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Hereditary Coproporphyria Clinical Presentation

  • Author: Thomas G DeLoughery, MD; Chief Editor: Emmanuel C Besa, MD  more...
 
Updated: Jan 21, 2015
 

History

Coproporphyria has neurovisceral, psychiatric, neurologic, and skin manifestations. The usual sequence of events in acute attacks is abdominal pain, then psychiatric symptoms (eg, hysteria), then peripheral neuropathies. The exact mechanism by which the porphyrin precursors lead to these symptoms is unknown.

Neurovisceral manifestations

Neurovisceral signs and symptoms consist of autonomic neuropathies such as constipation, abdominal pain, and vomiting. Patients can have very severe abdominal pain that lasts for several days. Pain of short duration (minutes) or chronic abdominal pain does not develop in coproporphyria. The pain often is epigastric and is colicky in nature.

Patients often are free of pain between attacks. Constipation is common and can be very severe. Nausea and vomiting frequently are present.

Neurologic manifestations

Patients with coproporphyria can have both central nervous system (CNS) and peripheral nervous system manifestations. CNS manifestations include seizures, mental status changes, cortical blindness, and coma. Peripheral neuropathies are predominantly motor neuropathies and can mimic Guillain-Barré syndrome. The weakness usually starts in the lower limbs and ascends, but neuropathies occur in any nerve distribution.

Diffuse pain, especially in the upper body, can be observed. Patients also can develop autonomic neuropathies, including hypertension and tachycardia.

Psychiatric manifestations

Patients can have a wide variety of psychiatric symptoms. Depression is common. Patients with psychiatric manifestations usually have concurrent neurologic or abdominal symptoms.

Skin manifestations

The skin disease is similar to porphyria cutanea tarda. With long-term (not acute) sun exposure, patients can develop vesicles and bullae. If patients are symptomatic with coproporphyria, they tend to have neurovisceral symptoms rather than skin symptoms. Blisters form in sun-exposed areas and can evolve into chronic scarred areas of fragile skin. Patients also may develop excessive hair growth in sun-exposed areas.

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Causes

Like AIP, coproporphyria is due to a combination of a genetic enzyme defect and acquired causes that become symptomatic in rare cases.[2] In patients with coproporphyria, the function of coproporphyrinogen oxidase is only 40-60% of normal.[3] Also, like AIP, most patients with defects in coproporphyrinogen oxidase never have any symptoms. The classic inducers of porphyria are chemicals or situations that boost heme synthesis. This includes fasting and many medications.

Although extensive lists of safe and unsafe drugs exist, many of these are based on anecdotes or laboratory evidence rather than meeting strict criteria. In general, drugs that lead to increased activity of the hepatic P450 system (eg, phenobarbital, sulfonamides, estrogens, alcohol) are associated with porphyria. A large and detailed list, shown below, is available through the European Porphyria Network. Fasting for several days also can trigger an attack. Many attacks will occur, however, without any obvious provocation.

Table 1. Drugs Thought Safe in Porphyria* (Open Table in a new window)

Acetazolamide acetylcholine



Actinomycin D



Acyclovir



Adenosine monophosphate



Adrenaline



Alclofenac



Allopurinol



Alpha tocopheryl



Acetate



Amethocaine



Amiloride



Aminocaproic acid



Aminoglycosides



Amoxicillin



Amphotericin



Ampicillin



Ascorbic acid



Aspirin



Atenolol



Atropine



Azathioprine



Beclomethasone



Benzhexol HCl



Beta-carotene



Biguanides



[Bromazepam]



Bromides



Buflomedil HCl



Bumetanide



Bupivacaine



Buprenorphine



Buserelin



Butacaine SO4



Canthaxanthin



Carbimazole



[Carpipramine HCl]



Chloral hydrate



[Chlormethiazole]



[Chloroquine]



[Chlorothiazide]



Chlorpheniramine



Chlorpromazine



Ciprofloxacin



Cisapride



Cisplatin



Clavulanic acid



Clofibrate



Clomiphene



Cloxacillin



Co-codamol



Codeine phosphate



Colchicine



[Corticosteroids]



Corticotrophin (adrenocorticotropic hormone [ACTH])



Coumarins



Cyclizine



Cyclopenthiazide



Cyclopropane



[Cyproterone acetate]



Danthron



Desferrioxamine



Dexamethasone



[Dextromoramide]



Dextrose



Diamorphine



Diazoxide



Dicyclomine HCl



Diflunisal



Digoxin



Dihydrocodeine



Dimercaprol



Dimethicone



Dinoprost



Diphenoxylate HCl



Dipyridamole



[Disopyramide]



Domperidone



Doxorubicin HCl



Droperidol



[Estazolam]



Ethacrynic acid



Ethambutol



[Ethinyl oestradiol]



Ethoheptazine citrate



Etoposide



Famotidine



Fenbufen



[Fenofibrate]



Fenoprofen



Fentanyl



Flucytosine



Flumazenil



Fluoxetine HCl



Flurbiprofen



Fluvoxamine



Maleate



Folic acid



Fructose



Fusidic acid



Follicle-stimulating hormone



Gentamicin



Glafenine



Glucagon



Glucose



Glyceryl trinitrate



Goserelin



Guanethidine



Guanfacine HCl



Haem arginate



[Haloperidol]



Heparin



Heptaminol HCl



Hexamine



[Hydrocortisone]



Ibuprofen



Indomethacin



Insulin



Iron



Josamycin



[Ketamine]



Ketoprofen



Ketotifen



Labetalol



Luteinizing hormone–releasing hormone



Liquorice



Lithium



Salts lofepramine



Loperamide



[Lorazepam]



Magnesium-sulphate



[Mebendazole]



Mecamylamine



Meclofenoxate HCl



Meclozine



Mefloquine HCl



[Melphalan]



Meptazinol



Mequitazine



Metformin



Methadone



[Methotrimeprazine]



Methylphenidate



Methyluracil



Metipropranolol



Metopimazine



Metoprolol



[Metronidazole]



[Midazolam]



Minaprine HCl



Minaxolone



Morphine



Nadolol



Naftidrofuryl



Oxalate



[Naproxen sodium]



Natamycin



Nefopam HCl



Neostigmine



Netilmicin



Niflumic acid



Nitrous oxide



Norfloxacin



Ofloxacin



Oxolinic acid



Oxybuprocaine



[Oxyphenbutazone]



Oxytocin



[Pancuronium bromide]



Paracetamol



Paraldehyde



Parapenzolate Br



Penicillamine



Penicillin



Pentolinium



Pericyazine



Pethidine



Phenformin



Phenoperidine



Phentolamine mesylate



Pipotiazine



Palmitate



Piracetam



Pirbuterol



Pirenzepine



Pizotifen



[Prazosin]



[Prednisolone]



Primaquine



Probucol



Procainamide HCl



Procaine



Prochlorperazine



Proguanil HCl



Promazine



Propantheline Br



Propofol



Propranolol



Propylthiouracil



[Proxymetacaine]



Pseudoephedrine HCl



Pyridoxine



[Pyrimethamine]



Quinidine



Quinine



[Ranitidine]



Reserpine



Resorcinol



Salbutamol



Senna



Sodium bromide



Sodium ethylenediaminetetraacetic acid



Sodium fusidate



Sorbitol



Streptomycin



Sulbutiamine



Sulindac



Sulfadoxine



Suxamethonium



Talampicillin



Temazepam



Tetracaine



[Tetracyclines]



Thiouracils



Thyroxine



Tiaprofenic acid



Ticarcillin



Tienilic acid



Timolol maleate



Tolazoline



Tranexamic acid



Triacetyloleandomycin



Triamterene



Triazolam



[Trichlormethiazide]



Trifluoperazine



Trimeprazine



Tartrate



Trimetazidine HCl



Tripelennamine



Tubocurarine



Vancomycin



[Vincristine]



Vitamins



Warfarin sodium



Zidovudine



Zinc Preparations



*Bracketed [] drugs are those in which experimental evidence of porphyrin genicity is conflicting.

Table 2. Drugs Thought Unsafe in Porphyria (Open Table in a new window)

Alcuronium



*Alphaxalone



Alphadolone



Alprazolam



Aluminium



Preparations



Amidopyrine



Aminoglutethimide



Aminophylline



Amiodarone



*Amitriptyline



[Amphetamines]



*Amylobarbitone



Antipyrine



*Auranofin



*Aurothiomalate



Azapropazone



Baclofen



*Barbiturates



*Bemegride



Bendrofluazide



Benoxaprofen



Benzbromarone



[Benzylthiouracil]



[Bepridil]



Bromocriptine



Busulphan



*Butylscopolamine



Captopril



*Carbamazepine



*Carbromal



*Carisoprodol



[Cefuroxime]



[Cephalexin]



[Cephalosporins]



[Cephradine]



[Chlorambucil]



*Chloramphenicol



*Chlordiazepoxide



*Chlormezanone



Chloroform



*Chlorpropamide



Cinnarizine



Clemastine



[Clobazam]



[Clomipramine HCl]



[Clonazepam]



Clonidine HCl



*Clorazepate



Cocaine



[Colistin]



Co-trimoxazole



Cyclophosphamide



Cycloserine



Cyclosporin



Danazol



*Dapsone



Dexfenfluramine



Dextropropoxyphene



Diazepam



*Dichloralphenazone



*Diclofenac Na



Dienoestrol



Diethylpropion



Dihydralazine



*Dihydroergotamine



Diltiazem



*Dimenhydrinate



*Diphenhydramine



[Dothiepin HCl]



Doxycycline



*Dydrogesterone



*Econazole NO3



*Enalapril



Enflurane



*Ergot compounds



Ergometrine maleate



Ergotamine tartrate



*Erythromycin



*Estramustine



Ethamsylate



*Ethanol



Ethionamide



*Ethosuximide



*Ethotoin



Etidocaine



Etomidate



Fenfluramine



*Flucloxacillin



*Flufenamic acid



Flunitrazepam



Flupenthixol



Flurazepam



*Frusemide



*Glibenclamide



*Glutethimide



*Glipizide



Gramicidin



*Griseofulvin



[Haloperidol]



*Halothane



*Hydantoins



*Hydralazine



*Hydrochlorothiazide



*Hydroxyzine



Hyoscine



*Imipramine



Iproniazid



Isometheptene mucate



[Isoniazid]



Kebuzone



Ketoconazole



*Levonorgestrel



Lignocaine



*Lisinopril



Loprazolam



Loxapine



*Lynestrenol



Lysuride



Maleate



Maprotiline HCl



Mebeverine HCl



*Mecillinam



*Medroxyprogesterone



[Mefenamic acid]



Megestrol acetate



*Mephenytoin



Mepivacaine



*Meprobamate



Mercaptopurine



Mercury compounds



Mestranol



[Metapramine HCl]



Methamphetamine



Methohexitone



Methotrexate



Methoxyflurane



Methsuximide



*Methyldopa



*Methylsulphonal



*Methyprylone



Methysergide



*Metoclopramide



Metyrapone



Mianserin HCl



Miconazole



[Mifepristone]



Minoxidil



*Nandrolone



*Nalidixic acid



Natamycin



*Nandrolone



[Nicergoline]



*Nifedipine



*Nikethamide



Nitrazepam



*Nitrofurantoin



Nordazepam



Norethynodrel



*Norethisterone



[Nortriptyline]



Novobiocin



*Oral contraceptives



*Orphenadrine



Oxanamide



[Oxazepam]



Oxybutynin HCl



Oxycodone



*Oxymetazoline



*Oxyphenbutazone



Oxytetracycline



Paramethadione



Pargyline



*Pentazocine



Perhexiline



Phenacetin



Phenelzine



*Phenobarbitone



Phenoxybenzamine



*Phensuximide



*Phenylbutazone



Phenylhydrazine



*Phenytoin



Pipebuzone



Pipemidic



Acid



Piritramide



*Piroxicam



*Pivampicillin



*Pivmecillinam



Prazepam



Prenylamine



*Prilocaine



*Primidone



[Probenecid]



*Progesterone



Progabide



Promethazine



[Propanidid]



*Pyrazinamide



Pyrrocaine



Quinalbarbitone



Rifampicin



Simvastatin



Sodium aurothiomalate



Sodium oxybate



[Sodium valproate]



*Spironolactone



Stanozolol



Succinimides



*Sulfacetamide



*Sulfadiazine



*Sulfadimidine



*Sulfadoxine



*Sulfamethoxazole



*Sulfasalazine



*Sulfonylureas



Sulfinpyrazone



Sulpiride



Sulthiame



Sultopride



*Tamoxifen



*Terfenadine



Tetrazepam



*Theophylline



*Thiopentone Na



Thioridazine



Tilidate



Tinidazole



*Tolazamide



*Tolbutamide



Tranylcypromine



Trazodone HCl



Trimethoprim



[Trimipramine]



Troxidone



Valproate



Valpromide



Veralipride



*Verapamil



*Vibramycin



Viloxazine HCl



[Vinblastine]



[Vincristine]



Zuclopenthixol



*These drugs have been associated with acute attacks of porphyria.



†Bracketed [] drugs are those in which experimental evidence of porphyringenicity is conflicting.



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Physical Examination

Vital signs are as follows:

  • Tachycardia develops in 30-80% of patients
  • Fever can be present in some patients
  • Hypertension develops in 50% of cases and may persist between attacks

Neurologic manifestations are as follows:

  • Typically, the neuropathy is a motor neuropathy that is more predominant in the lower limbs
  • Areflexia is observed during the examination; however, any nerve can be involved. Cranial neuropathies also are observed, and the patient may have cortical blindness

Abdominal examination: Despite the intense pain that may accompany a severe attack, the findings on abdominal examination often are nonspecific.

Skin manifestations are as follows:

  • Patients can have blisters, chronic erosion, and areas of excessive hair growth
  • Skin damage develops in sun-exposed areas of the skin
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Contributor Information and Disclosures
Author

Thomas G DeLoughery, MD Professor of Medicine, Pathology, and Pediatrics, Divisions of Hematology/Oncology and Laboratory Medicine, Associate Director, Department of Transfusion Medicine, Division of Clinical Pathology, Oregon Health and Science University School of Medicine

Thomas G DeLoughery, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American College of Physicians, American Society of Hematology, International Society on Thrombosis and Haemostasis, Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Marcel E Conrad, MD Distinguished Professor of Medicine (Retired), University of South Alabama College of Medicine

Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, SWOG

Disclosure: Partner received none from No financial interests for none.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

Clarence Sarkodee Adoo, MD, FACP Consulting Staff, Department of Bone Marrow Transplantation, City of Hope Samaritan BMT Program

Clarence Sarkodee Adoo, MD, FACP is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Society of Hematology, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

References
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  11. Anderson KE, Bloomer JR, Bonkovsky HL, et al. Recommendations for the diagnosis and treatment of the acute porphyrias. Ann Intern Med. 2005 Mar 15. 142(6):439-50. [Medline].

  12. Bickers DR, Pathak MA, Lim HW. The Porphyrias. In: Fitzpatrick B, et al, eds. Dermatology in General Medicine. New York, NY:. McGraw-Hill, Inc. 1993:1854-1893.

  13. Bonkovsky HL, Barnard GF. Diagnosis of porphyric syndromes: a practical approach in the era of molecular biology. Semin Liver Dis. 1998. 18(1):57-65. [Medline].

  14. Daniell WE, Stockbridge HL, Labbe RF, et al. Environmental chemical exposures and disturbances of heme synthesis. Environ Health Perspect. 1997 Feb. 105 Suppl 1:37-53. [Medline].

  15. Elder GH, Smith SG, Smyth SJ. Laboratory investigation of the porphyrias. Ann Clin Biochem. 1990 Sep. 27 ( Pt 5):395-412. [Medline].

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Table 1. Drugs Thought Safe in Porphyria*
Acetazolamide acetylcholine



Actinomycin D



Acyclovir



Adenosine monophosphate



Adrenaline



Alclofenac



Allopurinol



Alpha tocopheryl



Acetate



Amethocaine



Amiloride



Aminocaproic acid



Aminoglycosides



Amoxicillin



Amphotericin



Ampicillin



Ascorbic acid



Aspirin



Atenolol



Atropine



Azathioprine



Beclomethasone



Benzhexol HCl



Beta-carotene



Biguanides



[Bromazepam]



Bromides



Buflomedil HCl



Bumetanide



Bupivacaine



Buprenorphine



Buserelin



Butacaine SO4



Canthaxanthin



Carbimazole



[Carpipramine HCl]



Chloral hydrate



[Chlormethiazole]



[Chloroquine]



[Chlorothiazide]



Chlorpheniramine



Chlorpromazine



Ciprofloxacin



Cisapride



Cisplatin



Clavulanic acid



Clofibrate



Clomiphene



Cloxacillin



Co-codamol



Codeine phosphate



Colchicine



[Corticosteroids]



Corticotrophin (adrenocorticotropic hormone [ACTH])



Coumarins



Cyclizine



Cyclopenthiazide



Cyclopropane



[Cyproterone acetate]



Danthron



Desferrioxamine



Dexamethasone



[Dextromoramide]



Dextrose



Diamorphine



Diazoxide



Dicyclomine HCl



Diflunisal



Digoxin



Dihydrocodeine



Dimercaprol



Dimethicone



Dinoprost



Diphenoxylate HCl



Dipyridamole



[Disopyramide]



Domperidone



Doxorubicin HCl



Droperidol



[Estazolam]



Ethacrynic acid



Ethambutol



[Ethinyl oestradiol]



Ethoheptazine citrate



Etoposide



Famotidine



Fenbufen



[Fenofibrate]



Fenoprofen



Fentanyl



Flucytosine



Flumazenil



Fluoxetine HCl



Flurbiprofen



Fluvoxamine



Maleate



Folic acid



Fructose



Fusidic acid



Follicle-stimulating hormone



Gentamicin



Glafenine



Glucagon



Glucose



Glyceryl trinitrate



Goserelin



Guanethidine



Guanfacine HCl



Haem arginate



[Haloperidol]



Heparin



Heptaminol HCl



Hexamine



[Hydrocortisone]



Ibuprofen



Indomethacin



Insulin



Iron



Josamycin



[Ketamine]



Ketoprofen



Ketotifen



Labetalol



Luteinizing hormone–releasing hormone



Liquorice



Lithium



Salts lofepramine



Loperamide



[Lorazepam]



Magnesium-sulphate



[Mebendazole]



Mecamylamine



Meclofenoxate HCl



Meclozine



Mefloquine HCl



[Melphalan]



Meptazinol



Mequitazine



Metformin



Methadone



[Methotrimeprazine]



Methylphenidate



Methyluracil



Metipropranolol



Metopimazine



Metoprolol



[Metronidazole]



[Midazolam]



Minaprine HCl



Minaxolone



Morphine



Nadolol



Naftidrofuryl



Oxalate



[Naproxen sodium]



Natamycin



Nefopam HCl



Neostigmine



Netilmicin



Niflumic acid



Nitrous oxide



Norfloxacin



Ofloxacin



Oxolinic acid



Oxybuprocaine



[Oxyphenbutazone]



Oxytocin



[Pancuronium bromide]



Paracetamol



Paraldehyde



Parapenzolate Br



Penicillamine



Penicillin



Pentolinium



Pericyazine



Pethidine



Phenformin



Phenoperidine



Phentolamine mesylate



Pipotiazine



Palmitate



Piracetam



Pirbuterol



Pirenzepine



Pizotifen



[Prazosin]



[Prednisolone]



Primaquine



Probucol



Procainamide HCl



Procaine



Prochlorperazine



Proguanil HCl



Promazine



Propantheline Br



Propofol



Propranolol



Propylthiouracil



[Proxymetacaine]



Pseudoephedrine HCl



Pyridoxine



[Pyrimethamine]



Quinidine



Quinine



[Ranitidine]



Reserpine



Resorcinol



Salbutamol



Senna



Sodium bromide



Sodium ethylenediaminetetraacetic acid



Sodium fusidate



Sorbitol



Streptomycin



Sulbutiamine



Sulindac



Sulfadoxine



Suxamethonium



Talampicillin



Temazepam



Tetracaine



[Tetracyclines]



Thiouracils



Thyroxine



Tiaprofenic acid



Ticarcillin



Tienilic acid



Timolol maleate



Tolazoline



Tranexamic acid



Triacetyloleandomycin



Triamterene



Triazolam



[Trichlormethiazide]



Trifluoperazine



Trimeprazine



Tartrate



Trimetazidine HCl



Tripelennamine



Tubocurarine



Vancomycin



[Vincristine]



Vitamins



Warfarin sodium



Zidovudine



Zinc Preparations



*Bracketed [] drugs are those in which experimental evidence of porphyrin genicity is conflicting.
Table 2. Drugs Thought Unsafe in Porphyria
Alcuronium



*Alphaxalone



Alphadolone



Alprazolam



Aluminium



Preparations



Amidopyrine



Aminoglutethimide



Aminophylline



Amiodarone



*Amitriptyline



[Amphetamines]



*Amylobarbitone



Antipyrine



*Auranofin



*Aurothiomalate



Azapropazone



Baclofen



*Barbiturates



*Bemegride



Bendrofluazide



Benoxaprofen



Benzbromarone



[Benzylthiouracil]



[Bepridil]



Bromocriptine



Busulphan



*Butylscopolamine



Captopril



*Carbamazepine



*Carbromal



*Carisoprodol



[Cefuroxime]



[Cephalexin]



[Cephalosporins]



[Cephradine]



[Chlorambucil]



*Chloramphenicol



*Chlordiazepoxide



*Chlormezanone



Chloroform



*Chlorpropamide



Cinnarizine



Clemastine



[Clobazam]



[Clomipramine HCl]



[Clonazepam]



Clonidine HCl



*Clorazepate



Cocaine



[Colistin]



Co-trimoxazole



Cyclophosphamide



Cycloserine



Cyclosporin



Danazol



*Dapsone



Dexfenfluramine



Dextropropoxyphene



Diazepam



*Dichloralphenazone



*Diclofenac Na



Dienoestrol



Diethylpropion



Dihydralazine



*Dihydroergotamine



Diltiazem



*Dimenhydrinate



*Diphenhydramine



[Dothiepin HCl]



Doxycycline



*Dydrogesterone



*Econazole NO3



*Enalapril



Enflurane



*Ergot compounds



Ergometrine maleate



Ergotamine tartrate



*Erythromycin



*Estramustine



Ethamsylate



*Ethanol



Ethionamide



*Ethosuximide



*Ethotoin



Etidocaine



Etomidate



Fenfluramine



*Flucloxacillin



*Flufenamic acid



Flunitrazepam



Flupenthixol



Flurazepam



*Frusemide



*Glibenclamide



*Glutethimide



*Glipizide



Gramicidin



*Griseofulvin



[Haloperidol]



*Halothane



*Hydantoins



*Hydralazine



*Hydrochlorothiazide



*Hydroxyzine



Hyoscine



*Imipramine



Iproniazid



Isometheptene mucate



[Isoniazid]



Kebuzone



Ketoconazole



*Levonorgestrel



Lignocaine



*Lisinopril



Loprazolam



Loxapine



*Lynestrenol



Lysuride



Maleate



Maprotiline HCl



Mebeverine HCl



*Mecillinam



*Medroxyprogesterone



[Mefenamic acid]



Megestrol acetate



*Mephenytoin



Mepivacaine



*Meprobamate



Mercaptopurine



Mercury compounds



Mestranol



[Metapramine HCl]



Methamphetamine



Methohexitone



Methotrexate



Methoxyflurane



Methsuximide



*Methyldopa



*Methylsulphonal



*Methyprylone



Methysergide



*Metoclopramide



Metyrapone



Mianserin HCl



Miconazole



[Mifepristone]



Minoxidil



*Nandrolone



*Nalidixic acid



Natamycin



*Nandrolone



[Nicergoline]



*Nifedipine



*Nikethamide



Nitrazepam



*Nitrofurantoin



Nordazepam



Norethynodrel



*Norethisterone



[Nortriptyline]



Novobiocin



*Oral contraceptives



*Orphenadrine



Oxanamide



[Oxazepam]



Oxybutynin HCl



Oxycodone



*Oxymetazoline



*Oxyphenbutazone



Oxytetracycline



Paramethadione



Pargyline



*Pentazocine



Perhexiline



Phenacetin



Phenelzine



*Phenobarbitone



Phenoxybenzamine



*Phensuximide



*Phenylbutazone



Phenylhydrazine



*Phenytoin



Pipebuzone



Pipemidic



Acid



Piritramide



*Piroxicam



*Pivampicillin



*Pivmecillinam



Prazepam



Prenylamine



*Prilocaine



*Primidone



[Probenecid]



*Progesterone



Progabide



Promethazine



[Propanidid]



*Pyrazinamide



Pyrrocaine



Quinalbarbitone



Rifampicin



Simvastatin



Sodium aurothiomalate



Sodium oxybate



[Sodium valproate]



*Spironolactone



Stanozolol



Succinimides



*Sulfacetamide



*Sulfadiazine



*Sulfadimidine



*Sulfadoxine



*Sulfamethoxazole



*Sulfasalazine



*Sulfonylureas



Sulfinpyrazone



Sulpiride



Sulthiame



Sultopride



*Tamoxifen



*Terfenadine



Tetrazepam



*Theophylline



*Thiopentone Na



Thioridazine



Tilidate



Tinidazole



*Tolazamide



*Tolbutamide



Tranylcypromine



Trazodone HCl



Trimethoprim



[Trimipramine]



Troxidone



Valproate



Valpromide



Veralipride



*Verapamil



*Vibramycin



Viloxazine HCl



[Vinblastine]



[Vincristine]



Zuclopenthixol



*These drugs have been associated with acute attacks of porphyria.



†Bracketed [] drugs are those in which experimental evidence of porphyringenicity is conflicting.



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