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.




Coronavirus (Covid-19) advice

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

Search the Porphyria safe list

Download a PDF copy of the 2020 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.

2020 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

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

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

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

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

Eplenerone

Epoetin

Eprosartan

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

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 and 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

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

Remifentanyl

Repaglinide

Riboflavin

Risedronate

Rituximab

Rivaroxaban

Rivastigmine

Rizatriptan

Rocuronium

Rosuvastatin

Salbutamol

Salmeterol

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

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

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 2184 2251


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 2184 2251


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


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

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