The Welsh Medicines Advice Service (WMAS) offers a specialist advisory service on the safe use of drugs in porphyria to UK-based healthcare professionals and members of the public.
The UK Porphyria Medicines Information Service (UKPMIS) is provided in conjunction with the Cardiff Porphyria Service provided by the Department of Biochemistry and Immunology, University Hospital of Wales.
Drugs considered SAFE in the acute porphyrias – alphabetical list or therapeutic categories list
Porphyria Safe List
Download a PDF copy of the 2023 Porphyria Safe List or use the search function below Please note: we now have a separate copy of the Porphyria categories safe list available to download. 2023 SAFE LIST: Drugs that are considered to be SAFE for use in the acute porphyrias This safe list was produced jointly by the UK Porphyria Medicines Information Service (UKPMIS) and Cardiff Porphyria Service and is supported by the National Acute Porphyria Service (NAPS). We gratefully acknowledge the clinical impact of the evidence-based drug safety assessments provided on the comprehensive Drug Database for Acute Porphyria (http://www.drugs-porphyria.org) on the range of available medicines for porphyria patients. This list is based on the best information available to us at the time of compilation and provides guidance on drugs to use first line. It is not intended to be comprehensive. Inclusion of a drug does not guarantee that it will be safe in all circumstances. For information on medication not listed and advice on the use of antiretrovirals, antineoplastics or other complex treatment scenarios please contact UKPMIS by telephone (029 2184 2251). Unfortunately we are unable to accept enquiries via e-mail. All topical preparations (including topical antifungals, lice treatments & eye drops) are considered safe, when applied to intact skin or mucosa.
Healthcare professionals requiring clinical advice on management of acute porphyria attacks should contact NAPS on 029 2184 7747 – available 24 hours a day, 7 days a week.Abatacept Abciximab Acamprosate Acebutolol Acetazolamide Acetylcysteine Aciclovir Aclidinium bromide Adalimumab Adenosine Adrenaline Aflibercept Alemtuzumab Alendronic acid Alfacalcidol Alfentanil Alginates (e.g. Gaviscon®, Peptac®) Allopurinol Almotriptan Alogliptin Alpha tocopheryl/tocopherol Alteplase Aluminium salts Amantadine Amikacin Amiloride Aminophylline Amisulpride Amitriptyline Amlodipine Amoxicillin Amphotericin Ampicillin Anakinra Anidulafungin Apixaban Arachis oil enema Argatroban Aripiprazole Articaine Ascorbic acid Aspirin Atenolol Atomoxetine Atorvastatin Atovaquone Atracurium Atropine Azathioprine Azithromycin Aztreonam Baclofen Balsalazide Barium sulphate Basiliximab BCG vaccine Beclometasone Belatacept Belimumab Bendroflumethiazide Benralizumab Benzylpenicillin Betahistine Betamethasone Betaxolol Bevacizumab Bezafibrate Bisacodyl Bisoprolol Budesonide Bumetanide Bupivacaine Buprenorphine Calcitriol Calcium polystyrene sulfonate Calcium salts Canagliflozin Canakinumab Candesartan Captopril Carbimazole Carboprost Carvedilol Casirivimab Caspofungin Cefaclor Cefadroxil Cefalexin Cefepime Cefixime Cefotaxime Cefoxitin Cefradine Ceftaroline Ceftazidime Ceftriaxone Cefuroxime Celecoxib Certolizumab Cetirizine Cetuximab Chloroquine Chlorphenamine Ciclesonide Ciclosporin Cimetidine Cinacalcet Ciprofloxacin Cisatracurium Citalopram Clobazam Clonazepam Clonidine Clopidogrel Clozapine Co-amoxiclav Co-beneldopa Co-careldopa Codeine phosphate Co-fluampicil (1) Colchicine Colecalciferol Colesevelam Colestipol Colestyramine Contrast media – gadolinium‑based Contrast media – Gastrografin® Contrast media – iodine‑based COVID-19 vaccines Cyclizine Cycloserine Dabigatran Dalteparin Danaparoid Dapagliflozin Darbepoetin Deflazacort Demeclocycline Denosumab Desferrioxamine Desflurane Desloratadine Dexamethasone Dextromethorphan Diamorphine Diazepam Diclofenac Dicycloverine Digoxin Dihydrocodeine Dimeticone Dinoprostone Diphenhydramine Diphtheria/tetanus/pertussis/polio vaccine Diphtheria/tetanus/pertussis/ polio/Hib/hepatitis B vaccine Dipyridamole Dobutamine Domperidone Dopamine Doxazosin Doxycycline Dulaglutide Duloxetine Eculizumab Eletriptan Empagliflozin Enalapril Enoxaparin Entacapone Epinephrine Eplerenone Epoetin Eprosartan Eptifibatide Ergocalciferol Ertapenem Ertugliflozin Escitalopram Esmolol Esomeprazole Etanercept Ethambutol Etoricoxib Exenatide Ezetimibe Famciclovir Felodipine Fenofibrate Fentanyl Fexofenadine Fidaxomicin Filgrastim Flucloxacillin (1) Flucytosine Fludrocortisone Flumazenil Fluoxetine Fluticasone Fluvastatin Fluvoxamine Fondaparinux Formoterol Fosfomycin Fosinopril Furosemide Fusidic acid Gabapentin Galantamine Ganciclovir G-CSF (Granulocyte-colony stimulating factor) Gemeprost Gemfibrozil Gentamicin Glipizide Glucagon Glucosamine Glycerol suppositories Glyceryl trinitrate Glycopyrronium Golimumab Granisetron Haloperidol Heparin, unfractionated Hepatitis A vaccine Hepatitis B vaccine Hib/Meningococcal group C vaccine Human papillomavirus (HPV) vaccine Hydrocortisone Hyoscine butylbromide Hyoscine hydrobromide Ibandronic acid Ibuprofen Imdevimab Imipenem Immunoglobulins Indometacin Infliximab Influenza vaccine (inactivated) Influenza vaccine (live attenuated) Insulins Ipratropium bromide Irbesartan Iron salts Isoflurane Isosorbide dinitrate Isosorbide mononitrate Ispaghula husk Ivabradine Ketoprofen Labetalol Lacosamide Lactulose Lamotrigine Lansoprazole Leflunomide Lenograstim Lercanidipine Levetiracetam Levobunolol Levofloxacin Levomepromazine Levothyroxine Lidocaine (2) Linaclotide Linagliptin Linezolid Liothyronine Lipegfilgrastim Liquid paraffin enema Liraglutide Lisinopril Lithium carbonate Lithium citrate Lixisenatide Loperamide Loratadine Lorazepam Losartan Lymecycline Macrogols Magnesium citrate with sodium picosulfate Magnesium salts Measles/mumps/rubella vaccine Mebendazole Mebeverine Mefloquine Melatonin Meloxicam Memantine Menadiol Meningococcal group B vaccine Meningococcal groups A, C, W, Y vaccine Mepivacaine Meropenem Meropenem with vaborbactam Mesalazine Metformin Methadone Methotrexate Methylcellulose Methylnaltrexone bromide Methylphenidate Methylprednisolone Metoclopramide Metoprolol Metronidazole Midazolam (3) Midodrine Mirabegron Mirtazapine Misoprostol Mivacurium Mizolastine Mometasone Morphine Moxifloxacin Moxonidine Multivitamins Mycophenolate mofetil Mycophenolic acid Nadolol Naftidrofuryl Naloxone Naproxen Naratriptan Natalizumab Nateglinide Nebivolol Neostigmine Nicotinamide Nicotine replacement therapy Nifedipine Nimodipine Nitrous oxide Noradrenaline Norepinephrine Nortriptyline Nuclear medicine – technetium (4) Nystatin Octreotide Ofatumumab Ofloxacin Olanzapine Omeprazole Ondansetron Orlistat Oseltamivir Oxycodone Oxytocin Paliperidone Palivizumab Pamidronate disodium Pancuronium Panitumumab Pantoprazole Paracetamol Paraldehyde Paroxetine Pegfilgrastim Penicillamine Perindopril arginine Perindopril erbumine Pethidine Phenoxymethylpenicillin Phenylephrine Phosphate enema Phosphate salts Phytomenadione Pindolol Pioglitazone Piperacillin with tazobactam Pneumococcal conjugate vaccine Pneumococcal polysaccharide vaccine Pramipexole Prasugrel Pravastatin Prazosin Prednisolone Pregabalin Prilocaine Primaquine Prochlorperazine Proguanil Promethazine Propofol (3) Propranolol Propylthiouracil Prucalopride Pseudoephedrine Pyrazinamide Pyridostigmine Pyridoxine Quetiapine Quinapril Quinine Rabeprazole Ramipril Remifentanil Repagllinide Ribavirin Riboflavin Risedronate Rituximab Rivaroxaban Rivastigmine Rizatriptan Rocuronium Rosuvastatin Rotavirus vaccine Salbutamol Salmeterol Sarilumab Saxagliptin Semaglutide Senna Sertraline Sevelamer Shingles vaccine Sildenafil Siltuximab Simeticone Simvastatin Sitagliptin Sodium bicarbonate Sodium citrate enema Sodium clodronate Sodium fusidate Sodium picosulfate Sodium zirconium cyclosilicate Solifenacin Sotalol Sotrovimab Sterculia Streptokinase Strontium Sulpiride Sumatriptan Suxamethonium Tacrolimus Tadalafil Tamsulosin Teicoplanin Telmisartan Temazepam Tenecteplase Terazosin Terbinafine Terbutaline Tetanus/diphtheria/polio vaccine Tetracosactide Theophylline Thiamine Ticagrelor Tigecycline Tildrakizumab Timolol Tinzaparin Tiotropium Tirofiban Tobramycin Tocilizumab Tolterodine Tolvaptan Tramadol Trandolapril Tranexamic acid Trastuzumab Trazodone Triamcinolone Trifluoperazine Umeclidinium Urokinase Ursodeoxycholic acid Ustekinumab Valaciclovir Valganciclovir Valsartan Vancomycin Varicella-zoster vaccine Vedolizumab Venlafaxine Vigabatrin Vildagliptin Vitamin A Vitamin B Vitamin C Vitamin D Vitamin E Vitamin K Warfarin Zanamivir Zinc preparations Zoledronic acid Zolmitriptan Zonisamide Zopiclone Key
1.Conflicting safety advice for flucloxacillin. Consider an alternative in high risk patients. Contact UKPMIS for further advice. 2. Intravenous doses should be used with caution. 3. Clinical safety has not been assessed for continuous use of these preparations. 4. Clinical safety has not been assessed for compounds combined with technetium.
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To opt in, contact us on 029 2184 2251 or welshmedicines.information@wales.nhs.uk
About Porphyria
Porphyria is a rare genetic disorder that can be passed through families. The porphyrias are a group of disorders of the “haem biosynthesis pathway”.
Briefly…
Haemoglobin, which carries oxygen around the body in the blood, is made in the liver. Haemoglobin is formed as a result of a series of chemical reactions called the “haem biosynthesis pathway”. Each stage of the pathway is controlled by a specific enzyme. All porphyrias result from partial deficiency of one of the enzymes of the haem biosynthesis pathway.
This can lead to a build-up of chemicals which cannot be processed efficiently by the defective enzyme. This can sometimes cause acute attacks of porphyria.
Acute attacks are often provoked by drugs, alcohol, and hormonal changes. Infections and stressful situations may also precipitate an acute attack. Rarely an acute attack may be life-threatening.
For more detailed information see the sections below ‘resources for patients’ and ‘resources for healthcare professionals’
Many drugs, particularly those that induce cytochrome P450s, have long been recognised as important precipitants of acute attacks in those who inherit one of the acute porphyrias.
At present there is no consensus view about the safety of many widely-used drugs; largely because of difficulty in reconciling evidence from disparate sources.
A list of drugs considered safe in the acute porphyrias has been produced jointly by the Department of Biochemistry and Immunology, University Hospital of Wales and the WMAS. You can download these from the ‘resources for patients’ and ‘resources for healthcare professionals’ sections below.
A list of drugs considered safe in the acute porphyrias has been produced jointly by the Department of Biochemistry and Immunology, University Hospital of Wales and WMAS.
European Porphyria Initiative is an informative website on porphyria that includes a section for patients and their families/carers.
The Welsh Medicines Advice Service (WMAS) offers a specialist advisory service on the safe use of drugs in porphyria to patients and healthcare professionals in the UK. The service contact telephone number is 029 2184 2251
In conjunction with the Department of Biochemistry and Immunology, University Hospital of Wales, WMAS has published two articles in the Adverse Drug Reaction Bulletin on safe prescribing in the acute porphyrias:
- Lockett CD and Badminton MN. Safe prescribing in the autosomal dominant acute porphyrias: a practical approach: Part I. Adverse Drug Reaction Bulletin. August 2015; No. 293: pp. 1131 – 1134
- Lockett CD and Badminton MN. Safe prescribing in the autosomal dominant acute porphyrias: a practical approach: Part II. Adverse Drug Reaction Bulletin. October 2015; No. 294: pp. 1135 – 1138
And again in conjunction with the Department of Biochemistry and Immunology, University Hospital of Wales, WMAS has produced an information booklet about porphyria for healthcare professionals and a list of drugs considered safe in the acute porphyrias. You can download these from here:
- WMIC Porphyria Bulletin 2008
- Drugs considered ‘safe’ in the acute porphyrias
- Porphyria categories safe list
WMAS also produce a series of articles on medicines-related porphyria enquiries:
- Prescribing restrictions in non-acute cutaneous porphyria (available in Welsh)
- Travel – a guide for people with acute porphyria (available in Welsh)
- Are topical medicines safe in people with porphyria?
- How should haem arginate (human hemin) be administered in the management of acute porphyrias?
- Acne treatment in those with acute porphria (available in Welsh)
And finally, WMAS offers a specialist advisory service on the safe use of drugs in porphyria to patients and healthcare professionals in the UK. Medicines Advice enquiries can be submitted by telephoning the centre on 029 2184 2251
These links are provided for information only and WMAS is not responsible for the content of these sites.
Views expressed on these sites are the views of the site owners and do not necessarily represent the views of WMAS or the Department of Biochemistry and Immunology, University Hospital of Wales.
European Porphyria Initiative
Norwegian Porphyria Centre (NAPOS) in collaboration with the Swedish Porphyria Centre
Porphyria Service – Cardiff
The British and Irish Porphyria Network (BIPNET)
In order for us to answer a porphyria enquiry, please provide us with the following information where possible:
Patient details
Name of patient
Sex of patient
Age of patient
Type of porphyria
Acute Intermittent Porphyria (AIP)
Hereditary Coproporphyria (HCP)
Variegate Porphyria (VP)
Erythropoietic Protoporphyria (EPP)
Porphyria Cutanea Tarda (PCT)
Congenital Erythropoietic Porphyria
Unknown
Further information
Current status of illness i.e. active or latent
Any history of drug induced attacks
Condition being treated
