Northern California Community Blood Bank 2524 Harrison Avenue Eureka, CA 95501 (707)443-8004 MEDICATION DEFERRAL LIST
Please tell us if you are now taking or if you have EVER taken any of these medications:
Proscar (finasteride) - usually given for prostate gland enlargement
Avodart (dutasteride) - usually given for prostate enlargement
Propecia (finasteride) - usually given for baldness
Accutane (Amnesteem, Claravis, Sotret, isotretinoin) - usually given for severe acne
Soriatane (acitretin) - usually given for severe psoriasis
Tegison (etretinate) - usually given for severe psoriasis
Growth Hormone from Human Pituitary Glands - used for children with delayed or impaired growth
Insulin from Cows (Bovine, or Beef , Insulin) - used to treat diabetes
Hepatitis B Immune Globulin - given following an exposure to hepatitis B.*
Note: This is different from the hepatitis B vaccine which is a series of 3 injections given over a 6 month period to
prevent future infection from exposures to hepatitis B.
Unlicensed Vaccine - usually associated with a research protocol
Plavix, Ticlid or Feldene - irreversibly inhibits platelet function – may not donate platelets
Coumadin (Warfarin) - inhibits the vitamin K–dependent synthesis of biologically active forms of the calcium
dependent clotting factors II, VII, IX and X. You may not donate for 7 days from the last time you took it. If you would like to know why these medicines affect you as a blood donor, please keep

• If you have taken or are taking Proscar, Avodart, Propecia, Accutane, Soriatane, or Tegison, these
medications can cause birth defects. Your donated blood could contain high enough levels to damage the unborn baby if transfused to a pregnant woman. Once the medication has been cleared from your blood, you may donate again. Following the last dose, the deferral period is one month for Proscar, Propecia and Accutane, six months for Avodart and three years for Soriatane. Tegison is a permanent deferral. • Growth hormone from human pituitary glands was prescribed for children with delayed or impaired
growth. The hormone was obtained from human pituitary glands, which are found in the brain. Some people who took this hormone developed a rare nervous system condition called Creutzfeldt-Jakob Disease (CJD, for short). The deferral is permanent. • Insulin from cows (bovine, or beef, insulin) is an injected material used to treat diabetes. If this insulin
was imported into the US from countries in which “Mad Cow Disease” has been found, it could contain material from infected cattle. There is concern that “Mad Cow Disease” is transmitted by transfusion. The deferral is indefinite. • Hepatitis B Immune Globulin (HBIG) is an injected material used to prevent infection following an exposure
to hepatitis B. HBIG does not prevent hepatitis B infection in every case, therefore persons who have received HBIG must wait 12 months to donate blood to be sure they were not infected since hepatitis B can be transmitted through transfusion to a patient. • Unlicensed Vaccine is usually associated with a research protocol and the effect on blood transmission is
unknown. Deferral is one year unless otherwise indicated by Medical Director. EUROPEAN COUNTRIES LIST
European Countries List is used for deferral of donors based on geographic risk of bovine spongiform encephalopathy (BSE), commonly known as “mad cow disease”. Albania *The United Kingdom should be taken to
include all of the following:
United Kingdom*


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MMO USE ONLY INSTRUCTIONS: All questions must be answered. Incomplete applications will be returned. Section I: Contract Holder Information Marital Status: ▫ Single ▫ Married ▫ Divorced ▫ Separated ▫ Widowed Marriage Date: / / Reason for Application: ▫ Applying for new coverage ▫ Applying for dependent only coverage ▫ Applying for change to current coverage LIST BELOW

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