Version May 2024
| Safe | ||
| Acetaminophen (paracetamol) Aminoglycosides Anesthetic (eg, propofol) Antiemetics* (ondansetron); refer to note Aspirin Atropine Benzodiazepines¶ (eg, lorazepam, midazolam); refer to note | Cephalosporins; refer to note ErythropoietinΔ Gabapentin Glucocorticoids Histamine2 receptor antagonistsΔ (eg, cimetidine, famotidine) Insulin Levetiracetam | Local anesthetics¶ (eg, lidocaine, bupivacaine) Opioid analgesics¶ Penicillin and derivatives Phenothiazines (eg, chlorpromazine, prochlorperazine, promethazine) Proton pump inhibitors (eg, lansoprazole, omeprazole, pantoprazole) Vigabatrin |
| Unsafe | ||
| Alcohol Anesthetics¶ (eg, etomidate, ketamine, thiopental) Antipyrine (phenazone) BarbituratesΔ CarbamazepineΔ CarisoprodolΔ Clonazepam (high doses) DanazolΔ DiclofenacΔ and possibly other NSAIDs Efavirenz Ergot derivatives (including dihydroergotamine) EstrogensΔ | Ethosuximide and methsuximide GriseofulvinΔ Hydralazine Hydroxyzine MeprobamateΔ Nifedipine Nitrofurantoin Oxcarbazepine Pentazocine PhenytoinΔ PhenobarbitalΔ | PrimidoneΔ Progesterone and synthetic progestinsΔ PyrazinamideΔ RifampinΔ Spironolactone Sulfasalazine Sulfonamide antibioticsΔ (including trimethoprim-sulfamethoxazole [cotrimoxazole]) Tamoxifen Topiramate Valproic acidΔ |
This table includes examples of commonly used drugs known to be safe or unsafe in the acute porphyrias (ie, porphyrias associated with acute neurovisceral attacks).
NOTE: This list is incomplete and includes drugs for which there is general agreement among experts. It is recommended that clinicians consult the websites of the American Porphyria Foundation and the International Porphyria Network, which are frequently updated; list many other drugs, including those that are not classified with certainty; and provide evidence for these classifications. Because the evidence base is inadequate, expert assessments of the safety of drugs in porphyria may differ. Refer to the UpToDate topics on individual porphyrias for more information.NSAIDs: nonsteroidal antiinflammatory drugs.
* Serotonin 5HT3 antagonists are probably safe. Classification of metoclopramide is controversial but is generally a less effective antiemetic.
¶ Not all agents within the same class will necessarily have the same risk. For example, though opioids are generally considered safe, pentazocine may be unsafe. Benzodiazepines that are rapidly metabolized or administered in low doses are considered safe, but the safety of high doses or prolonged use of long-acting agents is less certain. There are conflicting reports on the safety of cephalosporins.
Δ In United States labeling for these drugs, porphyria is listed as a contraindication, warning, precaution, or adverse effect. Erythropoietin is regarded as safe by other sources. Estrogens are unsafe for porphyria cutanea tarda but can be used with caution in the acute porphyrias, especially in low doses or by the transdermal route.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
