Drugs and Porphyria
Drugs considered unsafe and safe in acute
porphyrias
Acute porphyrias include acute intermittent porphyria,
hereditary coproporphyria, variegate porphyria and ALAD porphyria.
Drugs are not listed if the available information is not sufficient
to classify them as clearly unsafe or safe.
Unsafe
- Alcohol
- Anti-epilepsy drugs
- Barbiturates1
- Birth control pills
- Calcium channel blockers4
- Carbamazepine1
- Carisoprodol1
- Clonazepam
- Danazol1
- Diclofenac1
- Diones
- Trimethadione
- Paramethadione
- Ergots
- Ethchlorvynol1
- Felbamate
- Glutethimide1
- Griseofulvin1
- Mephenytoin
- Meprobamate1
- Methyprylon
- Metoclopramide1
- Primidone1
- Progesterone1
- Pyrazinamide1
- Pyrazolones
- Rifampin1
- Sedatives
- Succinimides
- Ethosuximide
- Methsuximide
- Sulfonamide-antibiotics1
- Tranquilizers
- Valproic acid1
Safe
- Acetaminophen
- Aspirin
- Atropine
- Bromides
- Cimetidine
- Chloral hydrate
- Estrogens1,3
- Glucocorticoids
- Insulin
- Narcotic analgesics
- Penicillin and derivatives
- Phenothiazines
- Ranitidine1,2
- Serotonin Reuptake Inhibitors (anti-depressants)
- Streptomycin
1 Porphyria is listed as a contraindication, warning, precaution,
or adverse effect in 1994 U.S. labeling for these drugs.
2 Although porphyria is listed as a precaution in U.S.
labeling for this drug, it is regarded as safe by other sources.
3 There is little evidence that estrogens alone are
harmful in acute porphyrias. They have been implicated as harmful
based mostly on experience with estrogen-progestin combinations and
because they can exacerbate porphyria cutanea tarda. Some patients
with AIP, HCP, VP, and ADP may tolerate a low dose estrogen patch.
4 There is strong evidence in laboratory studies and
some clinical evidence that these agents may be harmful.
The text of this page was prepared by Karl E. Anderson, MD and
Douglas E. Goeger, PhD, The University of Texas Medical Branch at
Galveston.
It is important to understand that safe and unsafe drug lists for
the acute porphyris are not necessarily reliable, because they are
prepared from published and anecdotal experiences of porphyria patisnts,
laboratory testing results in porphyric animals, and exposure of
cell culture systems to drugs with measurement of the induction of
porphyrin synthesis. "Thus, those drugs observed to be porphyrinogenic
by experience or in these test systems will be considered as potentially
unsafe on most porphyria drug lists. On the other hand, some drugs
shown to induce porphyrin synthesis have indeed been used safely
in people with porphyria. Similarly, clinical experience may be misleading,
in that drugs may not have been given singly or other factors may
have been operative in precipitating the acute attack. Porphyric
patients' sensitivity to drugs is also variable."
Therefore,
a person with acute porphyria should not follow the published lists
blindly. Please discuss all of there drugs with your
own doctor.
Also see:
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