Drugs in Porphyria

The Welsh Medicines Advice Service (WMAS) offers a specialist advisory service on the safe use of drugs in porphyria.

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


Coronavirus (COVID-19) advice

COVID-19 vaccine

For more information on COVID-19 and porphyria visit:

http://www.porphyria.org.uk/coronavirus-covid-19-advice/

Search the Porphyria safe list

Download a PDF copy of the 2022 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.

2022 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.
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.

All topical preparations (including topical antifungals, lice treatments & eye drops) are considered safe, when applied to intact skin or mucosa.

 

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
Filgrastim
Flucloxacillin (1)
Flucytosine
Fludrocortisone
Flumazenil
Fluoxetine
Fluphenazine
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) (2)
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 (3)
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 (2)
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 (4)
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 (5)
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 (4)
Propranolol
Propylthiouracil
Prucalopride
Pseudoephedrine
Pyrazinamide
Pyridostigmine
Pyridoxine
Quetiapine
Quinapril
Quinine
Rabeprazole
Ramipril
Ranitidine
Remifentanil
Repaglinide
Ribavirin
Riboflavin
Risedronate
Rituximab
Rivaroxaban
Rivastigmine
Rizatriptan
Rocuronium
Rosuvastatin
Salbutamol
Salmeterol
Sarilumab
Saxagliptin
Senna
Sertraline
Sevelamer
Shingles vaccine (2)
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
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. An acute attack has been reported following yellow fever vaccine, so caution should be observed when using any live vaccine in adults.
3. Intravenous doses should be used with caution.
4. Clinical safety has not been assessed for continuous use of these preparations.


What is 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’.


Why can drugs be problematic?

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.


Resources for patients

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.

Drugs considered ‘safe’ in the acute porphyrias

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


Resources for healthcare professionals

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.

WMAS also produce a series of articles on medicines-related porphyria enquiries that are available to view through the SPS website:

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


Links to useful websites

Disclaimer: 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.

What information we need to answer porphyria enquiries

In order for us to answer a porphyria enquiry, please provide us with the following information where possible:

Patient’s 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


In line with the new General Data Protection Regulations you are required to opt in to receive any future communications regarding the Porphyria Safe List.

 Opt in here  OR contact us on 029 2184 2251 or welshmedicines.information@wales.nhs.uk

Cymraeg