Drugs in Porphyria

Drugs in Porphyria

The Welsh Medicines Information Centre (WMIC) 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.


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 2074 4298

Search the Porphyria safe list

Download a PDF copy of the 2019 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.

2019 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 2074 3877).

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 2074 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
Alteplase
Aluminium salts
Amantadine
Amikacin
Amiloride
Aminophylline
Amisulpride
Amitriptyline
Amlodipine
Amoxicillin
Amphotericin
Ampicillin
Anakinra
Apixaban
Arachis oil enema
Articaine
Ascorbic acid
Aspirin
Atenolol
Atomoxetine
Atorvastatin
Atovaquone
Atracurium
Atropine
Azathioprine
Azithromycin
Aztreonam
Baclofen
Balsalazide
Barium sulphate
Basiliximab
BCG vaccine
Beclometasone
Belatacept
Belimumab
Bendroflumethiazide
Benzylpenicillin
Betamethasone
Betaxolol
Bevacizumab
Bezafibrate
Bisacodyl
Bisoprolol
Budesonide
Bumetanide
Bupivacaine
Buprenorphine
Calcitriol
Calcium salts
Canagliflozin
Canakinumab
Candesartan
Captopril
Carbimazole
Carboprost
Carvedilol
Caspofungin
Cefaclor
Cefadroxil
Cefalexin
Cefixime
Cefotaxime
Cefradine
Ceftaroline
Ceftazidime
Ceftriaxone
Cefuroxime
Celecoxib
Certolizumab
Cetirizine
Cetuximab
Chloracetine
Chloroquine
Chlorphenamine
Ciclesonide
Ciclosporin
Cimetidine
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
Cyclizine
Cyclopenthiazide
Cycloserine
Dabigatran
Dalteparin
Danaparoid
Dapagliflozin
Darbepoetin
Deflazacort
Denosumab
Desferrioxamine
Desflurane
Desloratadine
Dexamethasone
Dextromethorphan
Diamorphine
Diazepam
Dicycloverine
Digoxin
Dihydrocodeine
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
Eplenerone
Epoetin
Eprosartan
Ergocalciferol
Ertapenem
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
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
Imipenem
Immunglobulins
Indometacin
Infliximab
Influenza vaccine (inactivated)
Influenza vaccine (live attenuated) 2
Insulins
Ipratropium bromide
Irbesartan
Iron
Isoflurane
Isosorbide dinitrate
Isosorbide mononitrate
Ispaghula husk
Ketoprofen
Labetalol
Lacosamide
Lactulose
Lamotrigine
Lansoprazole
Leflunomide
Lenograstim
Lercanidipine
Levetiracetam
Levobunolol
Levofloxacin
Levomepromazine
Levothyroxine
Lidocaine 3
Linagliptin
Linezolid
Liothyronine
Lipefilgrastim
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 and rubella vaccine 2
Mebendazole
Mebeverine
Mefloquine
Melatonin
Meloxicam
Memantine
Menadiol
Meningococcal group B vaccine
Meningococcal groups A, C, W, Y vaccine
Mepivacaine
Meropenem
Mesalazine
Metformin
Methadone
Methotrexate
Methylcellulose
Methylnaltrexone bromide
Methylphenidate
Methylprednisolone
Metoclopramide
Metoprolol
Metronidazole
Midazolam 4
Mirabegron
Mirtazapine
Misoprostol
Mivacurium
Mizolastine
Mometasone
Monoclonal antibodies
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
Norfloxacin
Nortriptyline
Nystatin
Octreotide
Ofatumumab
Ofloxacin
Olanzapine
Omeprazole
Ondansetron
Orlistat
Oseltamivir
Oxycodone
Oxytocin
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
Prednisolone
Pregabalin
Prilocaine
Primaquine
Prochlorperazine
Proguanil
Promethazine
Propofol 4
Propranolol
Propylthiouracil
Pseudoephedrine
Pyrazinamide
Pyridostigmine
Pyridoxine
Quinapril
Quinine
Rabeprazole
Ramipril
Ranitidine
Remifentanyl
Repaglinide
Riboflavine
Risedronate
Rituximab
Rivaroxaban
Rivastigmine
Rizatriptan
Rocuronium
Rosuvastatin
Salbutamol
Salmeterol
Saxagliptin
Senna
Sertraline
Sevelamer
Shingles vaccine 2
Sildenafil
Simvastatin
Sitagliptin
Situximab
Sodium bicarbonate
Sodium citrate enema
Sodium clodronate
Sodium fusidate
Sodium picosulfate
Solifenacin
Sotalol
Sterculia
Streptokinase
Strontium
Sulpiride
Sumatriptan
Suxamethonium
Tacrolimus
Tadalafil
Tamsulosin
Teicoplanin
Telmisartan
Temazepam
Tenecteplase
Terazosin
Terbinafine
Terbutaline
Tetanus/diphtheria/polio vaccine
Tetracosactide
Theophylline
Thiamine
Ticagrelor
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
Zanamavir
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 WMIC. 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 WMIC.

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 Information Centre (WMIC) offers a specialist advisory service on the safe use of drugs in porphyria to patients and healthcare professionals in the UK. The centre contact telephone number is 029 2074 2251/029 2074 2979 and fax number is 029 2074 3879.


Resources for healthcare professionals

In conjunction with the Department of Biochemistry and Immunology, University Hospital of Wales, WMIC has recently had two articles published in the Adverse Drug Reaction Bulletin on safe pescribing 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, WMIC 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 also produce a series of ‘questions and answers’ (Q&As) on medicines-related porphyria enquiries that are available to view through the SPS website:

And finally, WMIC offers a specialist advisory service on the safe use of drugs in porphyria to patients and healthcare professionals in the UK. Medicines Information enquiries can be submitted by telephoning the centre on 029 2074 2251/029 2074 2979 or faxing the centre on 029 2074 3879.


Links to useful websites

Disclaimer: These links are provided for information only and WMIC 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 WMIC 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


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