BNF for Children 2011-2012

498 9.8.2 Acute porphyrias BNFC 2011–2012Drugs unsafe for use in acuteporphyriasThe following list contains drugs on the UK market thathave been classified as ‘unsafe’ in porphyria becausethey have been shown to be porphyrinogenic in animalsor in vitro, or have been associated with acute attacks inpatients. Absence of a drug from the following lists doesnot necessarily imply that the drug is safe. For manydrugs no information about porphyria is available.An up-to-date list of drugs considered safe in acuteporphyrias is available at www.wmic.wales.nhs.uk/porphyria_info.php.Unsafe drug groups (check first)Further information may be obtained fromwww.porphyria-europe.org and also from:Welsh Medicines Information CentreUniversity Hospital of WalesCardiff, CF14 4XWTel: (029) 2074 2979/3877Note Quite modest changes in chemical structure can lead tochanges in porphyrinogenicity but where possible generalstatements have been made about groups of drugs; theseshould be checked first.Alkylating drugs 1AmfetaminesAnabolic steroidsAntidepressants 2Antihistamines 3Barbiturates 4 Calcium channel blockers 5Contraceptives, hormonal 6Ergot derivatives 7Gold saltsHormone replacement therapy 6Imidazole antifungals 8Non-nucleoside reverse transcriptaseinhibitors 1Progestogens 6Protease inhibitors 1Statins 9Sulfonamides 10 Sulfonylureas 11Taxanes 1TetracyclinesThiazolidinediones 1Triazole antifungals 8Unsafe drugs (check groups above first)9 Nutrition and bloodAceclofenacAlcoholAminophyllineAmiodaroneArtemether with lumefantrineBexaroteneBosentanBromocriptineBuspironeCabergolineCarbamazepineChloral hydrate 12ChloramphenicolChloroform 13ClindamycinCocaineColistimethate sodiumCycloserineDanazolDapsoneDexfenfluramineDiazepam 14DiclofenacDisopyramideDisulfiramErythromycinEtamsylateEthosuximideEtomidateFenfluramineFlupentixolFlutamideFosphenytoinGriseofulvinHalothaneHydralazineIndapamideIsometheptene mucateIsoniazidKetamineKetorolacLidocaine 15MebeverineMefenamic acid 16MeprobamateMethyldopaMetoclopramide 16MetolazoneMetronidazole 16MetyraponeMifepristoneMinoxidil 16MitotaneNalidixic acidNitrazepamNitrofurantoinOrphenadrineOxcarbazepineOxybutyninOxycodone 17Pentazocine 17PentoxifyllinePhenoxybenzaminePhenytoinPivmecillinamPorfimerPotassium canrenoate 18ProbenecidPyrazinamideRaloxifeneRifabutin 19Rifampicin 19RisperidoneSelegilineSpironolactoneSulfinpyrazoneTamoxifenTelithromycinTemoporfinTheophyllineTiagabineTinidazoleTopiramateToremifeneTrimethoprimValproate 14XipamideZidovudine 1Zuclopenthixol1. Contact Welsh Medicines Information Centre for further advice.2. Includes tricyclic (and related) antidepressants and MAOIs; fluoxetine, mianserin, and venlafaxine thought to be safe.3. Alimemazine, chlorphenamine, desloratadine, fexofenadine, ketotifen, loratadine, and promethazine thought to be safe.4. Includes primidone and thiopental.5. Amlodipine, felodipine, and nifedipine may be used with caution.6. Progestogens are more porphyrinogenic than oestrogens; oestrogens may be safe at least in replacement doses. Progestogensshould be avoided whenever possible by all young women susceptible to acute porphyria; however, when non-hormonalcontraception is inappropriate, progestogens may be used with extreme caution if the potential benefit outweighs risk. Therisk of an acute attack is greatest in young women who have had a previous attack. Long-acting progestogen preparationsshould never be used in those at risk of acute porphyria.7. Includes ergometrine (oxytocin probably safe) and pergolide.8. Applies to oral and intravenous use; topical antifungals are thought to be safe due to low systemic exposure.9. Rosuvastatin thought to be safe.10. Includes co-trimoxazole and sulfasalazine.11. Glipizide is thought to be safe.12. Although evidence of hazard is uncertain, manufacturer advises avoid.13. Small amounts in medicines probably safe.14. Status epilepticus has been treated successfully with intravenous diazepam.15. When used for local anaesthesia, articaine, bupivacaine, lidocaine, prilocaine, and tetracaine are thought to be safe.16. May be used with caution if safer alternative not available.17. Buprenorphine, codeine, diamorphine, dihydrocodeine, fentanyl, methadone, morphine, pethidine, and tramadol are thoughtto be safe.18. Evidence of hazard uncertain—contact Welsh Medicines Information Centre for further advice.19. Rifamycins have been used in a few patients without evidence of harm—use with caution if safer alternative not available.