Glucose-6-Phosphate Dehydrogenase Deficiency and Safety of Methylene Blue
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Drug Saf 2012; 35 (1): 85-86 0114-5916/12/0001-0085/$49.95/0
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Glucose-6-Phosphate Dehydrogenase Deficiency and Safety of Methylene Blue In the recent review article published in Drug Safety by Youngster and colleagues,[1] methylthioninium chloride (methylene blue) was identified as one of seven drugs that should be avoided in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency due to evidence of an association with haemolysis. However, this conclusion was based on case reports from the literature of only five patients, which were not well described. Of these, three were neonates and only four were G6PD deficient.[1] In their review, the authors acknowledge conflicting evidence by stating that our published data showed methylthioninium chloride to be safe in a large study on 74 adult men with G6PD deficiency.[2] Moreover, the authors have briefly referred to our first study on the safety and efficacy of methylthioninium chloride in young children of sub-Saharan Africa with malaria but forgot to document the findings in children with G6PD deficiency. There was no haemolysis amongst the 24 children with G6PD deficiency who were treated with methylthioninium chloride.[3] Finally, two further published studies on children treated with methylthioninium chloride for uncomplicated falciparum malaria were not considered in the review. These large studies included another 132 children with G6PD deficiency, and no clinically relevant association between methylthioninium chloride treatment and haemolysis was shown.[4,5] However, the predominant type of G6PD deficiency in sub-Saharan Africa (the region with the highest malaria burden) is G6PD A-, and the degree of safety of methylthioninium chloride in populations outside Africa with more severe types of G6PD deficiency still needs to be investigated. Olaf Mu¨ller,1 Peter Meissner2 and Ulrich Mansmann3
1 Institute of Public Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany 2 Department of Pediatrics, Medical School, Ulm University, Ulm, Germany 3 Institute of Medical Informatics, Biometry and Epidemiology, Medical School, Ludwig Maximilians University, Munich, Germany
References 1. Youngster I, Arcavi L, Schechmaster R, et al. Medications and glucose-6-phosphate dehydrogenase deficiency: an evidence-based review. Drug Saf 2010; 33 (9): 713-26 2. Mandi G, Witte S, Meissner P, et al. Safety of the combination of chloroquine and methylene blue in healthy adult men with G6PD deficiency from rural Burkina Faso. Trop Med Int Health 2005; 10: 32-8 3. Meissner P, Mandi G, Witte S, et al. Safety of the methylene blue plus chloroquine combination in the treatment of uncomplicated falciparum malaria in young children of Burkina Faso. Malar J 2005; 4: 45 4. Meissner P, Mandi G, Coulibaly B, et al. Methylene blue for malaria in Africa: results from a dose-finding study in combination with chloroquine. Malar J 2006; 5: 84 5. Zoungrana A, Coulibaly B, Sie´ A, et al. Safety and efficacy of methylene
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