Note: Severe hemolysis may cause hemoglobinuria(hemoglobin in the urine).
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Diagnosis The diagnosis is generally suspected when patients from certain ethnic groups (see below) develop anemia,jaundice and symptoms of hemolysis after challenge to any of the above causes, especially when there is a positive family history. Generally, tests will include: Complete blood count and reticulocyte count; in active G6PD, Heinz bodies can be seen in red blood cells on ablood film; Liver enzymes (to exclude other causes of jaundice); Lactate dehydrogenase (elevated in hemolysis and a marker of hemolytic severity) Haptoglobin (decreased in hemolysis); A "direct antiglobulin test" (Coombs' test) - this should be negative, as hemolysis in G6PD is not immune-mediated; Treatment The most important measure is prevention - avoidance of the drugs and foods that cause hemolysis. Vaccinationagainst some common pathogens (e.g. hepatitis A andhepatitis B) may prevent infection-induced attacks.[11] In the acute phase of hemolysis, blood transfusionsmight be necessary, or even dialysis in acute renal failure. Blood transfusion is an important symptomatic measure, as the transfused red cells are generally not G6PD deficient. Some patients benefit from removal of the spleen(splenectomy),[12] as this is an important site of red cell destruction. Folic acid should be used in any disorder featuring a high red cell turnover. Although vitamin E andselenium have antioxidant properties, their use does not decrease the severity of G6PD. Alternative treatment Vitamin E and folic acid (both anti-oxidants) may help decrease hemolysis in G6PD-deficient individuals.
) If the father is unaffected (healthy) and the mother is a carrier (no clinical symptoms): One daughter out of two will be a carrier One son out of two will be G6PD deficient B) If the father is G6PD deficient and the mother is unaffected: All sons will be unaffected C) If the father is G6PD deficient and the mother is a carrier:
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One daughter out of two will be G6PD deficient
D) If the father is unaffected and the mother is G6PD deficient: All sons will be G6PD deficient E) If both father and mother are G6PD deficient: All daughters will be G6PD deficient
TIPS FOR PARENTS Any boy suffering from Favism should be informed of his deficiency so he can help himself avoid the intake of the forbidden foodstuff in various situations where he is not under your supervision (such as school). You should also inform school supervisors and, where applicable, also the school caterers who provide school lunch. Best is to carry with you the To Avoid list and show it to all those who may treat your boy. How do you care for babies with G6PD deficiency? Parents should take proper precautions when caring for a child with G6PD deficiency. The main thing is keep your child from being exposed to triggers of G6PD deficiency symptoms. Newborns with G6PD deficiency may suffer from prolonged and more severe levels of jaundice. Often, if the levels are too high, mothers are advised to stop breast feeding their infants for a short period of time by paediatricians as breast milk might interfere with the liver’s ability to conjugate bilirubin. After being discharged from hospitals, breast-feeding mothers should avoid consuming certain types of food and medications which might induce anaemic hemolysisin G6PD deficient babies. The list of food and drugs to avoid is fairly similar to the ones a G6PD deficient person should avoid. Analgesics, anti-malarials, sulphonamide drugs should be strictly avoided. the number of drugs that should be avoided is fairly comprehensive. To be on the safe side, make sure every medication for your child is acquired via doctor’s prescription. Both breast-feeding mother and child must avoid fava beans (broad beans). Fava bean remains the most common food to avoid for G6PD deficient individuals. Keep your child away from mothballs. Do not let them touch or get close enough to inhale the scent of mothballs. If your newborn inherits some hand-me-down clothes, make sure to wash the clothes clean before your baby wears them. You’d never know the clothes may have been stored in close vicinity to mothballs. Choose milk formulaes which have no traces of soya or soybeans.
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Observe your child’s diet by carefully introducing legumes such as peas, beans, lentil or various types of beans. Some people with G6PD deficiency avoid legumes, but not all. Most people shows no symptoms. Soy products, blueberries and red wine are also trigger symptoms of G6PD deficiency but again, does not necessary affect all people. Peppermint oil should not be used around your child’s face. In fact, breastfeeding mothers themselves should refrain from using peppermint oil too.
Feeding and Caring for Babies with G6PD Deficiency or Favism Feeding your G6PD Deficient Baby By far the best milk for a baby with G6PD Deficiency is breast milk. The mother should avoid ALL contraindicated substances while breast feeding and also during pregnancy. See below. Unfortunately, not all mothers can breast feed, which can complicate matters for a G6PD Deficient baby. We have researched every baby formula we know about and ALL of them have contraindicated substances in them. Usually either soy or ascorbic acid or both. If you are unable to breast feed your baby we recommend fresh goat's milk as an alternative. You may supplement with vitamins, but unless specifically told to do so by a physician, we suggest moderation. More is not better. Natural (not man made) vitamin C is much better than ascorbic acid. Introduce solid foods as soon as your physician will allow it. The following website has some good information about goat's milk and also a recipe for home made formula. Goat's milk for babies If you are unable to get fresh goat's milk, canned goat's milk will work. If neither of them are available the next best would be fresh cow's milk and then evaporated (NOT CONDENSED) cow's milk. Evaporated milk should be diluted with water. Another possibility for milk for your baby is rice milk. One good thing about it is if you can't find it at the store, you can make your own. There are tons of rice milk recipes on the net. You will probably have to supplement with calcium and other vitamins though. Solid foods for G6PD Deficient Babies The best solid foods for your baby are those that you prepare yourself. If purchasing baby food from the store, be sure to check the ingredients carefully for soy products. Many times soy is disguised as lecithin or vegetable broth. To prepare baby food yourself, put food that you cook in a blender. It is a bit more trouble, but the food will be much better for your baby. Some Good First Foods For G6PD Deficient Babies First foods should be a single ingredient and can be given as soon as six months old. Ask your doctor for verification. Homemade foods are MUCH better and you have control over the ingredients. Salt and sugar should never be added to baby foods. Here's some examples. Rice cereal has been a staple first food for a long time. To make it, simply grind organic whole grain rice in a blender or food processor and thin with some breast milk or goat's milk. Avocados and bananas are also great first foods and they are simple to prepare and contain folate, which they need for blood production. Just remove the meat and mash with a fork. Add breast milk or goat's milk to thin or rice cereal to thicken.
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Pears, yams/sweet potatoes and winter squash are prepared by steaming or baking until tender and then processing in a blender or food processor. Add a bit of breast milk or goat's milk to thin or rice cereal to thicken. Be sure to cool to warm before serving. Apple can be made into applesauce by peeling, coring and cutting into chunks. Just cover with water and boil until soft. Be sure to stir often and do not use aluminum pans. Drain, reserving water, and puree. Add some of he reserved water to thin or rice cereal to thicken. Serve lightly warm. Canned applesauce can also be used if it contains only apples or apples and water and nothing else. Pregnant and Nursing Mothers and G6PD Deficiency It is very important that you avoid ALL contraindicated substances while pregnant with or nursing a potentially G6PD Deficient baby. Be sure to eat lots of antioxidants as well. What to look for at birth Many times G6PD Deficient babies develop jaundice (yellow skin) shortly after birth. This condition can cause brain damage (or kernicterus) if severe enough and not treated. The usual treatment is placing the baby under special lights. Jaundice can be caused by hemolysis as well as other conditions. G6PD Deficiency What is G6PD deficiency? G6PD deficiency is an inherited condition. If someone is G6PD deficient their body does not produce enough of the enzyme glucose-6-phosphate dehydrogenase (G6PD). G6PD helps red blood cells to function properly. G6PD also protects red blood cells from certain substances that are harmful to the body. If a person with G6PD deficiency is exposed to these substances, their red blood cells can be damaged or destroyed. G6PD deficiency can be serious if it is not diagnosed. Otherwise, with proper care and the right precautions, a child with G6PD deficiency can live a normal and active life. What causes G6PD deficiency? G6PD deficiency is ed on from parent to child. A child inherits it from one or both parents. It can neither be prevented or provoked. However, the symptoms of G6PD deficiency can be triggered by certain medicine, foods, and substances. Read more on symptoms and triggers below. How common is G6PD deficiency? G6PD deficiency is the most common known enzyme deficiency in humans. An estimated 400 million people around the world are affected.
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In the Philippines, around 1 in 50 children are G6PD deficient. G6PD deficiency is more common in boys than in girls. How is G6PD deficiency diagnosed? G6PD deficiency is tested through a simple blood pricking procedure. If you are pregnant or have just given birth, the Department of Health and your doctor will strongly advise you to participate in the Newborn Screening Program. It is a heelprick procedure that tests for five congenital (or inherited) conditions, including G6PD deficiency. Because it is quite common among Filipinos, your baby should be tested for G6PD deficiency as soon as possible. Newborn screening is available in many health institutions including hospitals, lying-in centers, rural health units and health centers. If your baby is delivered at home, you may bring him to the nearest health institution that offers newborn screening. Besides the Newborn Screening Program, you or your child can be tested in one of the G6PD Confirmatory Centers. You can also ask your doctor to refer you to a testing center near you. It may take several tests to completely confirm if your child is affected with G6PD deficiency. Can G6PD deficiency be cured? There is no known cure for G6PD deficiency. It is a lifelong condition that cannot be outgrown. However, a child with G6PD deficiency can live an active, healthy and normal life as long as he is able to avoid the substances that can trigger G6PD deficiency symptoms. What are the symptoms of G6PD deficiency? If your child is G6PD deficient, he will have no symptoms unless he is exposed to one of the harmful substances that can trigger the breakdown of red blood cells. Your child's symptoms will depend on what the harmful substance was and how much of it he was exposed to. In milder cases, your child may not even show any symptoms.
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In more serious cases, hemolysis (or hemolytic anemia) -- the accelerated destruction of red blood cells -- may happen. If so, he may have these symptoms: • pale skin (among darker skinned children, check the lips and tongue for paleness) • fatigue • shortness of breath • rapid heart rate • jaundice (yellowing of skin and eyes) especially among newborns • dark, tea-colored urine If your child is showing these symptoms, take him to the nearest hospital Emergency Room immediately. He may need hospitalization and medical care. When the trigger has been removed or treated, the symptoms usually resolve themselves within a few weeks. What are the triggers that cause G6PD deficiency symptoms? The foods and drugs that can trigger hemolysis are known as oxidative substances. These triggers may come in the form of: • an illness, such as a bacterial or viral infection • some painkillers and fever-reducing medication • some antibiotics (particularly those with "sulf" in the generic name) • some anti-malarial medicine (particularly those with "quine" in the generic name) • some chemicals and substances like menthol and moth balls • some food and drinks like flava beans, legumes and soya These triggers should not be eaten, ingested, touched or inhaled. The Newborn Screening Reference Center has provided a comprehensive list of food, medicine and substances to avoid.
How do I care for my G6PD deficient child? The best thing you can do to protect your child from triggers. Make sure he is not exposed to triggers for hemolysis in the food, drink and medicines he is given. Stay well-informed about the food and medicines which contain oxidative substances. Keep your list of symptom triggers (oxidative substances) in a convenient place. Make several copies: one to carry with you, one for a permanent place in your home, and several others to readily give out when necessary. Always double-check food, beverage, and medicine labels
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against the list. Make sure that your relatives, caregivers and health care providers know that they have to be careful about your child's condition. Brief everyone who will be caring, feeding, and treating your child about G6PD deficiency. Provide them with a list of oxidative substances to avoid. Tell them about the symptoms to watch out for. Teach them to be vigilant about avoiding exposing your child to possible symptom triggers. Take your child to his pediatrician for regular health-care maintenance checkups to keep him healthy and free from infection. She will monitor your child's levels of red blood cells. She may also prescribe diet supplements such as iron and folic acid. Do not ignore infections and persistent fever. If your child is sick, bring him at once to his pediatrician. Your pediatrician can give you more information about caring for your child. She may also refer you to a group if one is operating in your area. In Manila, the Institute of Human Genetics (of the National Institute of Health) at the U.P.-Philippine General Hospital conducts regular activities designed to spread awareness about G6PD deficiency and other genetic illnesses. You may also get in touch with the National Institute of Health for your concerns. As your child grows up, talk to him about G6PD deficiency. Honestly explain what the condition is about as simply and gently as you can. Let him know that he can be just like his friends as long as he takes care to avoid the food, drink, medicine and substances that may make him sick.
http://www.babycenter.com.ph/a1043402/g6pd-deficiency#ixzz2LrINjLI4 G6PD Medicines to avoid Contraindicated Vs. Allergy G6PD Deficiency does not cause individuals to be allergic to the substances below as commonly believed. An allergy causes itchy eyes, runny nose, etc. whereas in a person with G6PD Deficiency these substances cause red blood cells to burst (hemolysis) and can lead to hemolytic anemia. G6PD Deficiency Drugs to Avoid and Other Contraindicated Substances Low Risk drugs, medicine, foods and other substances below MAY be safe at normal theraputic doses. People with Class 1 G6PD Deficiency (ie: Mediterranean variant among others) may still react to low risk substances. Consult with your physician before using any of these substances.
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We try our best to keep this list up to date, but the constant influx of new drugs, medicines and research makes this task quite difficult. To be safe the following classes of drugs, medicines and other substances should be avoided if at all possible. 1. 2. 3. 4. 5. 6. 7. 8.
NSAIDS (Asprin, Ibuprophen) Tylenol Quinolones Drugs metabolized through the liver or known to cause blood or liver related problems or hemolysis Sulfa drugs Petrochemically derived substances (This is a long list and gets longer every year. Many artificial foods, dyes and vitamins are included in this list.) Moth Balls and anything containing naphthalene. Artificial Food Coloring (Methylene and Toluidine blue)
When in doubt, the safest course of action is to avoid the substance. If you react to something not on this list, avoid that substance in the future. Watch carefully for hemolysis signs at all times. To learn more about a substance (including information links, synonyms, notes, etc), click on the substance name. To just see a list of synonyms, click on the Synonym link. Acetaminophen
Analgesics / Antipyretics
C8H9NO2
Low Risk - Synonyms
N-(4-hydroxyphenyl)acetamide
Antazoline
Antihistamine
C17H19N3
Low Risk - Synonyms
N-benzyl-N-(4,5-dihydro-1H-imidazol-2-ylmethyl)aniline Acetanilid
Analgesics
C8H9NO
High Risk - Synonyms
N-phenylacetamide
Antipyrine
Analgesics / Antipyretics
C11H12N2O
Low Risk - Synonyms
2,3-DIMETHYL-1-PHENYL-3-PYRAZOLIN-5-ONE Acetylphenylhydrazine
Antimicrobial
C8H10N2O
High Risk - Synonyms
1-Acetyl-2-phenylhydrazine, Acetylphenylhydrazine
Ascorbic Acid
Vitamin
C6H8O6
Low Risk - Synonyms
(R)-3,4-dihydroxy-5-((S)- 1,2-dihydroxyethyl)furan-2(5H)-one Aminophenazone
Analgesics
C13H17N3O
High Risk - Synonyms
4-dimethylamino-1,5-dimethyl-2-phenyl-pyrazol-3-one
Aspirin
Anti Inflammatory
C9H8O4
High Risk - Synonyms
7|Page 2-acetyloxybenzoic acid
Astemizole
Antihistamine
C28H31FN4O
Low Risk - Synonyms
1-[(4-fluorophenyl)methyl]-N-[1-[2-(4-methoxyphenyl)ethyl]-4 piperidyl]-benzoimidazol-2-amine
Beta-Naphthol
Miscellaneous
C10H8O
High Risk - Synonyms
2-Naphthol
Celebrex
Sulfa Drug
C17H14F3N3O2S
High Risk - Synonyms
4-[5-(4-methylphenyl)- 3-(trifluoromethyl)-1H-pyrazol-1-yl] benzenesulfonamide
Colchicine
Anti Inflammatory
C22H25NO6
Low Risk - Synonyms
(S)-N-(5,6,7,9-tetrahydro-1,2,3,10-tetramethoxy-9-oxobenzo[a ] heptalen-7-yl) acetamide
Dapsone
Sulfones
C12H12N2O2S
High Risk - Synonyms
4-(4-aminophenyl)sulfonylaniline
Dimercaprol
Miscellaneous
C3H8OS2
High Risk - Synonyms
2,3-Dimercaptopropanol
Diphenhydramine
Antihistamine
C17H21NO
Low Risk - Synonyms
2-benzhydryloxy-N,N-dimethyl-ethanamine Chloramphenicol
Antibacterial
C11H12C12N2O5
High Risk - Synonyms
2,2-dichloro-N-[1,3-dihydroxy-1-(4-nitrophenyl)-propan-2-yl] acetamide
Dopamine
Anti-epileptic
C8H11NO2
Low Risk - Synonyms
4-(2-aminoethyl)benzene-1,2-diol Chloroquine
Antimalarials
C18H26ClN3
High Risk - Synonyms
Doxorubicin
Chemotherapeutic
N'-(7-chloroquinolin-4-yl)-N,N-diethyl-pentane-1,4-diamine
C27H29NO11
High Risk - Synonyms
Ciprofloxacin
Quinolones
10-(4-amino-5-hydroxy-6-methyl-oxan-2-yl)oxy-6,8,11-t rihydroxy-8-(2-hydroxyacetyl)-1-methoxy-9,10-dihydro-7H-tetr acene-5,12-dione
C17H18FN3O3
High Risk - Synonyms
1-cyclopropyl-6-fluoro-4-oxo-7-piperazin-1-yl-quinoline-3-ca rboxylic acid
Ethanol
Disinfectants
C2H6O
High Risk - Synonyms
8|Page Ethanol
C13H18O2
Low Risk - Synonyms
2-[4-(2-methylpropyl)phenyl]propanoic acid Furazolidone
Antibiotics
C8H7N3O5
High Risk - Synonyms
3-[(5-nitro-2-furyl)methylideneamino]oxazolidin-2-one
Isobutyl Nitrite
Miscellaneous
C4H9NO2
High Risk - Synonyms
Nitrous acid, 2-methylpropyl ester Furosemide
Diuretic
C12H11ClN2O5S
High Risk - Synonyms
4-chloro-2-(furan-2-ylmethylamino)-5-sulfamoylbenzoic acid
Isoniazid
Antibiotics
C6H7N3O
Low Risk - Synonyms
pyridine-4-carbohydrazide Gadopentetate dimeglumine
Contrast Agent
C28H54GdN5O20
High Risk - Synonyms
Lamotrigine
Antidepressants
2-[bis[2-[carboxymethyl-(2-oxido-2-oxoethyl)amino]ethyl]amin o]acetate; gadolinium(+3) cation; (2R,3R,4R,5S)-6methylaminohexane-1,2,3,4,5-pentol
C9H7Cl2N5
High Risk - Synonyms
Glucosulfone
Miscellaneous
Levofloxacin
Anti-bacterial
C24H34N2Na2O18S3
High Risk - Synonyms
C36H42F2N6O9
High Risk - Synonyms
Glyburide
Antidiabetic Agent
(-)-(S)-9-fluoro-2,3-dihydro-3-methyl-10-(4-methyl-1-piperaz inyl)-7-oxo-7Hpyrido[1,2,3-de]-1,4 benzoxazine-6-carboxylic acid hemihydrate
C32H28ClN3O5S
High Risk - Synonyms
5-chloro-N-[2-[4-(cyclohexylcarbamoylsulfamoyl)phenyl]ethyl] 2-methoxy-benzamide
Henna
Miscellaneous
C10H6O3
High Risk - Synonyms
4-hydroxynaphthalene-1,2-dione
Ibuprofen
Analgesics / Antipyretics
6-(2,3-dichlorophenyl)-1,2,4-triazine-3,5-diamine
Lisinopril
Antihypertensive Agents
C21H31N3O5
Low Risk - Synonyms
(2S)-1-[(2S)-6-amino-2-{[(1S)-1-carboxy-3-phenylpropyl]amino }hexanoyl]pyrrolidine-2-carboxylic acid
Magnevist
Contrast Agent
C28H54GdN5O20
Low Risk - Synonyms
2-[bis[2-[carboxymethyl-(2-oxido-2-oxoethyl)amino]ethyl]amin o]acetate; gadolinium(+3) cation; (2R,3R,4R,5S)-6-
9|Page methylaminohexane-1,2,3,4,5-pentol
1-carbamimidamido-N,N-dimethylmethanimidamide
Mefloquine
Anitmalarials
Methylene Blue
Miscellaneous
C17H16F6N2O
High Risk - Synonyms
C16H18ClN3S
High Risk - Synonyms
[2,8-bis(trifluoromethyl)quinolin-4-yl]-piperidin-2-ylmethan ol
3,7-Bis(dimethylamino)phenazathionium chloride
Menadiol Sodium Sulfate (Vitamin k4 sodium sulfate)
Miscellaneous
Mirtazapine
Antidepressant
C17H19N3
Low Risk - Synonyms
C11H8Na2O8S2
High Risk - Synonyms 1,2,3,4,10,14b-hexahydro-2-methylpyrazino[2,1-a]pyrido[2,3-c ][2]benzazepine
Menadione
Miscellaneous
C11H8O2
High Risk - Synonyms
2-methylnaphthalene-1,4-dione
Moxifloxacin
Anti-bacterial
C21H24FN3O4
High Risk - Synonyms
1-cyclopropyl-7-[(1S,6S)-2,8-diazabicyclo[4.3.0]non-8-yl]-6fluoro-8-methoxy-4-oxo-quinoline-3-carboxylic acid Menadione sodium Bisulfite Miscellaneous (Vitamin K3 sodium bisulfite) C11H8O2NaHSO3
Nalidixic Acid
Antibacterial
C12H12N2O3
High Risk - Synonyms
High Risk - Synonyms
1-ethyl-7-methyl-4-oxo-[1,8]naphthyridine-3-carboxylic acid Menthol
Miscellaneous
C10H20O
High Risk - Synonyms
2-(2-Propyl)-5-methylcyclohexanol
Naphthalene
Miscellaneous
C10H8
High Risk - Synonyms
Naphthalene Mesalazine
Anti Inflammatory
C7H7NO3
High Risk - Synonyms
5-amino-2-hydroxy-benzoic acid
Nimesulide
Anti-Inflammatory Agents
C13H12N2O5S
High Risk - Synonyms
N-[4-nitro-2-(phenoxy)phenyl]methanesulfonamide Metformin
Antidiabetic
C4H11N5
High Risk - Synonyms
Niridazole
Miscellaneous
10 | P a g e C6H6N4O3S
High Risk - Synonyms
1-(5-Nitro-2-thiazolyl)-2-imidazolinone
Pefloxacin
Anti-Infective
C17H20FN3O3
High Risk - Synonyms
1-ethyl-6-fluoro-7-(4-methylpiperazin-1-yl)-4-oxo-quinoline- 3carboxylic acid Nitrofurantoin
Cytotoxic / Antibacterial
C8H6N4O5
High Risk - Synonyms Pentaquine
Antimalarials
C18H27N3O
High Risk - Synonyms
1-[(5-nitro-2-furyl)methylideneamino]imidazolidine-2,4-dione
Nitrofurazone
Cytotoxic / Antibacterial
C6H6N4O4
High Risk - Synonyms
1-amino-N-[(5-nitro-2-furyl)methylideneamino]methanamide
Norfloxacin
Antibiotics
C16H18FN3O3
Low Risk - Synonyms
1-ethyl-6-fluoro-4-oxo-7-piperazin-1-yl-1H-quinoline-3-carbo xylic acid
1,5-Pentanediamine, N-(6-methoxy-8-quinolinyl)-N'-(1methylethyl)-
Phenacetin
Analgesics
C10H13NO2
High Risk - Synonyms
N-(4-ethoxyphenyl)ethanamide
Phenazopyridine
Miscellaneous
C11H11N5
High Risk - Synonyms
3-phenyldiazenylpyridine-2,6-diamine Oxidase, Urate
Miscellaneous
C1521H2381N417O461S7
High Risk - Synonyms Phenylbutazone
Anti-inflammatory
C19H20N2O2
Low Risk - Synonyms
Aspergilus urate oxidase
4-butyl-1,2-diphenyl-pyrazolidine-3,5-dione Pamaquine
Antimalarials
C42H45N3O7
High Risk - Synonyms Phenylhydrazine
Miscellaneous
C6H8N2
High Risk - Synonyms
N,N-diethyl-N'-(6-methoxyquinolin-8-yl)pentane-1,4-diamine
Phenylhydrazine Para-Aminobenzoic Acid
Miscellaneous
C7H7NO2
Low Risk - Synonyms Phenytoin
Anticonvulsants
C15H12N2O2
Low Risk - Synonyms
4-Aminobenzoic Acid
11 | P a g e 5,5-diphenylimidazolidine-2,4-dione
C20H24N2O2
Low Risk - Synonyms
(2-ethenyl-4-azabicyclo[2.2.2]oct-5-yl)-(6-methoxyquinolin-4 -yl)methanol Primaquine
Antimalarials
C15H21N3O
High Risk - Synonyms Quinine
Antimalarials
C20H24N2O2
Low Risk - Synonyms
N-(6-methoxyquinolin-8-yl)pentane-1,4-diamine
Probenecid
Analgesics / Antipyretics
C13H19NO4S
High Risk - Synonyms
4-[(dipropylamino)sulfonyl] benzoic acid
Procainamide
Cardiovascular Drugs
C13H21N3O
Low Risk - Synonyms
(2-ethenyl-4-azabicyclo[2.2.2]oct-5-yl)-(6-methoxyquinolin-4 -yl)methanol
Stibophen
Miscellaneous
C12H4Na5O16S4Sb
High Risk - Synonyms
2-(2-Oxido-3,5-Disulphonatophenoxy)-1,3,2,Benzodioxastibole4-6-Disulphonate
4-amino-N-(2-diethylaminoethyl)benzamide
Proguanil C11H16ClN5
Streptomycin
Anti-bacterial
C21H39N7O12
Low Risk - Synonyms
Antimalarial Low Risk - Synonyms
5-(2,4-diguanidino-3,5,6-trihydroxy-cyclohexoxy)-4-[4,5-dihy droxy-6-(hydroxymethyl)-3-methylamino-tetrahydropyran-2-yl]o xy-3-hydroxy-2-methyl-tetrahydrofuran-3-carbaldehyde
1-(4-chlorophenyl)-2-(N'-propan-2-ylcarbamimidoyl)guanidine
Pyrimethamine
Antimalarials
C12H13ClN4
Low Risk - Synonyms
Sulfacetamide
Sulfonamides / Sulfones
C8H10N2O3S
High Risk - Synonyms
N-acetyl-4-amino-benzenesulfonamide
5-(4-chlorophenyl)-6-ethyl-pyrimidine-2,4-diamine
Quinacrine C23H3OClN3 O
Sulfonamides / Sulfones
C12H14N4O3S
Low Risk - Synonyms
Antimalarials High Risk - Synonyms
N'-(6-chloro-2-methoxy-acridin-9-yl)-N,N-diethyl-pentane-1,4 diamine
Quinidine
Sulfacytine
Antiarrhythmic Agents / Antimalarials
4-amino-N-(6-methoxy-2-methylpyrimidin-4-yl)benzenesulfonami de
Sulfadiazine
Sulfonamides / Sulfones
C10H10N4O2S
Low Risk - Synonyms
12 | P a g e 4-amino-N-pyrimidin-2-yl-benzenesulfonamide
C6H8N2O2S
High Risk - Synonyms
4-aminobenzenesulfonamide Sulfadimidine
Sulfonamides / Sulfones
C12H14N4O2S
High Risk - Synonyms
4-amino-N-(4,6-dimethylpyrimidin-2-yl)benzenesulfonamide
Sulfapyridine
Sulfonamides / Sulfones
C11H11N3O2S
High Risk - Synonyms
4-amino-N-pyridin-2-ylbenzenesulfonamide Sulfafurazole
Sulfonamides / Sulfones
C11H13N3O3S
High Risk - Synonyms
4-amino-N-(3,4-dimethyl-1,2-oxazol-5-yl)benzenesulfonamide
Sulfasalazine
Sulfonamides / Sulfones
C18H14N4O5S
High Risk - Synonyms
2-hydroxy-5-[4-(pyridin-2-ylsulfamoyl)phenyl]diazenyl-benzoi c acid Sulfaguanidine
Miscellaneous
C7H10N4O2S
Low Risk - Synonyms Sulfathiazole
Cytotoxic / Antibacterial
C9H9N3O2S2
High Risk - Synonyms
4-Amino-N-(diaminomethylene)benzenesulfon Amide
4-amino-N-(1,3-thiazol-2-yl)benzenesulfonamide Sulfamerazine
Sulfonamides / Sulfones
C11H12N4O2S
Low Risk - Synonyms Sulfonylurea
Antidiabetic Agents
C21H27N5O4S
Low Risk - Synonyms
4-amino-N-(4-methylpyrimidin-2-yl)benzenesulfonamide
Sulfamethoxazole
Sulfonamides / Sulfones
C10H11N3O3S
High Risk - Synonyms
4-amino-N-(5-methyloxazol-3-yl)-benzenesulfonamide
Sulfamethoxypyridazine
Sulfonamides / Sulfones
C11H12N4O3S
Low Risk - Synonyms
1-cyclohexyl-3-[[p-[2-(5-methylpyrazinecarboxamido)ethyl]phe nyl] sulfonyl]urea
Sulfoxone
Antibacterial
C14H16N2O6S3
High Risk - Synonyms
[4-[4-(sulfinomethylamino)phenyl]sulfonylphenyl]aminomethane sulfinic acid
4-Amino-N-(6-methoxy-3-pyridazinyl)-benzenesulfonamide
Sulfanilamide
Tamsulosin
Sulfonamides
C20H28N2O5S
High Risk - Synonyms
Chemotherapeutic 5-[2-[2-(2-ethoxyphenoxy)ethylamino]propyl]-2-methoxy-benzen esulfonamide
13 | P a g e C14H18N4O3 Tiaprofenic Acid
Anti Inflammatory
C14H12O3S
Low Risk - Synonyms
2-[5-(benzoyl)thiophen-2-yl]propanoic acid
Toluidine Blue
Miscellaneous
C15H16N3SCl
High Risk - Synonyms
Low Risk - Synonyms
5-[(3,4,5-trimethoxyphenyl)methyl]pyrimidine-2,4-diamine
Trinitrotoluene
Miscellaneous
C7H5N3O6
High Risk - Synonyms
2-methyl-1,3,5-trinitrobenzene
3-Amino-7-(dimethylamino)-2-methylphenothiazin-5-ium Chloride
Tripelennamine
Antihistaminic
C16H21N3
Low Risk - Synonyms
N-benzyl-N',N'-dimethyl-N-pyridin-2-yl-ethane-1,2-diamine Trihexyphenidyl
Antiparkinson Agents
C20H31NO
Low Risk - Synonyms Vitamin K1
Miscellaneous
C31H46O2
Low Risk - Synonyms
1-cyclohexyl-1-phenyl-3-(1-piperidyl)propan-1-ol
Phytomenadione Trimethoprim
Antimalarials / Antibacterial
G6PD Deficiency Food To Avoid
Some of the foods commonly eaten around the world can cause people with G6PD Deficiency tohemolyze. Some of these foods can be deadly (like fava beans). Some others can cause low level hemolysis, which means that red blood cells die, but not enough to cause the person to go to the hospital. Low level hemolysis over time can cause other problems, such as memory dysfunction, overworked spleen, liver, kidney and heart, and iron overload. Even though a G6PD Deficient person may not have a crises when consuming these foods, they should be avoided.
Fava Beans and other legumes This list contains every legume we could find, but there may be other names for them that we do not know about. Low level hemolysis is very hard to detect and can cause other problems, so we recommend the avoidance of all legumes.
Sulfites
14 | P a g e
and foods containing them. Sulfites are used in a wide variety of foods, so be sure to check labels carefully.
Menthol and foods containing it. This can be difficult to avoid as tooth paste, candy, breath mints, mouth wash and many other products have menthol added to them. Mint from natural mint oils is alright to consume.
Artificial blue food coloring other artificial food color can also cause hemolysis. Natural food color such as found in foods like turmeric or grapes is okay.
Ascorbic acid Artificial ascorbic acid commonly put in food and vitamins can cause hemolysis in Large doses and should be avoided. It is put into so many foods that you can be getting a lot ofAscorbic Acid without realizing it. See Ascorbic Acid for more information about iron absorbtion and ascorbic acid.
Vitamin K This is from drugbank: "Menadione (vitamin K3), which is not used as a nutritionalsupplemental form of vitamin K for humans, has been reported to cause adverse reactions, including hemolytic anemia. Large doses have also been reported to cause brain damage. Vitamin K istered to newborns with G6PD Deficiency has been known to cause adverse outcomes including hemolytic anemia, neonatal brain or liver damage, or neonatal death in some cases."
Tonic water
(contains quinine, a contraindicated drug which causes hemolysis in G6PDD people).
Bitter Gourd and Garden Egg Bitter Gourd is also known as Bitter Mellon. These are common foods in some parts of Africa and Asia.
Some Chinese herbs
15 | P a g e
particularly Rhizoma Coptidis (huang lien), Calculus Bovis (neu huang), Flos Chimonanthi Praecocis (leh mei hua), Flos Lonicerae (kam ngan fa) and Margarita oranything containing them. Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive hereditary disease characterised by abnormally low levels of glucose-6-phosphate dehydrogenase (abbreviated G6PD or G6PDH), a metabolic enzyme involved in the pentose phosphate pathway, especially important in red blood cellmetabolism. Individuals with the disease may exhibit nonimmune hemolytic anemia in response to a number of causes, most commonly infection or exposure to certain medications or chemicals. G6PD deficiency is closely linked to favism, a disorder characterized by a hemolytic reaction to consumption of broad beans, with a name derived from the Italian name of the broad bean (fava). The name favism is sometimes used to refer to the enzyme deficiency as a whole, although this is misleading as not all people with G6PD deficiency will react to consumption of broad beans. G6PD deficiency is the most common human enzyme defect. The most common medical problem associated with glucose-6-phosphate dehydrogenase deficiency is hemolytic anemia, which occurs when red blood cells are destroyed faster than the body can replace them. This type of anemia leads to paleness, yellowing of the skin and whites of the eyes (jaundice), dark urine, fatigue, shortness of breath, and a rapid heart rate. In people with glucose-6-dehydrogenase deficiency, hemolytic anemia is most often triggered by bacterial or viral infections or by certain drugs (such as some antibiotics and medications used to treat malaria). Hemolytic anemia can also occur after eating fava beans or inhaling pollen from fava plants (a reaction called favism). Favism may be formally defined as a haemolytic response to the consumption of broad beans. All individuals with favism show G6PD deficiency. However, not all individuals with G6PD deficiency show favism. For example, in a small study of 757 Saudi men, more than 42% showed G6PD deficiency, but none reported symptoms of favism, despite fava in the diet.[2] Favism is known to be more prevalent in infants and children, and G6PD genetic variant can influence chemical sensitivity. Other than this, the specifics of the chemical relationship between favism and G6PD are not well understood. Symptoms Dark urine Enlarged spleen Paleness Rapid heart rate Shortness of breath Yellow skin color (jaundice) Note: Severe hemolysis may cause hemoglobinuria(hemoglobin in the urine).
16 | P a g e
Diagnosis The diagnosis is generally suspected when patients from certain ethnic groups (see below) develop anemia,jaundice and symptoms of hemolysis after challenge to any of the above causes, especially when there is a positive family history. Generally, tests will include: Complete blood count and reticulocyte count; in active G6PD, Heinz bodies can be seen in red blood cells on ablood film; Liver enzymes (to exclude other causes of jaundice); Lactate dehydrogenase (elevated in hemolysis and a marker of hemolytic severity) Haptoglobin (decreased in hemolysis); A "direct antiglobulin test" (Coombs' test) - this should be negative, as hemolysis in G6PD is not immune-mediated; Treatment The most important measure is prevention - avoidance of the drugs and foods that cause hemolysis. Vaccinationagainst some common pathogens (e.g. hepatitis A andhepatitis B) may prevent infection-induced attacks.[11] In the acute phase of hemolysis, blood transfusionsmight be necessary, or even dialysis in acute renal failure. Blood transfusion is an important symptomatic measure, as the transfused red cells are generally not G6PD deficient. Some patients benefit from removal of the spleen(splenectomy),[12] as this is an important site of red cell destruction. Folic acid should be used in any disorder featuring a high red cell turnover. Although vitamin E andselenium have antioxidant properties, their use does not decrease the severity of G6PD. Alternative treatment Vitamin E and folic acid (both anti-oxidants) may help decrease hemolysis in G6PD-deficient individuals.
) If the father is unaffected (healthy) and the mother is a carrier (no clinical symptoms): One daughter out of two will be a carrier One son out of two will be G6PD deficient B) If the father is G6PD deficient and the mother is unaffected: All sons will be unaffected C) If the father is G6PD deficient and the mother is a carrier:
17 | P a g e
One daughter out of two will be G6PD deficient
D) If the father is unaffected and the mother is G6PD deficient: All sons will be G6PD deficient E) If both father and mother are G6PD deficient: All daughters will be G6PD deficient
TIPS FOR PARENTS Any boy suffering from Favism should be informed of his deficiency so he can help himself avoid the intake of the forbidden foodstuff in various situations where he is not under your supervision (such as school). You should also inform school supervisors and, where applicable, also the school caterers who provide school lunch. Best is to carry with you the To Avoid list and show it to all those who may treat your boy. How do you care for babies with G6PD deficiency? Parents should take proper precautions when caring for a child with G6PD deficiency. The main thing is keep your child from being exposed to triggers of G6PD deficiency symptoms. Newborns with G6PD deficiency may suffer from prolonged and more severe levels of jaundice. Often, if the levels are too high, mothers are advised to stop breast feeding their infants for a short period of time by paediatricians as breast milk might interfere with the liver’s ability to conjugate bilirubin. After being discharged from hospitals, breast-feeding mothers should avoid consuming certain types of food and medications which might induce anaemic hemolysisin G6PD deficient babies. The list of food and drugs to avoid is fairly similar to the ones a G6PD deficient person should avoid. Analgesics, anti-malarials, sulphonamide drugs should be strictly avoided. the number of drugs that should be avoided is fairly comprehensive. To be on the safe side, make sure every medication for your child is acquired via doctor’s prescription. Both breast-feeding mother and child must avoid fava beans (broad beans). Fava bean remains the most common food to avoid for G6PD deficient individuals. Keep your child away from mothballs. Do not let them touch or get close enough to inhale the scent of mothballs. If your newborn inherits some hand-me-down clothes, make sure to wash the clothes clean before your baby wears them. You’d never know the clothes may have been stored in close vicinity to mothballs. Choose milk formulaes which have no traces of soya or soybeans.
18 | P a g e
Observe your child’s diet by carefully introducing legumes such as peas, beans, lentil or various types of beans. Some people with G6PD deficiency avoid legumes, but not all. Most people shows no symptoms. Soy products, blueberries and red wine are also trigger symptoms of G6PD deficiency but again, does not necessary affect all people. Peppermint oil should not be used around your child’s face. In fact, breastfeeding mothers themselves should refrain from using peppermint oil too.
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