5 Medications That Defer Blood Donation

The arrival of January 2025 brings with it the 55th year of celebrating National Blood Donor Month, and the reiterating of several alarming statistics: Every 2 seconds, someone in the US needs blood and/or platelets, and each blood and platelet donation has the ability to save 3 lives—but just 3% of individuals who have met the age requirement for donation do so each year, according to the Red Cross.¹

There are many reasons—both temporary and permanent—that someone who qualifies by age to donate blood may not ultimately be able to donate. These include having had certain forms of cancer,² including those involving blood cells (eg, leukemia or myeloma); ever having a positive test for HIV³; the presence of hypotension or hypertension⁴; and history of certain medications.^5,6

Just 3% of individuals who meet the age requirement for donation do so each year. | image credit: Creative Cat Studio - stock.adobe.com

The following types of medications are on deferral lists for blood donation:

1. Pre-exposure prophylaxis, or PrEP. Taken as a preventive measure against acquiring HIV, and meant to lower acquisition risk, Truvada (emtricitabine/tenofovir disoproxil fumarate; Gilead), Descovy (emtricitabine/tenofovir alafenamide; Gilead), and Apretude (cabotegravir; ViiV Healthcare) lead to deferrals of 3 months (Truvada and Descovy, oral medications) or 2 years (Apretude, injectable) because there is potential for them to delay detection of HIV in currently licensed blood tests.⁷ The wait time for injectable medications is longer, according to current guidelines, because of their ability to suppress the virus for longer periods.⁸

2. Acne treatment. Medications that encompass Amnesteem (Mylan), Absorica (Sun Pharma), and Claravis (Teva), all also known by the generic isotretinoin, confer a 1-month deferral to blood donation. The principal concerns with these medications is their ability to cause birth defects—they are considered teratogenic—as a pint of donated blood with high enough levels that is transfused to a pregnant woman can lead to birth defects in up to 35% of exposed infants,⁷ and these levels can occur even if someone has only taken the medication for a short period.⁹ The damaging mechanism behind isotretinoin is its inhibitory effect on normal cell activity and causing premature death of neural crest cells,¹⁰ which are stem cells in an embryo that eventually differentiate into other cell types.¹¹

3. Anticoagulants. The list of blood thinners leading to donation deferrals is extensive, but the deferral period is short, at either 2 days (fondaparinux, apixaban, dalteparin, enoxaparin, dabigatran, edoxaban, rivaroxaban) or 7 days (warfarin, heparin, low molecular weight heparin).⁷ Taken as a preventive measure against blood clots in the legs and lung, and to prevent stroke, these medications are on the deferral list because they affect the body’s ability to clot, which can lead to donation-related excessive bruising or bleeding in the person donating. Harm to the recipient is also possible.¹²

4. Hair loss remedies, also used for prostate symptoms. Use of finasteride (Propecia; Merck) confers a 1-month delay in donating, due to the potential for donated blood to contain high enough levels of finasteride (an anti-androgen) that have potential to cause birth defects if transfused to a pregnant woman.⁷ As with certain acne treatments, it is considered teratogenic, in that can cause abnormal development of male sex organs in utero. Donation is also deferred because the medication remains in the blood long after treatment has ceased.

5. Rheumatoid arthritis agent. Upadacitinib (Rinvoq; AbbVie) leads to a 1-month deferral, too. It has been linked to both birth defects and deaths of unborn babies, when transfused to a pregnant woman.⁷ As an immunosuppressant and Janus kinase inhibitor, it has also been linked to increased infection risk and can put a recipient at risk of more severe infection from its potential to weaken the immune system.

References

1. National blood donor month. The American National Red Cross. January 12, 2022. Accessed January 16, 2025. https://www.redcross.org/red-cross-youth/resources/monthly-focuses/january.html

2. Common reasons people can’t donate. New York Blood Center. Accessed January 16, 2025. https://www.nybc.org/donate-blood/donor-eligibility/common-reasons-people-cant-donate/#accordion-item-pregnancyabortionormiscarriage

3. Some conditions that disqualify people from donating blood. Merck. Accessed January 16, 2025. https://www.merckmanuals.com/home/multimedia/table/some-conditions-that-disqualify-people-from-donating-blood

4. Eligibility criteria: alphabetical. The American National Red Cross. Accessed January 16, 2025. https://www.redcrossblood.org/donate-blood/how-to-donate/eligibility-requirements/eligibility-criteria-alphabetical.html

5. Medication deferral list. Blood Assurance. Accessed January 16, 2025. https://www.bloodassurance.org/medication-deferral-list

6. Medication deferral list. American Red Cross Biomedical Services. Accessed January 16, 2025. https://rapidpass.redcrossblood.org/iCASIMobileConfig/External/Files/SOPs/MedicationDeferralList.pdf

7. FDA issues draft guidance updating blood donation policy. American Hospital Association. January 31, 2023. Accessed January 16, 2025. https://www.aha.org/special-bulletin/2023-01-31-fda-issues-draft-guidance-updating-blood-donation-policy

8. Medication deferral for PrEP/PEP for HIV prevention. Association for the Advancement of Blood & Biotherapies. Accessed January 16, 2025. https://www.aabb.org/docs/default-source/default-document-library/resources/prep-pep-qa-resource-for-the-public.pdf

9. Mother to baby/fact sheets: isotretinoin (Accutane). National Library of Medicine. October 2023. Accessed January 16, 2025. https://www.ncbi.nlm.nih.gov/books/NBK582775/

10. Choi EJ, Kim N, Kwak HS, et al. The rates of major malformations after gestational exposure to isotretinoin: a systematic review and meta-analysis. Obstet Gynecol Sci. 2021;64(4):364-373. doi:10.5468/ogs.20373

11. Xi M, Lui F. StatPearls: neuroanatomy, neural crest. National Library of Medicine. January 2025. Accessed January 16, 2025. https://www.ncbi.nlm.nih.gov/books/NBK547700/

12. Medication deferral list. Memorial Blood Centers. Accessed January 17, 2025. https://www.mbc.org/idonate-step-3/