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Simon A, Pompilus F, Querbes W, Wei A, Strzok S, Penz C, et al. Patient Perspective on Acute Intermittent Porphyria with Frequent Attacks: A Disease with Intermittent and Chronic Manifestations. Patient. 2018 Oct. 11 (5):527-537. [QxMD MEDLINE Link]. [Full Text].
Mikami Y, Nagai T, Gomi Y, Takai Y, Saito M, Baba K, et al. Methotrexate and actinomycin D chemotherapy in a patient with porphyria: a case report. J Med Case Rep. 2016 Jan 18. 10:9. [QxMD MEDLINE Link].
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Zheng X, Liu X, Wang Y, Zhao R, Qu L, Pei H, et al. Acute intermittent porphyria presenting with seizures and posterior reversible encephalopathy syndrome: Two case reports and a literature review. Medicine (Baltimore). 2018 Sep. 97 (36):e11665. [QxMD MEDLINE Link]. [Full Text].
Whatley SD, Mason NG, Woolf JR, et al. Diagnostic strategies for autosomal dominant acute porphyrias: retrospective analysis of 467 unrelated patients referred for mutational analysis of the HMBS, CPOX, or PPOX gene. Clin Chem. 2009 Jul. 55(7):1406-14. [QxMD MEDLINE Link].
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Table 1. Drugs Thought Safe in Porphyria*

Acetazolamide acetylcholine

Actinomycin D^[7]

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]^[7]

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

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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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.

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