6/21/2017 About Porphyria: Drug database

Porphyria Drug Safety Database
721 records found 
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Class Type Generic name Brand name Conclusion References

­ Levobunolol Betagan, others OK!

­ Proparacaine Alcaine, Ophthetic, OK!

Ophthaine, others
­ Timolol Combigan, OK!
Timolide, Cosopt

ANESTHETICS GENERAL Desflurane Suprane OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

ANESTHETICS GENERAL Etomidate Amidate BAD! www.porphyria­europe.com: Unsafe

web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in animals Br J
Anaesth 1985;57:420. Unsafe in animals
ANESTHETICS GENERAL Isoflurane Forane OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Unsafe in animals
ANESTHETICS GENERAL Ketamine Ketalar BAD! www.drugs­porphyria.org: Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Probably safe Br J Anaesth
1985;57:420. Safe in animals
Anesthetics GENERAL Midazolam Versed OK? www.drugs­porphyria.org: Possibly Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Cell culture ­ Safe Substrate
of CYP3A4. Transactivates pregnane X receptor, but low
probability of CYP3A4 induction (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Curr Drug Metab
7:375,2006; Curr Drug Metab 9:827,2008)
ANESTHETICS GENERAL Propofol Diprivan OK! www.porphyria­europe.com: safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients Anaesthesia
1992;47:355 Safe Anaesthesia 1988;43:1022. Safe in
patients
ANESTHETICS GENERAL Sevoflurane Ultane OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Caution Pediat
Anesthes 2005;15:426. Safe USP DI? Drug Info. for the
Health Care Pro. ­ 26th Ed. (2006): Only 5% is
metabolized, primarily by CYP2E1 (not CYP3A or 2C9)
Anesthetics General Thiamylal Surital BAD! Barbiturate drug

Anesthetics GENERAL Thiopental Pentothal BAD! www.drugs­porphyria.org: Porphyrinogenic

www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid See
Phenobarbital
ANESTHETICS LOCAL Benzocaine Many NO INFO
ANESTHETICS LOCAL Bupivacaine Many OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in animals Medicine
(Balt) 1992;71:1. Safe
ANESTHETICS LOCAL Chloroprocaine Nesacaine NO INFO
ANESTHETICS LOCAL Dibucaine Nupercainal NO INFO

ANESTHETICS LOCAL Ethyl chloride Ethyl Chloride OK!

ANESTHETICS LOCAL Prilocaine Citanest OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Unsafe in patients Medicine
(Balt) 1992;71:1. Safe
ANESTHETICS LOCAL Procaine Many OK! www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
ANESTHETICS LOCAL Ropivacaine Naropin OK? www.drugs­porphyria.org: Possibly Porphyrinogenic.
Substrate of CYP 1A. Use with care in doses >2 mL (of
10 mg/mL solution) Clin Pharmacol Ther 1998;64:484.
Mostly metabolized by CYP1A2
ANESTHETICS LOCAL Tetracaine Many OK! www.drugs­porphyria.org: Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in animals
Anesthetics MUSCLE RELAXANTS Baclofen Many OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
http://www.bio.net/bionet/hypermail/neur­sci/2005­
July/060879.html: Ca. 85% is excreted unchanged, and
ca. 15% of the dose is metabolized primarily by
deamination
Anesthetics MUSCLE RELAXANTS Cyclobenzaprine Flexeril BAD? www.drugs.com: Metabolized by CYP3A4; forms ligand
with PXR Williams DA. Drug metabolism. In: Foye?s
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007. Substrate of CYP3A4
ANESTHETICS MUSCLE RELAXANTS Doxacurium Nuromax NO INFO

ANESTHETICS MUSCLE RELAXANTS Pancuronium Pavulon OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

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6/21/2017 About Porphyria: Drug database
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Probably safe
ANESTHETICS MUSCLE RELAXANTS Succinylcholine Anectine OK? Patient report: Safe

ANESTHETICS MUSCLE RELAXANTS Vecuronium Norcuron OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

web.uct.ac.za/depts/porphyria/: Use with Caution
ANTI­INFECTIVES AMINOGLYCOSIDES Amikacin Amikin OK! www.drugs­porphyria.org: Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use PV Tishler MD
clinical data: Safe
ANTI­INFECTIVES AMINOGLYCOSIDES Gentamicin Many OK! www.drugs­porphyria.org: Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients and animals
ANTI­INFECTIVES AMINOGLYCOSIDES Neomycin Many OK?
ANTI­INFECTIVES AMINOGLYCOSIDES Streptomycin Many OK! www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe
www.porphyriafoundation.com: Safe
ANTI­INFECTIVES AMINOGLYCOSIDES Tobramycin Many OK! www.drugs­porphyria.org: Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use S Afr Med J
1984;65:924. Safe in patients
Anti­infectives Animycobacterial Rifapentine Priftin BAD! Induces CyP3A, 2C9, ALA synthase (analogous to
agents rifampicin)

Anti­infectives anthelmintics albendazole multiple BAD? poorly absorbed from GI tract; but signif metabolsim by

CyP3A4. Poor data.(Eur. J. Clin Pharm 71:528, 2011)
Anti­infectives anthelmintics mebendazole multiple No info Poorly absorbed from GI tract. Probably metabolised by
P450.
ANTI­INFECTIVES ANTIFUNGALS Amphotericin B Amphotec OK! www.drugs­porphyria.org: Probably Not
Porphyrinogenic/Not Porphyrinogenic www.porphyria­
europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
with Caution www.uq.edu.au/porphyria/: Safe in cell
culture
ANTI­INFECTIVES ANTIFUNGALS Carbamide Peroxide Debrox OK? www.drugs­porphyria.org: Not Porphyrinogenic

ANTI­INFECTIVES ANTIFUNGALS Caspofungin Cancidas OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

www.rxlist.com: Metabolized by hydrolysis and N­
acetylation
Anti­infectives ANTIFUNGALS Clotrimazole OK? www.drugs­porphyria.org: Probably Not /Possibly
Porphyrinogenic Comp Biochem Physiol C Toxicol
Pharmacol 2005;140:403. Induces CYP3A. Did not affect
expression of PXR and MDR1 in zebrafish. Inhibits
constituitive androstene receptor.
Anti­infectives ANTIFUNGALS Fluconazole Diflucan BAD! www.drugs­porphyria.org: Probably Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Inhibits Cyt3A,2C9, and pregnane X receptor. 3
Patient reports: Unsafe.
ANTI­INFECTIVES ANTIFUNGALS Flucytosine Ancobon OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in cell culture
www.porphyriafoundation.com: Safe
Anti­infectives ANTIFUNGALS Griseofulvin Many BAD! www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in patients
www.porphyriafoundation.com: Unsafe. Induces CYP3A
Anti­infectives ANTIFUNGALS Itraconazole Sporanox BAD! www.drugs­porphyria.org: Probably Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007. substrate & inhibitor of CYP3A4
Anti­infectives ANTIFUNGALS Ketoconazole Many BAD! www.drugs­porphyria.org: Porphyrinogenic
www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in cell culture
Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007. Substrate
& inhibitor of CYP3A4. Inhibitor of pregnane X receptor &
constit. androstene receptor.
Anti­infectives ANTIFUNGALS Metronidazole Flagyl BAD? www.drugs­porphyria.org: Probably Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: probably safe J
Neurol Neurosurg Psychiat 1997;62:421. Sinz: Cur Drug
Metab 2006; 7:375: no human pregnane X receptor
activation. Unsafe in patients. 1 patient: safe
Anti­infectives ANTIFUNGALS Micafungin Mycamine OK? Metab by and weakely inhibits CYP3A. 3A is not major
path.
Anti­infectives ANTIFUNGALS Miconazole Monistat, others BAD? www.drugs­porphyria.org: Probably Not
Porphyrinogenic/Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in cell culture
Anti­infectives ANTIFUNGALS Nystatin Many OK! www.drugs­porphyria.org: Not Porphyrinogenic USP DI?
Drug Info. for the Health Care Pro. ­ 26th Ed. (2006):
No P450 metabolism
ANTI­INFECTIVES ANTIFUNGALS Posaconazole Noxafil NO INFO

Anti­infectives ANTIFUNGALS Terbinafine Lamisil BAD? www.drugs­porphyria.org: Oral ­Probably

Porphyrinogenic. Topical ­ ok.
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution. Vickers, Drug Metab Disp 1999; 27:1029: Main
metab via CYP2C9, 1A2, 3A4. Sinz M. Cur Drug Metab
2006; 7:375: High activation of pregnane X receptor but
low prediction of clinical induction. (This is given over a
ca. 3 month period, so acute experimental data may not
be relevant.)

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Anti­infectives ANTIFUNGALS Terconazole Terazol No info Induces pregnane X receptor.

Anti­infectives ANTIFUNGALS Voriconazole Vfend BAD! www.drugs­porphyria.org: Probably Porphyrinogenic

Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007. Substrate
of & inhibits CYP3A4 & 2C9.
ANTI­INFECTIVES ANTIMALARIALS Atovaquone Mepron OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
www.porphyria­europe.com: Safe
http://www.pharmgkb.org/: Not much is metabolized
Anti­infectives ANTIMALARIALS Chloroquine Many OK? www.drugs­porphyria.org: Possibly Porphyrinogenic,
Compare the 8­aminoquioline primaquine: Inducer of
CYPs 1A1, 1A2 and 1B1. No data pointing to clinically
significant CYP­inducing properties. Conflicting
references. One report of possible porphyrinogenicity.
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Probably safe Williams DA.
Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007. Substrate of CYP3A4
ANTI­INFECTIVES ANTIMALARIALS Hydroxychloroquine Plaquenil OK? www.drugs­porphyria.org: Possibly Porphyrinogenic.
Partly CYP­metabolized. Compare the 8­aminoquinoline
primaquine: Inducer of CYPs 1A1, 1A2 and 1B1
ANTI­INFECTIVES ANTIMALARIALS Mefloquine Lariam OK! www.drugs­porphyria.org: Possibly Porphyrinogenic.
Substrate for CYP 3A4. No clinical observations pointing
to CYP­induction. Compare the other methanolquinoline
quinine: Inducer of CYPs 1A1, 1A2 and 2C9.
Activator/stimulator of CYP 3A4. Inhibitor of CYPs e.g.
1A1 (potent).
ANTI­INFECTIVES ANTIMALARIALS Primaquine Primaquine OK! www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
Anti­infectives ANTIMALARIALS Proguanil Malarone (also OK! www.drugs­porphyria.org: Possibly Porphyrinogenic,
contains substrate of CYP2C19, 1A2, 3A4; no clinical observations
atovaquone) pointing to CYP induction
web.uct.ac.za/depts/porphyria/: Use
ANTI­INFECTIVES ANTIMALARIALS Pyrimethamine Daraprim OK! www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
Anti­infectives ANTIMALARIALS Quinine Sulfate Many OK? www.drugs­porphyria.org: Possibly Porphyrinogenic.
Metab. by CYP3A. Inducer of 2C9. Possible
activator/stimulator of CYP 3A4.
1Aweb.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients S Afr Med J
1988;74:321. Safe in patients Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007. Substrate of CYP3A4
Anti­infectives antimycobacterial rifampicin

ANTI­INFECTIVES ANTIMYCOBACTERIAL Ethambutol Myambutol OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

AGENTS www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
ANTI­INFECTIVES ANTIMYCOBACTERIAL Isoniazid Many BAD! www.drugs­porphyria.org: Probably Porphyrinogenic.
AGENTS Inhibitor of CYP 1A2, 2A6, 2C19, 3A4. Several
references warn against its use
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Probably unsafe
ANTI­INFECTIVES ANTIMYCOBACTERIAL Pyrazinamide Many BAD! www.porphyria­europe.com: Unsafe
AGENTS web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: unsafe in patients
www.porphyriafoundation.com: Unsafe
Anti­infectives ANTIMYCOBACTERIAL Rifabutin Mycobutin BAD! www.drugs­porphyria.org: Probably Porphyrinogenic
AGENTS web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Substrate of CYP3A4. Induces CYP3A4 via
pregnane X receptor transactivation (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Arch Toxicol
82:667,2008; Cur Drug Metab 7:375,2006)
Anti­infectives ANTIMYCOBACTERIAL Rifampin Rifadin BAD! Substrate of CYP3A4. Induces CYP3A4 via transactivation
AGENTS of pregnane X receptor (Cur Drug Metab 7:375,2006;
Arch Toxicol 82:667,2008)
Anti­infectives ANTIPARASITICS Albendazole Many OK? web.uct.ac.za/depts/porphyria/: Use with Caution
Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007. Substrate
of CYP3A4
ANTI­INFECTIVES ANTIPARASITICS Iodoquinol Yodoxin NO INFO
ANTI­INFECTIVES ANTIPARASITICS Ivermectin Stromectol BAD? Xenabiotica 1998; 28: 313. Metabolized extensively by
CYP3A4
Anti­infectives ANTIPARASITICS Mebendazole Vermox OK? www.drugs­porphyria.org: Possibly Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Caution
Anti­infectives ANTIPARASITICS Praziquantel Many BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007. Substrate of CYP3A4
Anti­infectives ANTIPARASITICS Tinidazole Tindamax BAD? ~75% metab by CYP3A4. Porphyrinogenic in vitro (Eur J
Clin Pharmacol 59:429,2003)
Anti­infectives antiretroviral Telbivudine Tyzeka OK? Not metabolized; no P450 interaction (Medical Letter
49:11, 2007; Micromedex
ANTI­INFECTIVES ANTIRETROVIRALS Abacavir Ziagen OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed.
(2006): No P450 metabolism
www.drugs­porphyria.org: Probably Porphyrinogenic.
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Anti­infectives ANTIRETROVIRALS Amprenavir Agenerase BAD! Substrate of CYP3A4. Induces CYP3A4 via transactivation
of pregnane X receptor (Williams DA. Drug metabolism.
In: Foye's Principles of Medicinal Chemistry, ed. Lemke
T and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007; Arch Toxicol 82:667,2008)
Anti­infectives ANTIRETROVIRALS Atazanavir Reyataz BAD? USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed:
Extensively metabolized by CYP3A4 Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007. Substrate of CYP3A4
Anti­infectives ANTIRETROVIRALS Delavirdine Rescriptor BAD! www.drugs­porphyria.org: Probably Porphyrinogenic
Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007. Substrate
of CYP3A4
ANTI­INFECTIVES ANTIRETROVIRALS Didanosine Videx OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic

Anti­infectives ANTIRETROVIRALS Efavirenz Sustiva BAD? www.drugs­porphyria.org: Probably Porphyrinogenic

Metab mainly by CYP2B6, with minor role for CYP3A4.
Induces CYP2B6,3A4 via transactivation of constitutive
androstane rerceptor & pregnane X receptor
(Pharmacogenet Genomics 19:300, 2009; Arch Toxicol
82:667,2008; J Pharmacol Exp Therap 320:72,2007;
Clin. Pharmacol. Ther. 91: 475, 2012).
Anti­infectives ANTIRETROVIRALS Emtricitabine Emtriva, Truvada OK? Blum MR: C Clin Pharm 2007; 47:751 ­ Primarily
eliminated via renal excretion; 60­70% recovered
unchanged.
ANTI­INFECTIVES ANTIRETROVIRALS Enfuvirtide Fuzeon OK?
Anti­infectives ANTIRETROVIRALS Indinavir Crixivan BAD! www.drugs­porphyria.org: Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007. Substrate,inducer and inhibitor of CYP3A4;
pregnane X receptor inducer
ANTI­INFECTIVES ANTIRETROVIRALS Lamivudine Epivir OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.drugs.com: 70% excreted as unchanged
drug in urine
Anti­infectives ANTIRETROVIRALS Lopinavir/Ritonavir Kaletra BAD! Lopinavir www.drugs­porphyria.org: Probably
Porphyrinogenic USP DI? Drug Info. for the Health Care
Pro. ­ 26th Ed. (2006): Metabolized mainly by CYP3A,
but metabolized by CYP2D6 if used with ritonavir.
Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007. Substrate
of CYP3A4 Ritonavir www.drugs­porphyria.org:
Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use
with Extreme Caution. Substrate of & inhibits CYP3A via
human pregnane X receptor transactivation (Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T CYP2C9, pregnane X receptor
Combination: Induces CYP2C9
Anti­infectives ANTIRETROVIRALS Maraviroc Selzentry OK? ~50% meetab but does not induce CYP3A4 (Brit J Clin
Pharmacol 65S:5,2008; and 66:498,2008)
Anti­infectives ANTIRETROVIRALS Nelfinavir Viracept BAD? www.drugs­porphyria.org: Probably Porphyrinogenic
Williams DA: Op. Cit.: Substrate & inducer of CYP3A4,
2C9
Anti­infectives ANTIRETROVIRALS Nevirapine Viramune BAD! www.drugs­porphyria.org: Probably Porphyrinogenic.
>80% metab, by CYP3A4; also metab by CYP2B6.
Induces CYP3A4 & 2B6 via transactivation of constitutive
androstane receptor (Arch Toxicol 82:667,2008; Drug
Metab Disp 8:895,1999; J Pharmacol Exp Therap
320:72,2007)
Anti­infectives ANTIRETROVIRALS Nilotinib Tasigna No info ~30% metab by CYP3A4 (Clin Therapeutics
30:1956,2008)
Anti­infectives ANTIRETROVIRALS Raltegravir Isentress OK? No CYP meetabolism or induction (Drug Metab Disp
35:1657,2007)
Anti­infectives ANTIRETROVIRALS Ritonavir Norvir BAD! www.drugs­porphyria.org: Porphyrinogenic.
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution. Substrate of, induces and inhibits CYP3A via
human pregnane X receptor transactivation(Williams DA.
Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Cur Drug Metab
7:375,2006; Arch Toxicol 82:667,2008)
ANTI­INFECTIVES ANTIRETROVIRALS Saquinavir Fortovase BAD! www.drugs­porphyria.org: Possibly Porphyrinogenic. CYP
3A4­metabolized. Inhibitor of CYP 3A4, seemingly not
potent. Williams DA. Drug metabolism. In: Foye?s
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007. Substrate of CYP3A4
ANTI­INFECTIVES ANTIRETROVIRALS Stavudine Zerit NO INFO www.drugs­porphyria.org: Possibly Porphyrinogenic.
Furanosyl pyrimidine derivative. No P450 metabolism
Anti­infectives ANTIRETROVIRALS Tenofovir Viread, Truvada OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed:
70­80% eliminated as unchanged drug
http://redpoll.pharmacy.ualberta.ca/drugbank/: Not
substrate of CYP3A4 or CYP2C9
ANTI­INFECTIVES ANTIRETROVIRALS Zalcitabine Hivid OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
ANTI­INFECTIVES ANTIRETROVIRALS Zidovudine Retrovir BAD? www.drugs­porphyria.org: Probably Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Safe in patients

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ANTI­INFECTIVES ANTIVIRALS Acyclovir Acyclovir OK! www.drugs­porphyria.org: Not Porphyrinogenic
www.porphyria­europe.com: Safe
www.uq.edu.au/porphyria/: Safe in cell culture Patient
report: Safe
ANTI­INFECTIVES ANTIVIRALS Adefovir Hepsera OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
http://redpoll.pharmacy.ualberta.ca/drugbank/: Not a
P450 substrate
ANTI­INFECTIVES ANTIVIRALS Amantidine Many NO INFO USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed:
not metabolized www.rxlist.com: Primarily secreted as
unchanged drug
ANTI­INFECTIVES ANTIVIRALS Famciclovir Famvir OK! www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
ANTI­INFECTIVES ANTIVIRALS Ganciclovir Cytovene OK! www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
ANTI­INFECTIVES ANTIVIRALS Interferon alfa­ Rebetron OK! ???
2B/Ribavirin

Anti­infectives ANTIVIRALS Oseltamivir Tamiflu OK? www.drugs­porphyria.org: Not Porphyrinogenic Not a

P450 substrate (USP DI? Drug Info. for the Health Care
Pro. ­ 26th Ed;
http://redpoll.pharmacy.ualberta.ca/drugbank/) patient
report: safe
Anti­infectives ANTIVIRALS Ribavirin Pegetron (also OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
contains USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed:
peginterferon) not p450 substrate www.rxlist.com: Two pathways of
metabolism: (i) reversible phosphorylation in nucleated
cells; (ii) degradation via deribosylation and amide
hydrolysis to yield a triazole carboxylic acid. Should not
involve CYP3A4 or CYP2C9
Anti­infectives ANTIVIRALS Valacyclovir Valtrex OK! www.drugs­porphyria.org: Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use patient report: safe
ANTI­INFECTIVES ANTIVIRALS Zanamivir Relenza OK! www.drugs­porphyria.org: Not Porphyrinogenic
http://redpoll.pharmacy.ualberta.ca/drugbank/: Not
metabolized
Anti­infectives CEPHALOSPORIN Ceftaroline Fosamil Teflaro No info Incomplete information re metabolism (Drugs 69:809,
2009)
ANTI­INFECTIVES CEPHALOSPORINS Cefaclor Ceclor OK! web.uct.ac.za/depts/porphyria/: Use with Caution

ANTI­INFECTIVES CEPHALOSPORINS Cefazolin Ancef OK! web.uct.ac.za/depts/porphyria/: Use with Caution

ANTI­INFECTIVES CEPHALOSPORINS Cefepime Maxipime OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

web.uct.ac.za/depts/porphyria/: Use with Caution
Anti­infectives CEPHALOSPORINS Cefotaxime Claforan OK? Probably not metab by CYP

ANTI­INFECTIVES CEPHALOSPORINS Cefotetan Cefotan OK! USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed.

(2006): Not metabolized by P450
ANTI­INFECTIVES CEPHALOSPORINS Cefoxitin Mefoxin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Caution
Anti­infectives CEPHALOSPORINS Cefpodoxime Vantin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
Proxetil web.uct.ac.za/depts/porphyria/: Use with Caution.
Patient report: safe
Anti­infectives CEPHALOSPORINS Ceftazidime Fortaz OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Caution.
Patient report: safe
ANTI­INFECTIVES CEPHALOSPORINS Ceftriaxone Rocephin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Caution
ANTI­INFECTIVES CEPHALOSPORINS Cefuroxime Zinacef OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Caution
ANTI­INFECTIVES CEPHALOSPORINS Cephalexin Keflex OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Caution
Patient reports: Safe
ANTI­INFECTIVES CMV AGENTS Cidofovir Vistide OK?

ANTI­INFECTIVES CMV AGENTS Fosamprenavir Lexiva BAD?

ANTI­INFECTIVES CMV AGENTS Foscarnet Foscavir OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed.
(2006): No P450 metabolism
ANTI­INFECTIVES CMV AGENTS Valganciclovir Valcyte OK! USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed.
(2006): Undergoes hydrolysis
Anti­infectives FLUOROQUINOLONES Ciprofloxacin Cipro OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Safe in Patients PV
Tishler MD clinical data & patient reports: Safe J Appl
Toxicol 2005;25:339. Inhibits CYP3A
Anti­infectives FLUOROQUINOLONES Levofloxacin Levaquin OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
PV Tishler MD clinical data & patient report: Safe Drug
Metab Disp 1996;24:1134. Undergoes limited
metabolism http://biocomp.health.unm.edu/
p450/metabP450diseasep3.pdf: Substrate of CYP1
family
ANTI­INFECTIVES FLUOROQUINOLONES Moxifloxacin Avelox OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic

Anti­infectives FLUOROQUINOLONES Norfloxacin Noroxin OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic

web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Safe in cell culture
J Appl Toxicol 2005;25:339. Inhibits CYP3A
Anti­infectives MACROLIDES Azithromycin Zithromax OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
www.porphyria­europe.com: Safe. 2 patient reports:
safe web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution USP DI? Drug Info. for the Health Care Pro. ­
26th Ed. (2006): Metabolized in liver, but 50% in bile
unchanged & 35% metabolized by demethylation Patient
reports: safe
Anti­infectives MACROLIDES Clarithromycin Biaxin OK? www.drugs­porphyria.org: Possibly Porphyrinogenic.
Inhibitor of CYP3A4 but forms irreversible complexes

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less readily than erythromycin. Some clinical experience
of non­porphyrinogenicity. Two references state non­
porphyrinogenicity. web.uct.ac.za/depts/porphyria/: Use
with Caution www.uspharmacist.com: Inhibitor of
CYP3A4 Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007: Substrate & inhibitor of CYP3A4 Sinz: Cur Drug
Metab 2006; 7:375: no human pregnane X receptor
activation
Anti­infectives MACROLIDES Erythromycin Many BAD! www.drugs­porphyria.org: Porphyrinogenic
www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in patients Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007: Substrate of, induces
& inhibits CYP3A4. Patient report: Unsafe
ANTI­INFECTIVES MISCELLANEOUS Aztreonam Azactam OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
http://redpoll.pharmacy.ualberta.ca/drugbank/:
Metabolized via hydrolysis
ANTI­INFECTIVES MISCELLANEOUS Bacitracin Many OK?

Anti­infectives MISCELLANEOUS Chloramphenicol Many BAD! www.drugs­porphyria.org: Porphyrinogenic

www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in patients Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007. Substrate of CYP2C9
Anti­infectives MISCELLANEOUS Clindamycin Cleocin BAD? www.drugs­porphyria.org: Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Avoid Williams DA.
Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007. Substrate of &
induces CYP3A4 Patient report: Safe
Anti­infectives MISCELLANEOUS Dapsone Leprostatic BAD! www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in patients Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007. Substrate of CYP3A4
& CYP2C9
ANTI­INFECTIVES MISCELLANEOUS Daptomycin Cubicin NO INFO

Anti­infectives MISCELLANEOUS Fosfomycin Monurol OK? Mainly not metabolized (Ann Pharmacother

32:215,1998) patient report: safe
ANTI­INFECTIVES MISCELLANEOUS Linezolid Zyvox OK? www.drugs­porphyria.org: Possibly Porphyrinogenic;
insufficient data on metabolism but no indications for
P450 interaction in vivo. USP DI? Drug Info. for the
Health Care Pro. ­ 26th Ed. (2006): Not metabolized by
P450
Anti­infectives MISCELLANEOUS Meropenem Meronem OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
www.rxlist.com: 70% excreted as unchanged drug
ANTI­INFECTIVES MISCELLANEOUS Mupirocin Bactroban OK? www.drugs­porphyria.org: Possibly Porphyrinogenic.
Probably not significantly absorbed. Probably not
metabolized by P450
ANTI­INFECTIVES MISCELLANEOUS Polymyxin B Many OK?

ANTI­INFECTIVES MISCELLANEOUS Tigecycline Tygacil NO INFO

Anti­infectives MISCELLANEOUS Vancomycin Vancocin, Others OK! www.drugs­porphyria.org: Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients Br J Clin
Pharmacol 1990;29:273. Safe
Anti­infectives PENEM ANTIBIOTICS Doripenem Doribax OK! Not a CYP substrate (Clin Therapeut 31:42,2009)

Anti­infectives PENEM ANTIBIOTICS Ertapenem Invanz OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic

www.rxlist.com: Does not appear to undergo hepatic
metabolism
Anti­infectives PENEM ANTIBIOTICS Imipenem/Cilastatin Primaxin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed.
(2006): Not metabolized by P450
Anti­infectives PENICILLINS Amoxicillin Many OK! www.drugs­porphyria.org: Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients PV Tishler
MD clinical data & patient reports: Safe Pregnane X
receptor inducer.
Anti­infectives PENICILLINS Amoxicillin/ Augmentin OK! patient report: safe
Clavulanate
ANTI­INFECTIVES PENICILLINS Ampicillin Many OK! www.drugs­porphyria.org: Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
ANTI­INFECTIVES PENICILLINS Ampicillin/Sulbactam Unasyn NO INFO
ANTI­INFECTIVES PENICILLINS Carbenicillin Geopen NO INFO

Anti­infectives PENICILLINS Dicloxacillin Many OK? www.drugs­porphyria.org: Not Porphyrinogenic. Induces

CYP3A.
Anti­infectives Penicillins flucloxacillin Floxapen, etc. BAD? Not metabolizd by or inhibits CYP3A, 2C9, but induces
CYP3A, PXR
Anti­infectives PENICILLINS Nafcillin Many OK? http://medicine.iupui.edu/flockhart/table.htm: CYP3A
inducer.
ANTI­INFECTIVES PENICILLINS Oxacillin Many OK? http://www.rxlist.com/cgi/generic3/oxacillin_cp.htm:
Rapidly excreted as unchanged drug
ANTI­INFECTIVES PENICILLINS Penicillin Many OK! web.uct.ac.za/depts/porphyria/: Use

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6/21/2017 About Porphyria: Drug database
www.uq.edu.au/porphyria/: Safe in patients Patient
report: Safe
Anti­infectives PENICILLINS Piperacillin Zosyn, etc. OK! www.drugs­porphyria.org: Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use. Patient report:
safe
ANTI­INFECTIVES PENICILLINS Ticarcillin Ticar OK! www.uq.edu.au/porphyria/: Safe in patients

ANTI­INFECTIVES SEPSIS SYNDROME Drotrecogin alfa Xigris OK? www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS ­ NON­
ANTIBIOTIC

ANTI­INFECTIVES SULFONAMIDES Sulfadiazine Many BAD! www.porphyria­europe.com: Unsafe

www.uq.edu.au/porphyria/: Unsafe in patients
www.porphyriafoundation.com: Unsafe Medicine (Balt)
1992;71:1. Unsafe
Anti­infectives SULFONAMIDES Sulfamethoxazole/ Bactrim BAD! www.porphyria­europe.com: Unsafe
Trimethoprim www.uq.edu.au/porphyria/: Unsafe in patients
www.porphyriafoundation.com: Unsafe Medicine (Balt)
1992;71:1. Unsafe. CYP2C9 substrate. Pregnane X
receptor inducer.
ANTI­INFECTIVES SULFONAMIDES Sulfasalazine Azulfidine BAD! www.porphyria­europe.com: Unsafe
www.uq.edu.au/porphyria/: Unsafe in patients
www.porphyriafoundation.com: Unsafe Medicine (Balt)
1992;71:1. Unsafe
ANTI­INFECTIVES TETRACYCLINES Demeclocycline Declomycin NO INFO www.drugs­porphyria.org: Probably Porphyrinogenic

Anti­infectives TETRACYCLINES Doxycycline Vibramycin, others OK? www.drugs­porphyria.org: Possibly

Porphyrinogenic/Probably Not Porphyrinogenic. Induces
Pgrenane X receptor. web.uct.ac.za/depts/porphyria/:
Avoid 2 patient reports: safe 1 patient report: unsafe
Anti­infectives TETRACYCLINES Minocycline Dynacin, Minocin No info www.uq.edu.au/porphyria/: Safe in cell culture

Anti­infectives TETRACYCLINES Tetracycline Many OK? web.uct.ac.za/depts/porphyria/: Use with Extreme

Caution. Induces CYP3A. 1 patient report: safe
Anti­infectives URINARY ANTI­ Methenamine Many OK! www.drugs­porphyria.org: Not Porphyrinogenic
INFECTIVES Mandelate web.uct.ac.za/depts/porphyria/: Use patient report: safe

Anti­infectives URINARY ANTI­ Nitrofurantoin Macrodantin, BAD! www.drugs­porphyria.org: Porphyrinogenic

INFECTIVES Macrobid web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Probably Unsafe
Antidiabetics Biguanides Metformin Glucophage, others OK! www.drugs­porphyria.org: Not porphyrinogenic.
www.porphyria­europe.com: Safe.
web.uct.ac.za/depts/porphyria/: Use.
www.uq.edu/au/porphyria/: Safe in animals. Excreted
largely unchanged; no hepatic metab
(www.clinicalpharmacology­ip.com). Inhibits pregnane X
receptor
Antidiabetics Dopamine Agonist Bromocriptine Cycloset BAD! See Bromocriptine, brand name Parlodel, in Central
Nervous System Agents, Antiparkinson agents.
Antidiabetics DPP­4 Inhibitor Linagliptin Tradjenta, OK? >75% excreted unchanged. Major meteabolite created
Jentadueto via CYP3A4, which is not induced (Drug Metab Disp
2010; 38:667).
Antidiabetics DPP­4 Inhibitors Saxagliptin Onglyza, No info Primarily metab. by CYP3A4/5 (Clin Pharmacokinet
Kombiglyze XR 49:573, 2010)

Antidiabetics DPP­4 Inhibitors Sitagliptin Januvia OK? ~80% not metab; rest mainly by CYP3A4 (Drug Metab

Disp 35:523,2007)
Antidiabetics DPP­4 Inhibitors/ Saxagliptin/ Kombiglyze XR No info See Saxagliptin
Biguanides Metformin

Antidiabetics DPP­4 Inhibitors/ Sitagliptin/ Janumet OK? See Sitagliptin

Biguanidess Metformin

Antidiabetics GLP­1 Receptor Exenatide Byetta OK? Drug is a peptide, with peptide metabolism. Physicians'

Agonist Desk Reference 2010; 64:648

Antidiabetics GLP­1 Receptor Liraglutide Victoza OK? Polypeptide­fatty acid, metabolized enzymatically. Drug

Agonist Metab Disp 2010; 38:1944.

Antidiabetics Insulin Insulin detmir Levemir OK! Insulin analog; insulins are ok.

Antidiabetics Insulins Insulins Insulin OK! www.drugs­porphyria.org: Not porphyrinogenic.

www.porphyria­europe.com: Safe.
web.uct.ac.za/depts/porphyria/: Use.
www.uq.au/porphyria/: Safe in patients
Antidiabetics Meglitinides Repaglinide Prandin OK? Metab mainly by CYP2C8, less by CYP3A4. No evidence
of inducing CYPs (Clin Pharmacol Therap 77:341,2005;
Med Letter 51:41,2009)
Antidiabetics Meglitinides/ Repaglinide/ PrandiMet OK? See Repaglinide
Biguanides Metformin
Antidiabetics Sulfonylureas Glimepiride Amaryl BAD? www.drugs­porphyria.org: Possibly porphyrinogenic.
Substrate of CYP2C9. Significantly transactivates
pregnane X receptor but has a low probability of
inducing CYP3A4 (Williams DA. Drug metabolism. In:
Foye's Principles of Medicinal Chemistry, ed Lemke T
and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007; Curr Drug Meetab 7:375,2006)
Antidiabetics Sulfonylureas Glipizide Glucotrol BAD? www.drugs­porphyria.org: Possibly porphyrinogenic.
www.porphyria­europe.com:Safe.
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/ : Unsafe in patients. Metab
by CYP2C9(Pharmacogenetics 9:71,1999)
Antidiabetics Sulfonylureas Glyburide Micronase, OK? Medicine (Balt) 71:1,1992 ­ Safe. Major metab by
Diabeta, others CYP2C9, minor metab by CYP3A4. No evidence for CYP
induction (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed Lemke T and
Williams TA. Baltimore, Williams & Wilkins, 6th ed,
2007; Clin Pharm Therap 85:78,2008)
Antidiabetics Sulfonylureas/ Glipizide/ Metformin Metaglip BAD? See Glipizide

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Biguanides

Antidiabetics Sulfonylureas/ Glyburide/ Glucovance OK? See Glyburide

Biguanides Metformin
Antidiabetics Thiazolidinediones Pioglitazone Actos BAD? www.drugs­porphyria.org: Probably porphyrinogenic.
USP DI Drug Info. for the Health Care Pro. ­ 26th ED:
Extensively metab by CYP2C8 & 3A4. Induces CYP3A4 &
transactivates pregnane X receptor but at concns. higher
than usual (Drug Metab Disp 31:439,2003;Curr Drug
Metab 7:375,2006; Williams DA. Drug metabolism. In:
Foye's Principles of Medicinal Chemistry, ed. Lemke T
and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007; Drug Metab Dispos 31:439,2003; Mol
Pharmavcol 80:518, 2011)
Antidiabetics Thiazolidinediones Rosiglitazone Avandia BAD? www.drugs­porphyria.org: Probably porphyrinogenic.
Metab by CYP2C9, CYP2C8. Induces CYP3A4 & 2B6, &
does transactivate pregnane X receptor (Pharmaceutical
Res 23:1089,2006; Eur J Pharm Sci 11:185,2000; Drug
Metab Disp 31:439,2003; Curr Drug Metab 7:375,2006)
Patient report: Safe
Antidiabetics Thiazolidinediones/ Pioglitazone/ Actoplus Met BAD? See Pioglitazone
Biguanides Metformin

Antidiabetics Thiazolidinediones/ Rosiglitazone/ Avandamet BAD? See Rosiglitazone

Biguanides Metformin
ANTIDOTES ­ Deferoxamine Desferal OK! www.drugs­porphyria.org: Not Porphyrinogenic
www.rxlist.com: Mostly metabolized by plasma enzymes
ANTIDOTES ­ Dimercaprol BAL OK! web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe
ANTIDOTES ­ Edetate Many OK!

ANTIDOTES ­ Ipecac Many OK?

Antidotes ­ Physostigmine Antilirium, others OK?

Antidotes SMOKING CESSATION Varenicline Chantix OK? J Clin Pharmacol 2006; 46:991: not a human P450
substrate; mostly excreted unchanged in animals.
Antineoplastics ALKYLATING AGENTS Carboplatin Paraplatin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Caution No
P450 metabolism. Does not induce CYP3A4 or
transactivate pregnane X receptor (USP DI? Drug Info.
for the Health Care Pro. ­ 26th Ed. (2006); Cancer
Chemother Pharmacol 64:35,2009). Publ report: safe
(Exp Opin Drug Saf 2008; 7:159)
Antineoplastics ANTIESTROGENS Tamoxifen Nolvadex BAD? www.drugs­porphyria.org: Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Safe in patients
Metab by CYP3A4,2B6,2C9,2D6. Minimally to modestly
transactivates pregnane X receptor; inhibits CYP
(Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007; Curr Drug
Metab 7:375,2006; Clin Therapeutics 30:1385,2008;
Cancer Chemother Pharmacol 64:35,2009; Curr Drug
Metab 9:598,2008)
Antineoplastics ANTIMETABOLITES Fluorouracil, 5­ Many OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
Fluorouracil web.uct.ac.za/depts/porphyria/: Use with Caution. Safe
in patients. Does not induce CYP3A4 or transactivate
pregnane X receptor (S Afr Med J 65:924,1984; Cancer
Chemother Pharmacol 64:35,2009). Pub rpt: safe (Exp
Opin Drug Saf 2008; 7:159). Patient report:as skin
cream, safe
Antineoplastics ANTIMETABOLITES Methotrexate Trexall, OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
Rheumatrex, web.uct.ac.za/depts/porphyria/: Use with Caution
others www.uq.edu.au/porphyria/: Unsafe in animals S Afr Med
J 1984;65:924. Safe in patients Xenobiotica
1996;26:503. Limited or no interaction with CYP2C9 and
CYP3A4 except for inhibition of Cyp3A. No effect on
pregnane X receptor (Curr Drug Metab 7:375,2006; Drug
Metab Dispos 32:348,2004)
Antineoplastics ENZYME INHIBITORS Imatinib Gleevac OK? www.drugs­porphyria.org: Possibly Porphyrinogenic
Metab by CYP3A4, less by 2C9; induces and inhibits
both. Does not transactivate pregnane X receptor
(Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007; Cancer
Chemother Pharmacol 64:35,2009)
Antineoplastics MISC. Denosumab Xgeva OK! Antibody for skeletal mets., osteoporosis.

Antineoplastics MITOTIC INHIBITORS Docetaxel Taxotere, etc. OK? www.drugs­porphyria.org: Probably Porphyrinogenic.

Metab mainly by CYP3A4. Does not induce CYP3A, 2C9;
weakly inhibits 3A. No to minimal transactivation of
human pregnane X receptor (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Pharmacogenetics
8:391,1998; Cur Drug Metab 7:375,2006; Cancer
Chemother Pharmacol 64:35,2009. pt report pupblished:
safe (Expert Opin Druf Saf 2008; 7:159. Patient report:
safe.
Antineoplastics MITOTIC INHIBITORS Etoposide Eposin, Etopophos, BAD? www.drugs­porphyria.org: Probably Porphyrinogenic
Vepesid www.uq.edu.au/porphyria/: Safe in patients Extensively
metab by & induces CYP3A4. Transactivates pregnane X
receptor & induces CYP3A4 in several studies, but not in
one study (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007; Mol Pharmacol 2002;62:439; Clin Therapeutics

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30; 1385,2008; Cancer Chemother Pharmacol
64:35,2009)
Antineoplastics Mitotic Inhibitors Gefitinib Iressa OK? Well absorbed. Metabolized by CYP3A. Does not
induce/inhibit CYP3a, 2C9.
Antineoplastics MITOTIC INHIBITORS Paclitaxel Taxol BAD? www.drugs­porphyria.org: Probably Porphyrinogenic.
Minor metabolism by,& induces CYP3A4. Transactivates
and induces pregnane X receptor (Pharmacogenomics
8:803,2007; Clin Cancer Res 11: 6359,2005; Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Cancer Chemother
Pharmacol 64:35,2009)
Antineoplastics NITROGEN MUSTARDS Cyclophosphamide Cytoxan OK? www.drugs­porphyria.org: Probably Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Unsafe in animals S Afr Med
J 1984;65:924. Safe in patients Mainly metab by
CYP2B6,~10% by CYP3A4. Minimally/moderately
transactivates pregnane X receptor; strong constitutive
androstane receptor activator. Does not induce CYP3A4,
but does induce CYP2C9, CYP2B6 (Biochem Pharmacol
59:961,2000; Cancer Chemother Pharmacol 64:35,2009;
Curr Drug Metab 9:598,2008; J Pharmacol Exp Therap
320:72, 2007) Patient report: Safe
Antineoplastics TOPOISOMERASE I Topotecan Hycamtin BAD? www.drugs­porphyria.org: Probably Porphyrinogenic.
INHIBITORS Does induce CYP3A4 and transactivate pregnane X
receptor (Cancer Chemother Pharmacol 64:35,2009)
Antineoplastics TOPOSIOMERASE irinotecan Camptosar BAD? Major metab by & inhibits CYP3A4, also by CYP2B6.
INHIBITORS Strongly induces both CYPs in some studies, but neither
induces CYP3A4 or transactivates pregnane X receptor in
another study (Clin Cancer Res 7:2182,2001; Clin
Therapeutics 30:1385,2008; Cancer Chemother
Pharmacol 64:35,2009)
Antineoplastics TROPOISOMERASE Doxorubicin Doxil, Adriamycin OK! Does not induce CYPs or transactivate pregnane X
INHIBITORS receptor(Canad J Physiol Pharmacol 77:589,1999;
Cancer Chemother Pharmacol 64:35,2009). Publ. report:
safe (Exp Opin Drug Saf 2008; 7:159)
Antineoplastics ALKYLATING AGENTS Busulfan Myleran BAD! www.drugs­porphyria.org: Probably Porphyrinogenic
(Cancer Therapies) web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007. Substrate of CYP3A4
Antineoplastics ALKYLATING AGENTS Cisplatin Platinol, Blastolem, OK! www.drugs­porphyria.org: Not Porphyrinogenic
(Cancer Therapies) others www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients Does not
induce CYP3A4 or trnasactivate pregnane X receptor
(Cancer Chemother Pharmacol 64:35,2009).
ANTINEOPLASTICS ALKYLATING AGENTS Procarbazine Natulan BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme
(Cancer Therapies) Caution S Afr Med J 1984;65:924. Safe in patients

ANTINEOPLASTICS ALKYLATING AGENTS Thiotepa Thioplex NO INFO

(Cancer Therapies)

ANTINEOPLASTICS ANGIOGENESIS Bevacizumab Avastin OK?

(Cancer Therapies) INHIBITORS
Antineoplastics ANTIANDROGENS Flutamide Eulexin BAD! www.drugs­porphyria.org: Possibly Porphyrinogenic.
(Cancer Therapies) Possibly metabolised by P450. Possibly ALAS­inducer.
Metabolized by CYP3A or CYP2C9. Modestly
transactivates pregnane X receptor and markedly
induces CYP3A4 (J Gastroenterol 2006;41:231; Cancer
Chemother Pharmacol 64:35,2009) Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007. Substrate of CYP3A4
Antineoplastics ANTIBIOTICS Actinomycin D or Cosmegen OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
(Cancer Therapies) Dactinomycin www.uq.edu.au/porphyria/: Safe in animals

ANTINEOPLASTICS ANTIBIOTICS Bleomycin Blenoxane OK! www.drugs­porphyria.org: Not Porphyrinogenic

(Cancer Therapies) http://redpoll.pharmacy.ualberta.ca/drugbank/:
Metabolized by CYP1A1
Antineoplastics ANTIBIOTICS Idarubicin Idamycin BAD? www.drugs­porphyria.org: Probably Not Porphyrinogenic
(Cancer Therapies) web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution
ANTINEOPLASTICS ANTIBIOTICS Mitomycin Mutamycin BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic
(Cancer Therapies) web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Insufficient data on metabolism. Little systemic
resorption; probably safe for intravesical installation
ANTINEOPLASTICS ANTIBIOTICS Mitoxantrone Novantrone BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic.
(Cancer Therapies) Insufficient data on metabolism Largely unmetabolized.
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution
ANTINEOPLASTICS ANTIBIOTICS Plicamycin Mithracin NO INFO
(Cancer Therapies)
ANTINEOPLASTICS ANTIBODIES Alemtuzumab Campath OK! www.drugs­porphyria.org: Not Porphyrinogenic
(Cancer Therapies) http://redpoll.pharmacy.ualberta.ca/drugbank/: Not
metabolized
ANTINEOPLASTICS ANTIBODIES Cetuximab Erbitux OK?
(Cancer Therapies)
ANTINEOPLASTICS ANTIBODIES Rituximab Rituxan OK! www.drugs­porphyria.org: Not Porphyrinogenic
(Cancer Therapies) http://redpoll.pharmacy.ualberta.ca/drugbank/: No liver
metabolism
ANTINEOPLASTICS ANTIESTROGENS Megestrol Megace BAD!
(Cancer Therapies)

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ANTINEOPLASTICS ANTIMETABOLITES Azacitidine Vidaza NO INFO
(Cancer Therapies)

Antineoplastics ANTIMETABOLITES Capecitabine Xeloda OK? Not metab by CYP. Metab to 5­fluorouracil, which does

(Cancer Therapies) not induce CYPs (Drug Metab Disp 32:762,2004; Canad J
Physiol Pharmacol 74:150,1996)
ANTINEOPLASTICS ANTIMETABOLITES Capecitabine Xeloda NO INFO
(Cancer Therapies)
ANTINEOPLASTICS ANTIMETABOLITES Cladribine Leustatin OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
(Cancer Therapies) http://redpoll.pharmacy.ualberta.ca/drugbank/: Not
P450 substrate
Antineoplastics ANTIMETABOLITES Cytarabine Alexan, Cytarabin, OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
(Cancer Therapies) Cytocin, others www.rxlist.com: Not P450 substrate

ANTINEOPLASTICS ANTIMETABOLITES Floxuridine FUDR OK?

(Cancer Therapies)

Antineoplastics ANTIMETABOLITES Fludarabine Fludara, others OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

(Cancer Therapies) www.rxlist.com: Not P450 substrate

ANTINEOPLASTICS ANTIMETABOLITES Pemetrexed Alimta NO INFO

(Cancer Therapies)

ANTINEOPLASTICS ANTIMETABOLITES Thioguanine Lanvis OK! S Afr Med J 1984;65:924. Safe in patients

(Cancer Therapies)

Antineoplastics AROMATASE Letrozole Femara BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic.

(Cancer Therapies) INHIBITORS Administered in rather low dose. CYP 3A4 and 2A6­
mediated metabolism. Not an inhibitor of CYP19.
(Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007)
Antineoplastics ENZYME INHIBITORS Erlotinib Tarceva OK? Williams DA. ~70% metab by CYP3A4. Modestly
(Cancer Therapies) transactivates pregnane X receptor but does not induce
CYP3A4 (Eur J Clin Pharmacol 64:31,2008; Cancer
Chemother Pharmacol 64:35,2009)
Antineoplastics ENZYME INHIBITORS Lapatinib Tykerb OK? Metab mainly by CYP3A4,3A5. No evidence for CYP
(Cancer Therapies) induction (Drugs 67:2101,2007)

Antineoplastics ENZYME INHIBITORS Sorafenib Nexavar No info ~50% metab by CYP3A4, ~50% not metab (PDR

(Cancer Therapies) 63:784,2009)

Antineoplastics ENZYME INHIBITORS Sunitinib Sutent OK? ~30% metab by CYP3A4, ~40% not metab (PDR

(Cancer Therapies) 63:2540,2009; Medical Letter 49:18,2007). Does not
induce CYPs (Clin Therapeutics 30:1385,2008)
ANTINEOPLASTICS ENZYMES Asparaginase Elspar OK! www.drugs­porphyria.org: Not Porphyrinogenic
(Cancer Therapies) web.uct.ac.za/depts/porphyria/: Use with Caution

ANTINEOPLASTICS HORMONAL AGENTS Diethylstilbestrol Many NO INFO

(Cancer Therapies)
ANTINEOPLASTICS HORMONAL AGENTS Estramustine Emcyt BAD? www.drugs­porphyria.org: Probably Porphyrinogenic
(Cancer Therapies)

ANTINEOPLASTICS HORMONAL AGENTS Testolactone Teslac NO INFO

(Cancer Therapies)
Antineoplastics IMMUNOMODULATORS Levamisole Ergamisol No info
(Cancer Therapies)

ANTINEOPLASTICS INTERLEUKINS Aldesleukin Proleukin OK?

(Cancer Therapies)
ANTINEOPLASTICS KERATINOCYTE Palifermin Kepivance OK?
(Cancer Therapies) GROWTH FACTOR

ANTINEOPLASTICS MISC. Arsenic Trioxide Trisenox NO INFO

(Cancer Therapies)

ANTINEOPLASTICS MISC. Dacarbazine Dtic­Dome BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic. Not

(Cancer Therapies) porphyrinogenic in chick embryo model. Like
chloroambucil, melphalan, may be safer than other
alkylating agents.
ANTINEOPLASTICS MISC. Hydroxyurea Hydrea OK? S Afr Med J 1984;65:924. Safe in patients
(Cancer Therapies)

ANTINEOPLASTICS MISC. Interferon Alfa­2A Roferon­A OK! www.drugs­porphyria.org: Not Porphyrinogenic

(Cancer Therapies) web.uct.ac.za/depts/porphyria/: Use with Caution USP
DI? Drug Info. for the Health Care Pro. ­ 26th Ed: Liver
metabolism is minor pathway
http://medicine.iupui.edu/flockhart/table.htm: Inhibitor
of CYP1A2
ANTINEOPLASTICS MISC. Interferon Alfa­2B Intron A OK! www.drugs­porphyria.org: Not Porphyrinogenic
(Cancer Therapies) web.uct.ac.za/depts/porphyria/: Use with Caution
http://medicine.iupui.edu/flockhart/table.htm: Inhibitor
of CYP1A2
ANTINEOPLASTICS MISC. Interferon Gamma­ Actimmune OK! www.drugs­porphyria.org: Not Porphyrinogenic
(Cancer Therapies) 1B web.uct.ac.za/depts/porphyria/: Use with Caution
http://medicine.iupui.edu/flockhart/table.htm: Inhibitor
of CYP1A2
Antineoplastics MISC. Ixabepilone Ixempra BAD? Highly metab by and induces CYP3A4; weakly
(Cancer Therapies) transactivates pregnane X receptor (Clin Cancer Res
14:2701,2008; S Mani, pers commun)
Antineoplastics MISC. oxaliplatin Eloxatin OK? No evidence for CYP metabolism (PDR 63:2731,2009)
(Cancer Therapies)

ANTINEOPLASTICS MISC. Pentostatin Nipent NO INFO

(Cancer Therapies)
Antineoplastics MITOTIC INHIBITORS Vinblastine Velban BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic
(Cancer Therapies) web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Probably safe in cell
culture Extensively metab by CYP3A4. Does not induce

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CYP3A4 or transactivate pregnane X receptor (Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Cancer Chemother
Pharmacol 64:35,2009)
Antineoplastics MITOTIC INHIBITORS Vincristine Oncovin OK? www.drugs­porphyria.org: Possibly Porphyrinogenic.
(Cancer Therapies) Porphyrinogenic in vitro. Administered in low weekly
dose, probably insignificant hepatic exposure. Some
clinical reports of non­porphyrinogenicity.
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Probably safe in cell culture
S Afr Med J 1984;65:924. Safe in patients USP DI? Drug
Info. for the Health Care Pro. ­ 26th Ed. (2006):
Metabolized by CYP3A4. Does not induce CYP3A4 or
transactivate pregnane X receptor (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Cancer Chemother
Pharmacol 64:35,2009)
ANTINEOPLASTICS MITOTIC INHIBITORS Vinorelbine Navelbine BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic.
(Cancer Therapies) Substrate for CYP 3A4. No reports of CYP­induction in
humans. Other vinca alkaloids have shown to be
porphyrinogenic in vitro. Drug Metab Dispos
2000;28:1121. Major interaction with CYP3A4
ANTINEOPLASTICS NITROGEN MUSTARDS Chlorambucil Leukeran BAD! www.drugs­porphyria.org: Possibly Porphyrinogenic.
(Cancer Therapies) Insufficient data on metabolism. Conflicting references.
Considered better tolerated than other alkylating agents
generally avoided. One case report of uneventful use in
a 54 yr old patient with IAP.
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in animals
Antineoplastics NITROGEN MUSTARDS Ifosfamide Ifex BAD? www.drugs­porphyria.org: Probably Porphyrinogenic
(Cancer Therapies) web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Substrate of CYP3A4. Modestly transactivates
pregnane X receptor. Does not induce CYP3A4 but does
induce CYP2B6(Williams DA. Drug metabolism. In:
Foye's Principles of Medicinal Chemistry, ed. Lemke T
and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007; Cancer Chemother Pharmacol 64:35,2009;
Curr Drug Mdetab 9:598,2008)
ANTINEOPLASTICS NITROGEN MUSTARDS Mechlorethamine Mustargen NO INFO
(Cancer Therapies)
ANTINEOPLASTICS NITROGEN MUSTARDS Melphalan Alkeran OK? www.drugs­porphyria.org: Possibly Porphyrinogenic. Not
(Cancer Therapies) porphyrinogenic in experimental rat and chicken
systems. Two references safe/probably safe.
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Probably safe
ANTINEOPLASTICS NITROSOUREAS Carmustine Bicnu NO INFO
(Cancer Therapies)

ANTINEOPLASTICS NITROSOUREAS Lomustine Ceenu BAD! www.drugs­porphyria.org: Probably Porphyrinogenic

(Cancer Therapies) http://redpoll.pharmacy.ualberta.ca/drugbank: CYP3A4
substrate
ANTINEOPLASTICS NITROSOUREAS Streptozocin Zanosar NO INFO
(Cancer Therapies)

ANTINEOPLASTICS RETINOIDS Tretinoin Retin­A OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic

(Cancer Therapies) Williams DA: Op. Cit.: Substrate of CYP3A4

Antineoplastics Thyroid Cancer­ Radioactive Iodine ­­ OK! Patient experience

(Cancer Therapies) Specific (I­131)
ANTINEOPLASTICS URINARY TRACT Amifostine Ethyol OK! www.drugs­porphyria.org: Not Porphyrinogenic
(Cancer Therapies) PROTECTIVE AGENTS http://redpoll.pharmacy.ualberta.ca/drugbank/: No P450
metabolism
ANTINEOPLASTICS URINARY TRACT Mesna Mesnex OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
(Cancer Therapies) PROTECTIVE AGENTS

Arthritis

Arthritis Abatacept Orencia OK! Protein. Not metab by CYPs (PDR 63:921,2009)

Arthritis adalimumab Humira OK! Protein. Not metab by CYPs (PDR 63:442,2009)

Arthritis Celecoxib Celebrex BAD? www.drugs­porphyria.org: Possibly porphyrinogenic.

Metab.~80% by CYP2D9, <25% by CYP3A4;
transactivates pregnane X receptor & induces CYP3A4
(Clin Pharmacokinetics 42:283, 2003; Durg Metab Disp
33:1567,2005; Clin Pharm Therap 80:298,2006)
Arthritis Certolizumab Pegol Cimzia OK! Protein + polyethylene glycol. Not metab by CYPs (PDR
63:3127,2009)
Arthritis etanercept Enbrel OK! Protein. Not metab by CYPs (PDR 63:569,2009)

Arthritis Golimumab Simponi OK! Protein. No CYP metabolism

Arthritis Leflunomide Arava No info Prob metab by CYPs (www.clinicalpharmacology­ip.com)

Arthritis ­ Allopurinol Zyloprim OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in animals Patient
reports: Safe
Arthritis ­ Auranofin Ridaura OK? www.drugs­porphyria.org: Possibly Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Unsafe in patients
Arthritis ­ Aurothioglucose Solganal OK! www.drugs­porphyria.org: Not Porphyrinogenic

Arthritis ­ Colchicine Colsalide OK! www.porphyria­europe.com: Safe

web.uct.ac.za/depts/porphyria/: Use

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www.uq.edu.au/porphyria/: Safe in patients Int J
Biochem 1985;17:937. Safe in patients Substrate of
CYP3A4 (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007)
Arthritis ­ Gold Sodium Myochrysin BAD! www.drugs­porphyria.org: Possibly Porphyrinogenic
Thiomalate web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Unsafe in animals
Arthritis ­ Penicillamine Cuprimine OK! www.drugs­porphyria.org: Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: use
www.uq.edu.au/porphyria/: Safe in patients
Arthritis ­ Probenecid Benemid BAD? www.drugs­porphyria.org: Probably Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Probably unsafe
Little to no induction of CYPs and no transactivation of
pregnane X receptor (Curr Drug Metab 7:375,2006; Drug
Metab Dispos 32:348,2004)
Arthritis ­ Sulfinpyrazone Many BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Unsafe in cell
culture Major metabolism by CYP3A4,2C9. Induces
CYP3A4 via transactivation of pregnane X receptor (Drug
Metab Disp 29:701,2001; Arch toxicol 82:667,2008; Cur
Drug Metab 7:375,2006). Inhibits CYP2C9.
Arthritis Gout Treatment Pegloticase Krystexxa OK! Protein enzyme, with no metabolic problem

Blood related ANTICOAGULANTS Dabigatran Pradaxa OK! No appreciable P450 metab. (Drug Metab Disp 36:386,

2008)
Blood related ANTICOAGULANTS Fondaparinux Arixtra OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed:
77% eliminated unchanged. Patient report: safe
Blood related Bleeding retardant Tranexamic acid Lystela, etc. OK! Mostly excreted unchanged

Blood related Plasma Replacement Hydroxyethyl starch Voluven OK! Not metabolized in any injurious way.

BLOOD RELATED ANTICOAGULANTS Abciximab Reopro OK! www.drugs­porphyria.org: Not Porphyrinogenic

THERAPY

BLOOD RELATED ANTICOAGULANTS Argatroban Argatroban OK? USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed:

THERAPY CYP3A4/5 is not an important elimination pathway

BLOOD RELATED ANTICOAGULANTS Bivalirudin Angiomax OK? USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed:

THERAPY Clearance from plasma does not seem to involve liver

Blood related ANTICOAGULANTS Clopidogrel Plavix OK? Metab by a number of CYPs. CYP3A4 and 2C19 are

therapy probably the most important, but their relative
contributions are unknown. Does not induce CYP3A4
(Drug Metab Pharmacokinet 23:412,2008; Drug Metab
Rev 37:99,2005; WC Lau, Pers Commun; MP Knadler,
Pers Commun)
BLOOD RELATED ANTICOAGULANTS Dalteparin Fragmin OK! www.drugs­porphyria.org: Not Porphyrinogenic
THERAPY

BLOOD RELATED ANTICOAGULANTS Dipyridamole Persantine OK! www.drugs­porphyria.org: Not Porphyrinogenic

THERAPY www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in cell culture
BLOOD RELATED ANTICOAGULANTS Enoxaparin Lovenox OK! www.drugs­porphyria.org: Not Porphyrinogenic
THERAPY www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
Blood related ANTICOAGULANTS Eptifibatide Integrilin OK! www.drugs­porphyria.org: Not Porphyrinogenic Clin Ther
therapy 1998;20:307. Polypeptide; deamidation probably via
hydrolysis, not inlving P450
BLOOD RELATED ANTICOAGULANTS Heparin Many OK! www.drugs­porphyria.org: Not Porphyrinogenic
THERAPY www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
Blood related ANTICOAGULANTS Lepirudin Refludan OK! Polypeptide. Not metab by CYPs
therapy

BLOOD RELATED ANTICOAGULANTS Protamine Protamine OK!

THERAPY

Blood related ANTICOAGULANTS Ticlopidine Ticlid OK? www.drugs­porphyria.org: Probably Porphyrinogenic

therapy http://medicine.iupui.edu/flockhart/table.htm: Similar
to (and see discussion of) clopidogrel
BLOOD RELATED ANTICOAGULANTS Warfarin Coumadin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
THERAPY www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients Williams
DA. Drug metabolism. In: Foye?s Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007. Substrate of CYP3A4
& 2C9
BLOOD RELATED HEMATOPOIETICS Cyanocobalamin Vitamin B12 OK! www.drugs­porphyria.org: Probably Porphyrinogenic PV
THERAPY Tishler, MD clinical data: Safe

BLOOD RELATED HEMATOPOIETICS Epoetin Alfa Epogen OK! www.drugs­porphyria.org: Not Porphyrinogenic

THERAPY www.porphyria­europe.com: Safe

Blood related HEMATOPOIETICS Filgrastim (G­CSF) Neupogen OK! (G­C web.uct.ac.za/depts/porphyria/) www.drugs­

therapy porphyria.org: Not Porphyrinogenic

BLOOD RELATED HEMATOPOIETICS Multivitamins Many OK!

THERAPY
BLOOD RELATED HEMOSTATICS Aminocaproic Acid Amicar OK! web.uct.ac.za/depts/porphyria/: Use
THERAPY www.uq.edu.au/porphyria/: Safe in patients

BLOOD RELATED HEMOSTATICS Aprotinin Trasylol OK! www.drugs­porphyria.org: Not Porphyrinogenic

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6/21/2017 About Porphyria: Drug database
THERAPY

BONES BISPHOSPHONATES Alendronate Fosamax OK! USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed.

(2006): Not metabolized Patient reports: safe
Bones Bisphosphonates Ibandronate Boniva OK? Bisphosphonates are not metabolized.

BONES BISPHOSPHONATES Zoledronic Acid Zometa OK! www.drugs­porphyria.org: Not Porphyrinogenic USP DI?

Drug Info. for the Health Care Pro. ­ 26th Ed: No P450
inhibition in vitro
Bones Bisphosponates Risedronate Actonel OK? Bisphosphonates are not metabolized

Cardiovascular ACE INHIBITORS Enalapril Vasotec OK! www.drugs­porphyria.org: Not Porphyrinogenic 2 Patient

(Enalaprilat) reports: Safe No transactivation of pregnane X receptor
(Curr Drug Metab 6:375,2006)
Cardiovascular ACE INHIBITORS Lisinopril Prinivil OK! www.drugs­porphyria.org: Not Porphyrinogenic P4 atient
reports: Safe No transactivation of pregnane X receptor
(Curr Drug Metab 6:375,2006)
Cardiovascular ACE INHIBITORS Ramipril Altace OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
Patient reports: Safe
Cardiovascular ANGIOTENSIN II Candesartan Cilexetil Atacand OK! www.drugs­porphyria.org: Not Porphyrinogenic
RECEPTOR www.porphyria­europe.com: Safe, Metab by CYP2C9.
ANTAGONISTS

Cardiovascular ANGIOTENSIN II Losartan Cozaar OK! www.drugs­porphyria.org: Possibly Porphyrinogenic. >2

RECEPTOR clinical reports: safe. Substrate of mainly CYP2C9,
ANTAGONISTS lesser of CYPs 3A4, 3A5. No data pointing to CYP
induction. Safe in cell culture. (Biochem Pharmacol
1999;58:887;Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007)
Cardiovascular ANGIOTENSIN II Olmesartan Benicar OK! Virtually not metabolized (PDR 63:1009,2009). 1 patient
RECEPTOR report: safe
ANTAGONISTS

Cardiovascular ANGIOTENSIN II Valsartan Diovan OK! www.drugs­porphyria.org: Not Porphyrinogenic USP DI?

RECEPTOR Drug Info. for the Health Care Pro. ­ 26th Ed: Some
ANTAGONISTS metabolism by CYP2C9. Patient reports: Safe

Cardiovascular ANGIOTENSIN Eprosartan Teveten OK! 98% excreted unchanged, 2% as glucuronide.

RECEPTOR
ANTAGONISTS

Cardiovascular ANTIADRENERGICS Doxazosin Cardura OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

web.uct.ac.za/depts/porphyria/: Use with Caution PV
Tishler MD clinical data: Safe Br J Clin Pharmacol
1997;43:339. Safe at <10mg/d. patient report: safe (5
yrs)
Cardiovascular ANTIHYPERLIPIDEMIC Atorvastatin Lipitor OK? www.drugs­porphyria.org: Patient report ­ safe Mainly
AGENTS metab by CYP3A4, but very low likelihood of CYP3A4
induction (Clin Pharmacol Therap 80:565,2006; Curr
Drug Metab 7:375,2006) 4 patient reports: Safe
Cardiovascular ANTIHYPERLIPIDEMIC Colestipol Colestid OK! Not absorbed. Patient reports: safe
AGENTS

Cardiovascular ANTIHYPERLIPIDEMIC Fluvastatin Lescol OK? Mainly metab by CYP2C9, also 3A4. Minimal

AGENTS transactivation of pregnane X receptor (Clin Pharmacol
Therap 80:565,2006; Curr Drug Metab 7:375,2006)
Cardiovascular Antihyperlipidemic Lovastatin Mevacor, etc BAD? Readily absorbed by liver. Metabolized by & induces
Agents CYP3A, 2C9. Induces PXR.

Cardiovascular ANTIHYPERLIPIDEMIC Pravastatin Pravachol OK? www.drugs­porphyria.org: Possibly Porphyrinogenic

AGENTS web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution. Substrate of CYP3A, but excreted mostly
unchanged, and does not induce CYPs (Mol Pharmacol
65:1302,2004;Clin Pharm Therap 80:565,2006)
Experience of P. Tishler, MD and others ­ safe
Cardiovascular ANTIHYPERLIPIDEMIC Rosuvastatin Crestor OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
AGENTS www.porphyria­europe.com: Safe. Metab by CYP2C9;
not metab. by CYP3A4,5. patient report: safe
Cardiovascular ANTIHYPERLIPIDEMIC Simvastatin Zocor, others OK? www.drugs­porphyria.org: Patient experience ­ safe
AGENTS web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Unsafe in animals
Unsafe in cell culture (Biomed Pharmacother
43:135,1989). Mainly metab by CYP3A4,but very low
likelihood of CYP3A4 induction (Clin Pharm Therap
80:565,2006;Curr Drug Metab 7:375,2006); strong
pregnane xenobiotic activator (J Pharm Exp Therap
320:72, 2007). Patient reports: Safe
Cardiovascular ANTIOGENSIN Telmisartan Micardis OK! Only metabolite is glucuronide (J Clin Pharm 2000: 40
RECEPTOR (12 pt 1), 1312.
ANTAGONISTS

Cardiovascular BETA BLOCKERS Labetalol Normodyne, OK! www.drugs­porphyria.org: Not Porphyrinogenic

(includes some Trandate web.uct.ac.za/depts/porphyria/: Use
ophthalmic www.uq.edu.au/porphyria/: Safe in patients patient
preparations) report: safe

Cardiovascular BETA BLOCKERS Metoprolol Lopressor OK! web.uct.ac.za/depts/porphyria/: Use

(includes some www.uq.edu.au/porphyria/: Safe in patients PV Tishler
ophthalmic MD clinical data & patient report: Safe Medicine
preparations) (Balt)1992;71:1. Safe. Induces CYP3A.

Cardiovascular CALCIUM CHANNEL Amlodipine Norvasc OK? www.drugs­porphyria.org: Probably Porphyrinogenic

BLOCKERS web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Not safe in patients (Ann Pharmacother
1997;31:253) Safe at <10mg/d (Br J Clin Pharmacol
1997;43:339) Substrate of & induces CYP3A4 (Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,

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Williams & Wilkins, 6th ed., 2007. Induces pregnane X
receptor. 4 patient reports: Safe, certainly at 5 mg/day.
Cardiovascular CALCIUM CHANNEL Diltiazem Cardizem BAD? www.drugs­porphyria.org: Probably Porphyrinogenic
BLOCKERS web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Probably unsafe Substrate
of & inhibitor of CYP3A4. Modest transactivation of
pregnane X receptor, but low probability of CYP3A4
induction (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007; http://medicine.iupui.edu/clinpharm/ddis/; Curr
Drug Metab 7:375,2006)
Cardiovascular CALCIUM CHANNEL Felodipine Plendil BAD? www.drugs­porphyria.org: Probably Porphyrinogenic
BLOCKERS web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Substrate of & inducer of CYP3A4. Modest
transactivator of pregnane X receptor, metabolism. In:
Foye's Principles of Medicinal Chemistry, ed. Lemke T
and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007; Curr Drug Metab 7:375,2006)
Cardiovascular CALCIUM CHANNEL Nicardipine Cardene BAD! Induces CYP3A4, 2C9; inhibits 3A. Transactivates
BLOCKERS pregnane X receptor (Drug Metab Disp 29:1325,2001)

Cardiovascular CALCIUM CHANNEL Nifedipine Procardia, Adalat BAD! www.drugs­porphyria.org: Probably Porphyrinogenic

BLOCKERS web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Unsafe in patients
www.porphyriafoundation.com: Unsafe Medicine (Balt)
1992;71:1. Safe Clin Sci (Lond) 1985;69:581. Unsafe in
cell culture Substrate of CYP3A4. Induces CYP3A4, 2C9
via transactivation of pregnane X receptor (Williams DA.
Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Drug Metab Disp
29:1325,2001) Patient report: safe
Cardiovascular CALCIUM CHANNEL Verapamil Verapamil, Tarka OK? Metab by & inhibits induction of CYP3A4.
BLOCKERS (http://medicine.iupui.edu/clinpharm/ddis/; Amer J
Therap 16:155, 2009; Curr Drug Metab 5:543,2004)
Cardiovascular DIURETICS Furosemide Lasix OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Unsafe in patients PV Tishler
MD clinical data & patient reports: Safe Medicine (Balt)
1992;71:1. Safe
Cardiovascular DIURETICS Spironolactone Aldactone BAD? www.drugs­porphyria.org: Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Unsafe in animals Safe
(Medicine (Balt) 1992;71:1, 1992). Induces CYP3A.
Transactivates pregnane X receptor (Expert Opin Drug
Metab Toxicol 4:895,2008)
Cardiovascular DIURETICS Torsemide Demadex, others OK? ~75% metab, mostly by CYP2C9 (Br J Clin Pharm
50:573,2000; Clin Pharmacol Therap 76:557,2004). 2
Patient reports: safe
Cardiovascular IMPOTENCE AGENTS Sildenafil Viagra BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic
Major metab by CYP3A4, less by CYP2C9; weak
inhibitors of both (Drug Metab Disp 36:986,2008).
Patient report: Safe
Cardiovascular ACE INHIBITORS Benazepril Lotensin OK! Patient report: safe
agents
Cardiovascular ACE INHIBITORS Captopril Capoten OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic.
agents Patient report: safe No transactivation of pregnane X
receptor (Curr Drug Metab 6:375,2006)
Cardiovascular ACE INHIBITORS Trandolapril Mavik OK!
agents

Cardiovascular ANGIOTENSIN II Irbesartan Avapro, Avalide OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

agents RECEPTOR Mostly not metab by CYPs. Some metab by CYP2C9, but
ANTAGONISTS doessnot induce any CYP (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; PDr 63:892,2009)
Cardiovascular ANTIADRENERGICS Clonidine Catapres BAD! www.drugs­porphyria.org: Probably Porphyrinogenic
agents www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in patients and cell
culture
Cardiovascular ANTIADRENERGICS Methyldopa Aldomet BAD! www.drugs­porphyria.org: Porphyrinogenic
agents www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid Patient report:
Unsafe
Cardiovascular ANTIADRENERGICS Prazosin Minipress OK! www.porphyria­europe.com: Safe
agents web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Probably safe Medicine
(Balti) 1992:71:1. Safe
Cardiovascular ANTIADRENERGICS Terazosin Hytrin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
agents web.uct.ac.za/depts/porphyria/: Use with Caution No
transactivation of pregnane X receptor (Curr Drug Metab
6:375,2009)
Cardiovascular ANTIANGINAL AGENTS Isosorbide Dinitrate Imdur OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
agents web.uct.ac.za/depts/porphyria/: Use with Caution

Cardiovascular ANTIANGINAL AGENTS Nitroglycerin Many OK? Not a CYP substrate (Biochem. J 1993; 292:545)

agents

Cardiovascular ANTIARRHYTHMICS Adenosine Many OK! www.drugs­porphyria.org: Not Porphyrinogenic USP DI?

agents Drug Info. for the Health Care Pro. ­ 26th Ed. (2006):
Not metabolized by P450
Cardiovascular ANTIARRHYTHMICS Amiodarone Many BAD? www.drugs­porphyria.org: Probably Porphyrinogenic
agents web.uct.ac.za/depts/porphyria/: Avoid

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www.uq.edu.au/porphyria/: Unsafe in cell culture Gen
Pharmacol 1999;32:259. Safe Probably mostly metab by
CYP3A4. Induces but more strongly inhibits CYP3A4 (J
Pharm Pharm Sci 11:147,2008; Clin Pharm Therap
77:63, 2005)
Cardiovascular ANTIARRHYTHMICS Bretylium Bretylol OK?
agents

Cardiovascular ANTIARRHYTHMICS Disopyramide Norpace BAD? www.drugs­porphyria.org: Probably Porphyrinogenic

agents web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Probably safe
Cardiovascular ANTIARRHYTHMICS Flecainide Tambocor, others OK! www.drugs­porphyria.org: Possibly Porphyrinogenic.
agents Metabolized by CYP2D6. No data pointing to CYP­
induction (http://medicine.iupui.edu/clinpharm/ddis/)
Cardiovascular ANTIARRHYTHMICS Ibutilide Corvert OK? www.drugs­porphyria.org: Possibly Porphyrinogenic
agents Circulation 1998;97:493. Metabolic pathway does not
seem to involve CYP3A4 or CYP2D6
Cardiovascular ANTIARRHYTHMICS Lidocaine Xylocaine OK? www.drugs­porphyria.org: Porphyrinogenic metab by
agents CYP3A4, 1A2. May ihibit its metab (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007: Pharmacol 1990;
255:1385; Curr Drug Metab 5:543, 2004)
Cardiovascular ANTIARRHYTHMICS Mexiletine Mexitil OK? www.drugs­porphyria.org: Possibly Porphyrinogenic.
agents Metabolized by CYP2D6, 1A2. No data pointing to CYP­
induction (Clin Pharmacokinet 46:985,2007)
Cardiovascular ANTIARRHYTHMICS Moricizine Ethmozine No info
agents
Cardiovascular ANTIARRHYTHMICS Procainamide Pronestyl OK! www.porphyria­europe.com: Safe
agents web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in cell culture
Cardiovascular ANTIARRHYTHMICS Propafenone Rhthmol BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic
agents Metabolized by CYP2D6, 3A4, others; relative
importances not known (Curr Drug Metab 5:543,2004;
Clin Pharmacokinet 46:985,2007)
Cardiovascular ANTIARRHYTHMICS Quinidine Many OK? www.drugs­porphyria.org: Probably Porphyrinogenic
agents Substrate of CYP3A4. Minimal transactivation of
pregnane X receptor (Williams DA. Drug metabolism.
In: Foye's Principles of Medicinal Chemistry, ed. Lemke
T and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007; Curr Drug Metab 7:375,2006)
Cardiovascular ANTIARRHYTHMICS Tocainide Tonocard No info
agents

Cardiovascular ANTIHYPERLIPIDEMIC Cholestyramine Questran OK! Not absorbed from GI tract

agents AGENTS

Cardiovascular ANTIHYPERLIPIDEMIC Clofibrate Atromid­S OK! www.porphyria­europe.com: Safe

agents AGENTS web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Safe in cell culture
Cardiovascular ANTIHYPERLIPIDEMIC Ezetimibe Zetia, Vitorin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
agents AGENTS USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed.
(2006): Undergoes minimal oxidation. Extensively
metabolized but not by CYP (PDR 63:2149,2009) Patient
report: Safe
Cardiovascular ANTIHYPERLIPIDEMIC Gemfibrozil Lopid OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
agents AGENTS www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use with Caution Metab
by CYP2C8. Minimally transactivates pregnane X
receptor (Drug Metab Disp 34:191,2006; Curr Drug
Metab 7:375,2006)
Cardiovascular ANTIHYPERLIPIDEMIC Niacin Many No info USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed:
agents AGENTS Not P450 substrate

Cardiovascular ANTIHYPERTENSIVE ­ Aliskiren Tekturna OK? ~20% metab, mainly by CYP3A4; does not induce

agents RENIN INHIBITOR CYP3A4 (Pharmacol Rpts 60:623,2008; J clin Pharmacol
48:1323,2008)
Cardiovascular ANTIHYPERTENSIVE­ Aliskiren/ Tekamlo BAD? See individual drug listings.
agents DUAL AGENT Amlodipine
Cardiovascular BETA BLOCKERS Nebivolol Bystolic OK? Extensively metab by CYP2D6 (Med Letter 50:17,2008).
agents Patient experience: safe

Cardiovascular BETA BLOCKERS Acebutolol Many OK! web.uct.ac.za/depts/porphyria/: Use Medicine

agents (includes some (Balt)1992; 71:1. Safe
ophthalmic biocomp.health.unm.edu/p450/metabP450diseasep4.pdf:
preparations) Substrate/inhibitor of CYP2D6

Cardiovascular BETA BLOCKERS Atenolol Tenormin OK! www.drugs­porphyria.org: Not Porphyrinogenic

agents (includes some web.uct.ac.za/depts/porphyria/: Use
ophthalmic www.uq.edu.au/porphyria/ safe in patients PV Tishler
preparations) MD clinical data & patient reports: Safe Medicine (Balt)
1992;71:1. Safe
Cardiovascular BETA BLOCKERS Betaxolol Many OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
agents (includes some
ophthalmic
preparations)

Cardiovascular BETA BLOCKERS Carteolol Many OK! web.uct.ac.za/depts/porphyria/: Use

agents (includes some
ophthalmic
preparations)

Cardiovascular BETA BLOCKERS Esmolol Brevibloc OK! www.drugs­porphyria.org: Not Porphyrinogenic

agents (includes some web.uct.ac.za/depts/porphyria/: Use
ophthalmic
preparations)

Cardiovascular BETA BLOCKERS Nadolol Corgard OK! web.uct.ac.za/depts/porphyria/: Use

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agents (includes some
ophthalmic
preparations)

Cardiovascular BETA BLOCKERS Pindolol Visken OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

agents (includes some web.uct.ac.za/depts/porphyria/: Use
ophthalmic
preparations)

Cardiovascular BETA BLOCKERS Propranolol Inderal OK! www.drugs­porphyria.org: Not Porphyrinogenic

agents (includes some web.uct.ac.za/depts/porphyria/: Use PV Tishler MD
ophthalmic clinical data & patient report: Safe Safe (Br J Clin
preparations) Pharmacol 1997;43:339) Safe (Medicine (Balt)
1992;71:1) Substrate of CYP3A4 & other CYPs. Does not
transactivate pregnane X receptor (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Curr Drug Metab
7:375,2006; http://medicine.iupui.edu/clinpharm/ddis/)
Cardiovascular BETA BLOCKERS Sotalol Betapace, others OK! www.drugs­porphyria.org: Not Porphyrinogenic
agents (includes some web.uct.ac.za/depts/porphyria/: Use Medicine (Balt)
ophthalmic 1992;71:1. Safe
preparations)

Cardiovascular BETA BLOCKERS Timolol Blocadren OK! www.drugs­porphyria.org: Not Porphyrinogenic

agents (includes some web.uct.ac.za/depts/porphyria/: Use
ophthalmic www.uq.edu.au/porphyria/: Safe in cell culture Medicine
preparations) (Balt)1992;71:1. Safe

Cardiovascular CALCIUM CHANNEL Amlodipine/ Azor BAD? See amlodipine

agents BLOCKERS olmesartan

Cardiovascular CALCIUM CHANNEL Bepridil Vascor BAD! www.uq.edu.au/porphyria/: Unsafe in cell culture

agents BLOCKERS Williams DA: Op. Cit.: Substrate of CYP3A4

Cardiovascular CALCIUM CHANNEL Clevidipine Cleviprex OK? Unlikely inducer of CYPs at therapeutic doses (Drug

agents BLOCKERS Metab Disp 34:734,2006)

Cardiovascular CALCIUM CHANNEL Nimodipine Nimotop BAD! www.drugs­porphyria.org: Probably Porphyrinogenic

agents BLOCKERS web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Substrate of CYP3A4 (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007)
Cardiovascular CARDIAC Digoxin Lanoxin OK! www.drugs­porphyria.org: Not Porphyrinogenic
agents GLYCOSIDES www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Safe in patients Medicine
(Balt) 1992;71:1. Safe
Cardiovascular DIURETICS Acetazolamide Diamox OK! web.uct.ac.za/depts/porphyria/: Use
agents www.uq.edu.au/porphyria/: Safe in patients & cell
culture
Cardiovascular DIURETICS Amiloride Midamor, OK! www.drugs­porphyria.org: Not Porphyrinogenic
agents Moduretic, others www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
Cardiovascular DIURETICS Bumetanide Bumex OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
agents www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients Patient
report: Safe
Cardiovascular DIURETICS Eplerenone Inspra BAD? ~95% metab, mainly by CYP3A4. (Williams DA. Drug
agents metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; J Clin Pharmacol
45:810,2005; Am J Therapeutics 16:255,2009)
Cardiovascular DIURETICS Ethacrynic Acid Edecrin OK! www.uq.edu.au/porphyria/: Safe in patients
agents http://www.emedicine.com/MED/topic1880.htm: Safe in
porphyria
Cardiovascular DIURETICS Hydrochlorothiazide Many OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
agents www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Safe in patients PV Tishler
MD clinical data & patient reports: Safe
Cardiovascular DIURETICS Metolazone Zaroxolyn BAD? web.uct.ac.za/depts/porphyria/: Use with Extreme
agents Caution

CARDIOVASCULAR DIURETICS Triamterene Dyrenium OK! www.porphyria­europe.com: Safe

AGENTS web.uct.ac.za/depts/porphyria/: Use

Cardiovascular DOPAMINE D1 Fenoldopam Corlopam No info

agents RECEPTOR AGONISTS

Cardiovascular IMPOTENCE AGENTS Tadalafil Cialis OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic

agents www.premiumdrugs.com/globalcart/
html/media/docs/cialis­pi­us.pdf: metabolized primarily
by CYP3A4
Cardiovascular IMPOTENCE AGENTS Vardenafil Levitra No info Major metab by CYP3A4, 3A5 (Drug Metab Disp
agents 36:986,2008)

Cardiovascular MISC. Diazoxide Hyperstat OK! www.porphyria­europe.com: Safe

agents web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in cell culture
Cardiovascular MISC. Tolazoline Priscoline OK! www.uq.edu.au/porphyria/: Safe in patients
agents http://www.emedicine.com/MED/topic1880.htm: Safe in
porphyria
Cardiovascular PHOSPHODIESTERASE Milrinone Primacor No info
agents INHIBITORS

Cardiovascular THROMBOLYTIC Alteplase Activase OK! www.drugs­porphyria.org: Not Porphyrinogenic

agents ENZYMES www.porphyria­europe.com: Safe

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web.uct.ac.za/depts/porphyria/: Use with Caution
Cardiovascular THROMBOLYTIC Streptokinase Many OK! www.drugs­porphyria.org: Not Porphyrinogenic
agents ENZYMES www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
Cardiovascular THROMBOLYTIC Tenecteplase Tnkase OK! www.drugs­porphyria.org: Not Porphyrinogenic
agents ENZYMES

Cardiovascular VASODILATORS Hydralazine Apresoline BAD! www.drugs­porphyria.org: Porphyrinogenic

agents web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Unsafe in patients
Cardiovascular VASODILATORS Minoxidil Many BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic
agents web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution
Cardiovascular VASODILATORS Nitroprusside Nipride OK? web.uct.ac.za/depts/porphyria/: Use with Caution Redox
agents Rep 2004;9:360: No P450 metabolism

Cardiovascular VASOPRESSORS Dobutamine Dobutrex, others OK! www.drugs­porphyria.org: Not Porphyrinogenic

agents www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
Cardiovascular VASOPRESSORS Dopamine Intropin, others OK! www.drugs­porphyria.org: Not Porphyrinogenic
agents www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
Cardiovascular VASOPRESSORS Ephedrine Many OK! www.drugs­porphyria.org: Not Porphyrinogenic
agents

Central nervous ANTICONVULSANTS Carbamazepine Tegretol BAD! www.drugs­porphyria.org: Porphyrinogenic

system www.porphyria­europe.com: unsafe
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in patients
Unsafe/risky in patients (Epilepsia 33:108,1992;
Neurology 32:1409,1982; Neurology 45:1216,1995).
Major metab by CYP3A4. Induces CYP3A4 via
transactivation of constitutive androstane receptor &
kpregnane X receptor. Also induces CYP2C9, other CYPs.
(Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007; Arch
toxicol 82:667,2008; Clin Therapeutics 30:1385,2008)
Patient report: Safe (low dose)
Central nervous ANTICONVULSANTS Gabapentin Neurontin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
system www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use PV Tishler MD
clinical data & patient reports: Safe Not a substrate for
& does not induce CYPs (Fundam Clin Pharmacol
14:301,2000; Clin Therapeutics 30:1385,2008)
Central nervous ANTICONVULSANTS Phenytoin Dilantin BAD! www.drugs­porphyria.org: Porphyrinogenic
system www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in patients Unsafe in
patients (Neurology 45:1216,1995; Epilepsia
33:108,1992) Substrate & inducer of CYP3A4 & CYP2C9.
Strongly activates constitutive androstane receptor &
pregnane X receptor, & induces CYP3A4. (Williams DA.
Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; JBC 279:29295,2004;
Arch Toxicol 82:667,2008) 1 Patient report: Safe. 1
patinet report: unsafe
Central nervous ANTICONVULSANTS Pregabalin Lyrica OK! >90% non­metabolized (PDR 63:2527,2009). Patient
system reports: safe

Central nervous ANTICONVULSANTS Topiramate Topomax BAD? www.drugs­porphyria.org: Probably porphyrinogenic.

system www.porphyria.uct.ac.za: Use only with extreme
caution. 30­40% metabolized, some by CYP2C9; metab
by CYP3A4 probably minimal, but induces CYP3A4 via
transactivation of pregnane X receptor (Pharmacokinet
45:1061,2006; Epilepsia 46:378,2005; Arch Toxicol
82:667,2008; Clin Therapeutics 30:1385,2008) 1 patient
report: safe
Central nervous ANTICONVULSANTS Valproic Acid Depakene, Stavzor OK? www.drugs­porphyria.org: Porphyrinogenic
system web.uct.ac.za/depts/porphyria/: Avoid
www.porphyriafoundation.com: Unsafe Largely not CYP
metab; some metab by multiple CYP2C9 but not
CYP3A4. Induces CYP3A. Does not transactivate
pregnane X receptor. (Clin Therapeutics 30:1385,2008;
Curr Drug Metab 7:375,2006)
Central nervous ANTIPARKINSON Ropinirole Roquid OK? ~90% metab by CYP1A2, small amt by CYP3A (Clin
system AGENTS Pharmacokinet 39:243,2000). 1 patient report: safe.

Central nervous Antispasmodic Trospium Sanctura OK! Ester hydrolysis, with probably littel/no P450

system metabolism. 1 patient report: safe.

Central nervous BENZODIAZEPINES Alprazolam Xanax OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic

system web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Unsafe in cell culture Mainly
metab by CYP3A4, but does not transactivate pregnane
X receptor (USP DI? Drug Info. for the Health Care Pro.
­ 26th Ed; Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007; Curr Drug Metrab 7:375,2006) >1Patient reports:
Safe
Central nervous BENZODIAZEPINES Diazepam Valium OK? www.drugs­porphyria.org: Probably Porphyrinogenic
system web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Unsafe in patients Medicine
(Balt) 1992;71:1. Safe Substrate of CYP3A4,2B6,2C9.
Modest transactivator of pregnane X receptor, but low
prediction of CYP3A4 inducibility (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal

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Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Curr Drug Metab
7:375,2006; Curr Drug Metab 9:598,2008) 2 Patient
reports: Safe
Central nervous BENZODIAZEPINES Temazepam Restoril OK! www.porphyria­europe.com: Safe
system web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients Substrate
of CYP3A4 (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007) 2 Patient reports: Safe
Central nervous BENZODIAZEPINES Triazolam Halcion OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
system web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in animals Medicine
(Balt) 1992;71:1. Safe Substrate of CYP3A4 (Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007). 1 patientreport:
safe.
Central nervous HYPNOTICS (Sleeping Chloral Hydrate Many OK! www.porphyria­europe.com: Safe
system Medications) www.uq.edu.au/porphyria/: Safe in patients Peter V.
Tishler, MD, clinical experience: safe patient report:
safe
Central nervous HYPNOTICS (Sleeping Zolpidem Ambien, Edluar, OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
system Medications) Intermezzo, CYP3A substrate. Moderate transactivator of pregnane X
Zolpimist receptor, but low prediction of CYP3A4 inducibility
(Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed.,
2007;http://medicine.iupui.edu/flockhart/table.htm;
Curr Drug Metab 7:375,2006) 6 Patient reports: safe
Central nervous MIGRAINE THERAPY Sumatriptan Imitrex OK? www.drugs­porphyria.org: Possibly Porphyrinogenic
system web.uct.ac.za/depts/porphyria/: Use with Caution 2
patient reports: safe
Central nervous NARCOTICS (Pain Fentanyl Duragesic OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
system Therapies) www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in animals Substrate of
& induces CYP3A4 (Williams DA. Drug metabolism. In:
Foye's Principles of Medicinal Chemistry, ed. Lemke T
and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007).Induces pregnane X receptor Patient reports:
Safe
Central nervous NARCOTICS (Pain Methadone Many OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
system Therapies) www.porphyria­europe.com: safe
web.uct.ac.za/depts/porphyria/: Use Metab by CYP3A,
less by 2C9.
Central nervous NARCOTICS (Pain Tramadol Ultram, Ultracet, No info Largely metab by CYP3A4,2D6 (Eur J Clin Pharm
system Therapies) Ryzolt, etc. 62:513,2006). Patient report: safe

Central nervous NONSTEROIDAL ANTI­ Acetaminophen Tylenol OK! www.porphyriafoundation.com: Safe PV Tishler MD

system INFLAMMATORY clinical data & patient reports: Safe Induces constitutive
AGENTS ­NSAIDs androstene receptor.
(Pain, Arthritis
Therapies, etc.)

Central nervous NONSTEROIDAL ANTI­ Ibuprofen Advil, Motrin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

system INFLAMMATORY www.porphyria­europe.com: Safe. Metab by
AGENTS ­NSAIDs CYP2C9,2C8. PV Tishler MD clinical data & patient
(Pain, Arthritis reports: Safe at low dose used intermittently, BUT one
Therapies, etc.) acute attack at high, prolonged dose (Drug Metab Disp
33:1567, 2005) patient reports: safe
Central nervous AMPHETAMINES Dextroamphetamine Dexedrine OK?
system agents
Central nervous Anti­Glaucoma Brinzolamide/ Simbrinza BAD! Brinzolamide is a sulfonamide, and thus this is
system agents Brimonidine contraindicated

Central nervous ANTICONVULSANTS Clonazepam Klonopin BAD! www.drugs­porphyria.org: Probably Not Porphyrinogenic

system agents www.porphyria­europe.com: safe
web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Probably unsafe
www.porphyriafoundation.com: unsafe Epilepsia
1992;33:108. porphyrogenic but safe in lose dosages
Neurology 1982;32:1409. safe in low dosages Greatly
induces CYP2B. Substrate of but does not induce CYP3A
or 2C9 (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007; Drug Metab Dispos 25:750,1997)
Central nervous ANTICONVULSANTS Divalproex Depakote OK? Dimer of valproic acid. See Valproic acid.
system agents

Central nervous ANTICONVULSANTS Ethosuximide Zarontin BAD? www.drugs­porphyria.org: Probably Porphyrinogenic

system agents www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Unsafe in patients
www.porphyriafoundation.com: Unsafe Unsafe in
animals (Neurology 1981;31:480) Substrate of CYP3A4,
but does not transactivate pregnane X receptor. Minor
metab by CYP2C9, other CYPs (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Curr Drug Metab
7:375, 2006; Clin Therapeutics 30:1385,2008)
Central nervous ANTICONVULSANTS Felbamate Felbatol BAD! www.drugs­porphyria.org: Probably Porphyrinogenic
system agents www.porphyriafoundation.com: Unsafe Metab mainly by
CYP3A4, also 2C9, others. Induces CYP3A4 but does not
transactivate pregnane X receptor (Fundam Clin

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6/21/2017 About Porphyria: Drug database
Pharmacol 14:301,2000; Curr Drug Metab 7:375,2006;
Clin Therapeutics 30:1385,2008)
Central nervous ANTICONVULSANTS Fosphenytoin Cerebyx BAD! www.drugs­porphyria.org: Porphyrinogenic Metab mainly
system agents by CYP2C9, also CYP3A4, others. Induces CYP2C9,3A4
(Clin Therapeutics 30:1385,2008. Same as Phenytoin.
Central nervous ANTICONVULSANTS Levetiracetam Keppra OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
system agents www.porphyria­europe.com: Safe Not a substrate for &
does not induce CYPs (Fundam Clin Pharmacol
14:301,2000; Clin Therapeutics 30:1385,2008)
Central nervous ANTICONVULSANTS Methsuximide Celontin BAD! www.uq.edu.au/porphyria/: Unsafe in patients Neurology
system agents 1981;31:480. Unsafe in animals

Central nervous ANTICONVULSANTS Oxcarbazepine Trileptal BAD! www.drugs­porphyria.org: Probably Porphyrinogenic

system agents www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid Induces CYP3A4
(Fundam Clin Pharmacol 14:301,2000)
Central nervous ANTICONVULSANTS Phenobarbital Luminal BAD! www.drugs­porphyria.org: Porphyrinogenic
system agents www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid Strongly
activates constitutive androstane receptor, pregnane X
receptor, & induces CYP3A4 (BBRC 277:1, 2000; Arch
Toxicol 82:667,2008)
Central nervous ANTICONVULSANTS Primidone Mysoline BAD! www.drugs­porphyria.org: Porphyrinogenic
system agents www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in patients
www.porphyriafoundation.com: Unsafe Neurology
1981;31:480. Unsafe in animals. Metab by CYP3A4 to
phenobarbital (BAD!!); induces CYP3A4 (Clin
Therapeutics 30:1385,2008)
Central nervous ANTICONVULSANTS Zonisamide Zonegran BAD? Major metab by CYP3A4; also CYP2C19. (Williams DA.
system agents Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Clin Therapeutics
30:1385,2008)
Central nervous ANTIMYASTHENIC Ambenonium Mytelase OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
system agents AGENTS

Central nervous ANTIMYASTHENIC Edrophonium Tensilon OK!

system agents AGENTS

Central nervous ANTIMYASTHENIC Guanidine Guanidine NO INFO

system agents AGENTS

Central nervous ANTIMYASTHENIC Neostigmine Prostigmine OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

system agents AGENTS www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
Central nervous ANTIMYASTHENIC Pyridostigmine Mestinon OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
system agents AGENTS web.uct.ac.za/depts/porphyria/: Use with Caution.
Patient report: safe
Central nervous ANTIPARKINSON Amantadine Symmetrel OK! www.porphyria­europe.com: Safe
system agents AGENTS web.uct.ac.za/depts/porphyria/: Use

Central nervous ANTIPARKINSON Benztropine Cogentin NO INFO

system agents AGENTS

Central nervous ANTIPARKINSON Bromocriptine Parlodel BAD! www.drugs­porphyria.org: Probably Porphyrinogenic

system agents AGENTS web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Unsafe in cell
culture Metab by CYP3A4 (Clin Therapeutics
28:1065,2006)
Central nervous ANTIPARKINSON Entacapone Comtan, Stalevo OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic.
system agents AGENTS Not metab by CYPs (PDR 63:2208, 2009)

Central nervous ANTIPARKINSON Levodopa Many OK! web.uct.ac.za/depts/porphyria/: Use with Caution USP

system agents AGENTS DI? Drug Info. for the Health Care Pro. ­ 26th Ed: Not
P450 substrate http://www.ukmi.nhs.uk/NewMaterial/
html/docs/entacapo.pdf: Main metabolic pathway does
not involve P450
Central nervous ANTIPARKINSON Levodopa/ Carbidopa Sinemet OK!
system agents AGENTS

Central nervous ANTIPARKINSON Pergolide Permax No info metab by CYP3A4 (Clin Therapeutics 28:2065,2006)

system agents AGENTS

Central nervous ANTIPARKINSON Pramipexole Mirapex OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

system agents AGENTS www.rxlist.com: ~90% excreted unchanged. No CYP
metab (Eur J Neurol 7 Suppl 1:15,2000)
Central nervous ANTIPARKINSON Rotigotine Neupro (patch) OK? Metab by multiple CYPs. Does not induce CYP3A4, 2C9
system agents AGENTS (PDR 63:3149,2009)

Central nervous ANTIPARKINSON Selegiline Emsam, Eldepryl, BAD? www.drugs­porphyria.org: Probably Porphyrinogenic

system agents AGENTS Zelapar web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution Metab by CYP2B6, which may involve pregnane
X receptor
Central nervous ANTIPARKINSON Trihexyphenidyl Artane BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic
system agents AGENTS web.uct.ac.za/depts/porphyria/: Avoid

Central nervous BENZODIAZEPINES Chlordiazepoxide Librium BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme

system agents Caution www.uq.edu.au/porphyria/: Unsafe in patients
Medicine (Balt) 1992;71:1. Safe
Central nervous BENZODIAZEPINES Estazolam Prosom OK? www.uq.edu.au/porphyria/: Cell cuture ­ probably safe
system agents PV Tishler MD clinical data: Safe Metab. almost
exclusively by CYP3A4
(https://online.epocrates.com/front_porch/; Xenobiotica
35:455,2005)
Central nervous BENZODIAZEPINES Flurazepam Dalmane BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme
system agents Caution www.uq.edu.au/porphyria/: Unsafe in patients

Central nervous BENZODIAZEPINES Lorazepam Ativan OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

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6/21/2017 About Porphyria: Drug database
system agents www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Probably safe Not metab by
CYPs (Curr Drug Metab 9:827,2008) PV Tishler MD
clinical data: Safe Medicine (Balt) 1992;7:1. Safe
Central nervous BENZODIAZEPINES Oxazepam Serax OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
system agents web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Probably unsafe. Not metab
by CYPs (Curr Drug Metab 9:827,2008)
Central nervous HYPNOTICS (Sleeping Butabarbital Butisol BAD! www.porphyria­europe.com: Unsafe. See phenobarbital
system agents Medications)

Central nervous HYPNOTICS (Sleeping Butalbital Fiorinal BAD! See phenobarbital

system agents Medications)

Central nervous HYPNOTICS (Sleeping Eszopiclone Lunesta OK? Substrate of CYP3A4 (Williams DA. Drug metabolism.

system agents Medications) In: Foye's Principles of Medicinal Chemistry, ed. Lemke
T and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007)
Central nervous HYPNOTICS (Sleeping Ethchlorvynol Placidyl BAD!
system agents Medications)

Central nervous HYPNOTICS (Sleeping Pentobarbital Nembutal BAD! www.porphyria­europe.com: Unsafe Patient report:

system agents Medications) Unsafe See Phenobarbital

Central nervous HYPNOTICS (Sleeping Ramelteon Rozerem BAD? Patient report ­ bad. Minor metab. by CYP3A4.

system agents Medications)

Central nervous HYPNOTICS (Sleeping Secobarbital Seconal BAD! www.porphyria­europe.com: Unsafe Induces CYP3A4

system agents Medications) (Arch Toxicol 82:667,2008) See Phenobarbital

Central nervous HYPNOTICS (Sleeping Zaleplon Sonata BAD! www.drugs­porphyria.org: Possibly Porphyrinogenic

system agents Medications) Metabolized by CYP3A4 (Williams DA. Drug metabolism.
In: Foye's Principles of Medicinal Chemistry, ed. Lemke
T and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007; Xenobiotica 2002;32:835) Patient reports:
Safe
Central nervous MIGRAINE THERAPY Ergotamine Cafergot BAD! www.porphyria­europe.com: Unsafe
system agents web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in patients
www.porphyriafoundation.com: Unsafe Substrate of
CYP3A4 (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007)
Central nervous MIGRAINE THERAPY Isometheptene/ Midrin, others BAD? Isometheptene www.uq.edu.au/porphyria/: Unsafe in
system agents Dichloralphenazone animals Dichloralphenazone www.uq.edu.au/porphyria/:
Unsafe in patients
Central nervous MIGRAINE THERAPY Naratriptan Amerge NO INFO www.drugs­porphyria.org: Possibly Porphyrinogenic
system agents
Central nervous MIGRAINE THERAPY Rizatriptan Maxalt OK? www.drugs­porphyria.org: Possibly Porphyrinogenic No
system agents significant interaction with CYPs. Primary metabolism
does not involve CYPs (PDR 63:2056,2009; www.cbg­
meb.nl/uk/docs/nieuws/par­maxalt.pdf)
Central nervous MIGRAINE THERAPY Zolmitriptan Zomig OK? www.drugs­porphyria.org: Possibly Porphyrinogenic.
system agents Insufficient data on metabolism. One report (Swedish)
of tolerance. Xenobiotica 1999;29:847. Metabolized
almost entirely by CYP1A2. Sinz M: Cur Drug Metab
2006; 7:375. No activation of pregnane X receptor.
Central nervous NARCOTICS (Pain Alfentanil Alfenta OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
system agents Therapies) www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use Substrate ~equally
of CYP3A4, 3A5 (Williams DA. Drug metabolism. In:
Foye?s Principles of Medicinal Chemistry, ed. Lemke T
and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007; Drug Metab Disp 33:303,2005)
Central nervous NARCOTICS (Pain Buprenorphine Buprenex, OK! www.drugs­porphyria.org: Not Porphyrinogenic
system agents Therapies) Suboxone, Subutex www.porphyria­europe.com: Safe
www.uq.edu.au/porphyria/: Safe in patients PV Tishler
MD clinical data: Safe Ann Fr Anesth Reanim
1989;8:525. Safe Substrate of CYP3A4 (Williams DA.
Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007)
Central nervous NARCOTICS (Pain Butorphanol Stadol OK!
system agents Therapies)

Central nervous NARCOTICS (Pain Codeine Many OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

system agents Therapies) www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients PV Tishler
MD clinical data & patient report: Safe Substrate of
CYP3A4 (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007)
Central nervous NARCOTICS (Pain Hydrocodone Vicodin, others OK! see Respiratory Agents/antitussive Agents
system agents Therapies)
Central nervous NARCOTICS (Pain Hydromorphone Dilaudid OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
system agents Therapies)

Central nervous NARCOTICS (Pain Meperidine Demerol OK! PV Tishler MD clinical data: Safe JAMA 1965;194:1037.

system agents Therapies) Safe in patients

Central nervous NARCOTICS (Pain Morphine Many OK! www.drugs­porphyria.org: Not Porphyrinogenic

system agents Therapies) www.porphyria­europe.com: safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients PV Tishler
MD clinical data: Safe

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6/21/2017 About Porphyria: Drug database
Central nervous NARCOTICS (Pain Nalbuphine Nubain OK! www.porphyria­europe.com: Safe
system agents Therapies) web.uct.ac.za/depts/porphyria/: Use

Central nervous NARCOTICS (Pain Oxycodone Oxycontin, OK! www.drugs­porphyria.org: Possibly Porphyrinogenic

system agents Therapies) Percocet, Percodan, www.uq.edu.au/porphyria/: Unsafe in animals PV Tishler
others MD clinical data & patient reports: Safe

Central nervous NARCOTICS (Pain Pentazocine Talwin BAD! web.uct.ac.za/depts/porphyria/: Avoid

system agents Therapies) www.uq.edu.au/porphyria/: Unsafe in patients

Central nervous NONSTEROIDAL ANTI­ Aspirin Many OK! www.drugs­porphyria.org: Not Porphyrinogenic

system agents INFLAMMATORY www.porphyria­europe.com: Safe
AGENTS ­NSAIDs web.uct.ac.za/depts/porphyria/: Use
(Pain, Arthritis www.uq.edu.au/porphyria/: Safe in patients
Therapies, etc.) www.porphyriafoundation.com: Safe PV Tishler MD
clinical data & patient reports: Safe
Central nervous NONSTEROIDAL ANTI­ Diclofenac Voltaren BAD? www.drugs­porphyria.org: Probably Porphyrinogenic
system agents INFLAMMATORY web.uct.ac.za/depts/porphyria/: Use with Extreme
AGENTS ­NSAIDs Caution www.uq.edu.au/porphyria/: Unsafe in patients
(Pain, Arthritis www.porphyriafoundation.com: Unsafe PV Tishler MD
Therapies, etc.) clinical data: Safe Biomed Pharmacother 43:135,1989 ­
Unsafe in cell culture Limited metab by CYP2C9, ?2C8
(Drug Metab Disp 33:1567, 2005)
Central nervous NONSTEROIDAL ANTI­ Indomethacin Indocin OK! web.uct.ac.za/depts/porphyria/: Use
system agents INFLAMMATORY www.uq.edu.au/porphyria/: Probably safe. ~50% metab
AGENTS ­NSAIDs by CYP2C9 (Drug Metab Disp 33:1567, 2005). Medicine
(Pain, Arthritis (Balt) 71:1, 1992 ­ Safe in some, not safe in others
Therapies, etc.)

Central nervous NONSTEROIDAL ANTI­ Ketoprofen Orudis, Oruvail, OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

system agents INFLAMMATORY others www.porphyria­europe.com: Safe
AGENTS ­NSAIDs web.uct.ac.za/depts/porphyria/: Use with Caution
(Pain, Arthritis Probably not metab by CYPs PV Tishler MD clinical data:
Therapies, etc.) Safe (Drug Metab Disp 33:1567,2005)

Central nervous NONSTEROIDAL ANTI­ Ketorolac Toradol BAD! www.drugs­porphyria.org: Possibly Porphyrinogenic

system agents INFLAMMATORY Tromethamine web.uct.ac.za/depts/porphyria/: Use with Extreme
AGENTS ­NSAIDs Caution Eksp Klin Farmakol. 2005;68:56. CYP2C
(Pain, Arthritis substrate
Therapies, etc.)

Central nervous NONSTEROIDAL ANTI­ Naproxen Naprosyn, Aleve OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

system agents INFLAMMATORY www.porphyria­europe.com: Safe
AGENTS ­NSAIDs web.uct.ac.za/depts/porphyria/: Use
(Pain, Arthritis www.uq.edu.au/porphyria/: Safe in patients and animals
Therapies, etc.) 20­40% metab by CYP2C9 (<50% of this), other CYPs
Patient reports: Safe (Drug Metab Disp 33:1567,2005)
Central nervous NONSTEROIDAL ANTI­ Sulindac Clinoril OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
system agents INFLAMMATORY www.porphyria­europe.com: Safe
AGENTS ­NSAIDs web.uct.ac.za/depts/porphyria/: Use
(Pain, Arthritis www.uq.edu.au/porphyria/: Safe in animals Minimal
Therapies, etc.) CYP2D9 metab (Drug Metab Disp 33:1567,2005)

CONTRAST MEDIA ­ Diatrizoate Hypaque OK!

Meglumine

CONTRAST MEDIA ­ Ethiodized Oil Ethiodol OK!

CONTRAST MEDIA ­ Ferumoxides Endorem OK!

CONTRAST MEDIA ­ Gadopentetate Magnevist OK!

Dimeglumine

CONTRAST MEDIA ­ Iodipamide Chlorografin, OK!

Meglumine Sinografin

Contrast media ­ Iodixanol Visipaque OK! www.drugs­porphyria.org: Not Porphyrinogenic

www.fda.gov/medwatch/SAFETY/
2003/03DEC_PI/Visipaque_PI.pdf: No metabolism
CONTRAST MEDIA ­ Iohexol Omnipaque OK! www.drugs­porphyria.org: Not Porphyrinogenic

CONTRAST MEDIA ­ Iopanoic Acid Telepaque OK!

CONTRAST MEDIA ­ Iopromide Ultravist OK! www.drugs­porphyria.org: Not Porphyrinogenic

Dermatologicals ACNE Isotretinoin Accutane, Sotret, BAD? web.uct.ac.za/depts/porphyria/: Use with Extreme

Amnesteem, Caution Substrate of CYP3A4. Minimally transactivates
Claravis pregnane X receptor, and has low proability of inducing
CYP3A4 (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007; Curr Drug Metab 7:375,2006)
Dermatologicals ANTIPSORIATICS ­ Acitretin Soriatane BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic
SYSTEMIC web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution
Dermatologicals Dermatosis, allergy, desoximetasone topicort OK? Topical corticosteroid. 1 patinet report: safe
psoriasis

Diagnostic ­ Methacholine Provocholine, OK!

others

Diagnostic Imaging Gadobutrol Gadavist OK! MRI contrast agent that is not metabolized

Gastrointestinal ANTIDIARRHEAL Rifaximin Xifaxan OK! >99% excreted in feces unabsorbed/unchanged (PDR

AGENTS 65:2911, 2011). Induces pregnane X receptor.

Gastrointestinal ANTIEMETICS Dronabinol Marinol BAD? Major metab by CYP3A4 & 2C9 (Williams DA. Induces

(Vomiting Therapies) pregnane X receptor. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007)
Gastrointestinal ANTIEMETICS Meclizine Antivert, Bonine OK! >3 patient reports: safe. Induces & inhibits constitutive
(Vomiting Therapies) androstene receptor.

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Gastrointestinal ANTISPASMODICS Dicyclomine Bental, others OK! www.uq.edu.au/porphyria/: Safe in patients Patient
reports: Safe
Gastrointestinal ANTISPASMODICS Hyoscyamine Levsin, others OK! 3 patient reports: safe

Gastrointestinal H­2 ANTAGONISTS, Cimetidine Tagamet OK! www.drugs­porphyria.org: Not Porphyrinogenic

PPIs (Reflux, Ulcer web.uct.ac.za/depts/porphyria/: Use with Caution
Therapies) www.uq.edu.au/porphyria/: Probably unsafe Clin Chim
Acta 1995;234:171. Safe in patients Ann Int Med 2005;
143:694. Safe and possibly therapeutic during acute
attack. PV Tishler, MD clinical data & patient reports:
Safe Substrate % inhibitor of CYP3A4 but does not
transactivate pregnane X receptor (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Curr Drug Metab
7:375,2006)
Gastrointestinal H­2 ANTAGONISTS, Famotidine Pepcid OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
PPIs (Reflux, Ulcer web.uct.ac.za/depts/porphyria/: Use with Caution
Therapies) www.uq.edu.au/porphyria/: Safe in patients Patient
reports: Safe
Gastrointestinal H­2 ANTAGONISTS, Omeprazole Prilosec OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
PPIs (Reflux, Ulcer www.porphyria­europe.com: Safe
Therapies) web.uct.ac.za/depts/porphyria/: Substrate & inducer of
CYP3A4. Significantly transactivates pregnane X
receptor, but has low probability of inducing CYP3A4
(Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007; Curr Drug
Metab 7:375, 2006; Drug Safety 29:769, 2006) 7
patient reports: safe
Gastrointestinal H­2 ANTAGONISTS, Rabeprazole Aciphex OK? www.drugs­porphyria.org: Probably Porphyrinogenic
PPIs (Reflux, Ulcer Major metab is nonenzymatic. Minor metab via
Therapies) CYP2C19,3A4. Modestly transactivates pregnane X
receptor, but has low probability of inducing CYP3A4
(Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007; Curr Drug
Metab 7:375,2006; Drug Safety 29:769, 2006). 1
patient report: safe
Gastrointestinal H­2 ANTAGONISTS, Ranitidine Zantac OK! www.drugs­porphyria.org: Not Porphyrinogenic
PPIs (Reflux, Ulcer web.uct.ac.za/depts/porphyria/: Use with Caution
Therapies) www.uq.edu.au/porphyria/: Probably unsafe
www.porphyriafoundation.com: Safe PV Tishler MD
clinical data: Safe
Gastrointestinal LAXATIVES Bisacodyl Dulcolax OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use with Caution PV
Tishler MD clinical data: Safe
Gastrointestinal POTASSIUM Sodium Polystyrene Kayexalate OK! patient report: safe
REMOVING RESINS Sulfonate

Gastrointestinal ANTI­INFLAMMATORY Infliximab Remicade OK! www.drugs­porphyria.org: Not Porphyrinogenic Protein;

therapies AGENTS no CYP metab

Gastrointestinal ANTI­INFLAMMATORY Mesalamine Rowasa, Pentasa, OK! <30% absorbed; not metab by CYPs

therapies AGENTS Asacol, others

Gastrointestinal ANTI­INFLAMMATORY Olsalazine Dipentum OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

therapies AGENTS metab to mesalamine which has no CYP metab

GASTROINTESTINAL ANTIDIARRHEAL Diphenoxylate Lomotil OK! www.porphyria­europe.com: Safe

THERAPIES AGENTS web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
GASTROINTESTINAL ANTIDIARRHEAL Kaolin­Pectin Kaopectate OK! web.uct.ac.za/depts/porphyria/: Use
THERAPIES AGENTS www.uq.edu.au/porphyria/: Safe in patients

GASTROINTESTINAL ANTIDIARRHEAL Loperamide Imodium OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

THERAPIES AGENTS www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in cell culture Patient
report: Safe
Gastrointestinal ANTIEMETICS Cyclizine Merezine OK! www.drugs­porphyria.org: Probably Porphyrinogenic
therapies (Vomiting Therapies) web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
Gastrointestinal ANTIEMETICS Dimenhydrinate Dramamine BAD! www.porphyria­europe.com: unsafe
therapies (Vomiting Therapies) web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in patients
Gastrointestinal ANTIEMETICS Ondansetron Zofran OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
therapies (Vomiting Therapies) www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use with Caution PV
Tishler MD clinical data & patient reports: Safe
Substrate of CYP3A4. Modestly transactivates pregnane
X receptor but has a low probability of inducing CYP3A4
(Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007; Curr Drug
Metab 7:375,2006)
Gastrointestinal ANTIEMETICS Palonosetron Aloxi OK?
therapies (Vomiting Therapies)

Gastrointestinal ANTIEMETICS Scopolamine Transderm­Scop, OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

therapies (Vomiting Therapies) Scopace, web.uct.ac.za/depts/porphyria/: Use
Meldemar, others

Gastrointestinal ANTIEMETICS Thiethylperazine Torecan OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic

therapies (Vomiting Therapies)

Gastrointestinal ANTIEMETICS Trimethobenzamide Tigan No info

therapies (Vomiting Therapies)

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GASTROINTESTINAL ANTISPASMODICS Atropine Many OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
THERAPIES www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
www.porphyriafoundation.com: Safe
GASTROINTESTINAL ANTISPASMODICS Belladonna Alkaloids Many BAD? web.uct.ac.za/depts/porphyria/: Avoid
THERAPIES

Gastrointestinal GASTROINTESTINAL Alvimopan Entereg OK? Hepatic/CYP metab unlikely (Clin Pharmacol Therap

therapies MOTILITY 83:770,2008; PDR 63:3293,2009; pkg insert)
STIMULANTS

Gastrointestinal GASTROINTESTINAL Lubiprostone Amitiza OK? No CYP metabolism or induction (PDR 63:3082,2007)

therapies MOTILITY
STIMULANTS

Gastrointestinal GASTROINTESTINAL Metoclopramide Reglan OK? www.drugs­porphyria.org: Probably Porphyrinogenic

therapies MOTILITY web.uct.ac.za/depts/porphyria/: Use with Caution
STIMULANTS www.uq.edu.au/porphyria/: Probably unsafe
www.porphyriafoundation.com: Unsafe Lancet 1981;2:91
Not safe However, ~80% not metab by CYP
(www.clinicalpharmacology­ip.com)
Gastrointestinal H­2 ANTAGONISTS, Esomeprazole Nexium OK! www.drugs­porphyria.org: Possibly Porphyrinogenic.
therapies PPIs (Reflux, Ulcer www.porphyria.uct.ac.za: Use with extreme caution. PV
Therapies) Tishler MD clinical data & patient report: Safe. Major
metabolic path via CYP2C19, minor via CYP3A4
(Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007) .
Gastrointestinal H­2 Antagonists, PPIs Lansoprazole Pravacid OK? www.drugs­porphyria.org: Probably porphyrinogenic.
therapies (Reflux, Ulcer www.porphyria.uct.ac.za: Use but with caution.
Therapies) Metabolsim mainly via CYP2C19. Sinz M: Cur Drug
Metab 2006; 7:375: Moderate activation of pregnane X
receptor but low prediction of clinical induction.
Gastrointestinal H­2 ANTAGONISTS, Pantoprazole Protonix OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
therapies PPIs (Reflux, Ulcer web.uct.ac.za/depts/porphyria/: Use with Caution
Therapies) Metabolized by CYP2C19, 3A4. No evidence for CYP3A4
inducibility (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007; Drug Safety 29:769,2006) 2 Patient reports: Safe
GASTROINTESTINAL LAXATIVES Senna Senokot OK! www.drugs­porphyria.org: Not Porphyrinogenic
THERAPIES www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
GASTROINTESTINAL PHOSPHATE BINDER Sevelamer Renagel OK? www.drugs­porphyria.org: Not Porphyrinogenic
THERAPIES AGENTS

Gastrointestinal PROSTAGLANDINS Misoprostol Cytotec OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic

therapies Not metab by and does not affect CYPs
(www.clinicalpharmacology­ip.com)
Hormones CORTICOSTEROIDS Dexamethasone Decadron OK? www.drugs­porphyria.org: Possibly Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use Substrate of
CYP3A4. Induces CYP3A4, 2C9 via transactivation of
pregnane X receptor (modest). Patient report: Safe.
MAY BE UNSAFE if used for prolonged periods. (Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Arch Toxicol
82:667,2008)
Hormones CORTICOSTEROIDS Methylprednisolone Medrol,others OK? www.drugs­porphyria.org: Possibly Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use Substrate &
inhibitor of CYP3A4. Induces CYP3A4 via transactivation
of pregnane X receptor. Patient report: Safe. MAY BE
UNSAFE if used for prolonged periods. (Williams DA.
Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Arch Toxicol
82:667,2008)
Hormones ESTROGENS Ethinyl Estradiol Many OK? web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Probably safe PV
Tishler MD clinical data & patient report: Safe Horm
Metab Res 1995;27:379. Safe in patients Mass. College
of Pharmacy databse: Substrate & inhibitor of CYP3A4.
Inducer of pregnane X receptor.
Hormones ORAL Birth Control Pills Many BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme
CONTRACEPTIVES Caution www.uq.edu.au/porphyria/: Unsafe in patients
www.porphyriafoundation.com: Unsafe Substrate of
CYP3A4 (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007) 1Patient report: Safe. 3 patient reports: unsafe ­
ethinyl estradiol/drospirenone (Yasmin), ethinyl
estradiol­desogestrel (Orthocoept), ethinyl estradiol­
norgestimate (Orcho Cyclen) unsafe
Hormones PROGESTINS Levonorgestrel Many BAD! www.drugs­porphyria.org: Possibly Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution. Metab by CYP3A4.
Hormones PROGESTINS Norethindrone Loestrin No info JAMA 1965;194:1037. Safe in patients USP DI? Drug
Info. for the Health Care Pro. ­ 26th Ed. (2006):
Undergoes reduction in liver; induces CYP2C9.
Hormones PROGESTINS Progesterone Many BAD! www.drugs­porphyria.org: Probably Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.porphyriafoundation.com: Unsafe Patient
report: unsafe. Induces CYP3A, pregnane X receptor
Hormones, ANDROGENS Danazol Danocrine BAD! www.drugs­porphyria.org: Probably Porphyrinogenic

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hormone­like www.porphyria­europe.com: Unsafe
web.uct.ac.za/depts/porphyria/: Avoid
www.uq.edu.au/porphyria/: Unsafe in patients
www.porphyriafoundation.com: Unsafe J Clin Endocrinol
Metab 1981;52:549. Exacerbates acute porphyria J Clin
Endocrinol Metab 1979;48:123. Unsafe in patients
HORMONES, ANDROGENS Methyltestosterone Many BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme
HORMONE­LIKE Caution

HORMONES, ANDROGENS Nandrolone Deca­Durabolin BAD! www.drugs­porphyria.org: Porphyrinogenic

HORMONE­LIKE www.uq.edu.au/porphyria/: Probably unsafe

HORMONES, ANDROGENS Oxandrolone Oxandrin BAD?

HORMONE­LIKE

HORMONES, ANDROGENS Stanozolol Winstrol BAD? www.drugs­porphyria.org: Not Porphyrinogenic

HORMONE­LIKE

Hormones, ANDROGENS Testosterone Many BAD! www.drugs­porphyria.org: Porphyrinogenic Substrate of

hormone­like CYP3A4 & CYP2C9. Modestly transactivates pregnane X
receptor (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007; Curr Drug Metab 7:375,2006)
HORMONES, CORTICOSTEROIDS Betamethasone Many OK! www.drugs­porphyria.org: Not Porphyrinogenic
HORMONE­LIKE web.uct.ac.za/depts/porphyria/: Use with Caution

HORMONES, CORTICOSTEROIDS Cortisone Many OK!

HORMONE­LIKE

HORMONES, CORTICOSTEROIDS Fludrocortisone Florinef OK! www.drugs­porphyria.org: Possibly Porphyrinogenic

HORMONE­LIKE web.uct.ac.za/depts/porphyria/: Use with Caution

Hormones, CORTICOSTEROIDS Hydrocortisone Many OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

hormone­like www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Probably safe Substrate of
CYP3A4 (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007)
Hormones, CORTICOSTEROIDS Prednisolone Many OK? Substrate of CYP3A4. Induces CYP3A4 via transactivation
hormone­like of pregnane X receptor. Patient report: Safe. MAY BE
UNSAFE if used for prolonged periods. (Williams DA.
Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Arch Toxicol
82:667,2008)
Hormones, CORTICOSTEROIDS Prednisone Many OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
hormone­like web.uct.ac.za/depts/porphyria/: Use Substrate of
CYP3A4. Weakly transactivates pregnane X receptor
(Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007; Curr Drug
Metab 7:375, 2006) Patient reports: Safe
HORMONES, CORTICOSTEROIDS Triamcinolone Aristocort OK! www.drugs­porphyria.org: Not Porphyrinogenic
HORMONE­LIKE web.uct.ac.za/depts/porphyria/: Use with Caution

HORMONES, ESTROGENS Estrogens, Many OK! www.drugs­porphyria.org: Possibly Porphyrinogenic

HORMONE­LIKE Conjugated

Hormones, ESTROGENS Estropipate Ogen, Ortho­est No info

hormone­like
HORMONES, LHRH/GNRH Goserelin Zoladex OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
HORMONE­LIKE AGONISTS

HORMONES, LHRH/GNRH Leuprolide Lupron OK? Protein, metabolized by proteolysis

HORMONE­LIKE AGONISTS

HORMONES, LHRH/GNRH Nafarelin Synarel OK! www.drugs­porphyria.org: Possibly Porphyrinogenic

HORMONE­LIKE AGONISTS www.porphyria­europe.com: Safe

HORMONES, OVULATION Clomiphene Clomid OK! web.uct.ac.za/depts/porphyria/: Use

HORMONE­LIKE STIMULANTS www.uq.edu.au/porphyria/: Safe in patients

Hormones, PARATHYROID Calcitonin Miacelcin, OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

hormone­like Calcimar, Fortical web.uct.ac.za/depts/porphyria/: Use www.porphyria­
europe.com: Safe Patient report: Safe
HORMONES, PITUITARY Chorionic Pregnyl OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
HORMONE­LIKE Gonadotropin

HORMONES, PITUITARY Desmopressin DDAVP OK! www.drugs­porphyria.org: Not Porphyrinogenic

HORMONE­LIKE

HORMONES, PITUITARY Ergonovine Ergotrate OK!

HORMONE­LIKE

HORMONES, PITUITARY Menotropins Repronex OK!

HORMONE­LIKE

HORMONES, PITUITARY Methylergonovine Methergine OK!

HORMONE­LIKE

HORMONES, PITUITARY Oxytocin Pitocin OK! www.drugs­porphyria.org: Not Porphyrinogenic

HORMONE­LIKE www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
HORMONES, PITUITARY Urofollitropin Fertinorm OK!
HORMONE­LIKE

HORMONES, PITUITARY Vasopressin Pitressin OK!

HORMONE­LIKE
www.drugs­porphyria.org: Porphyrinogenic

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HORMONES, PROGESTINS Medroxyprogesterone Provera BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme
HORMONE­LIKE Caution

Hormones, SELECTIVE ESTROGEN Raloxifene Evista BAD? www.drugs­porphyria.org: Probably Porphyrinogenic.

hormone­like RECEPTOR Chang: Drug Metab Disp 2006; 34:2073: bound to P­
MODULATORS gycoprotein & activated by CYP3A4. Sinz M: Cur Drug
(SERMs) Metab 2006; 7:375: Little activation of human pregnane
X receptor & low prediction of clinical induction.
HORMONES, SOMATOSTATIC Octreotide Sandostatin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
HORMONE­LIKE AGENTS www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
HORMONES, SPERMICIDES Nonoxynol­9 Many NO INFO
HORMONE­LIKE (VAGINAL)
HORMONES, THYROID Levothyroxine Levoxyl, Synthroid OK! www.drugs­porphyria.org: Not Porphyrinogenic
HORMONE­LIKE www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use PV Tishler MD
clinical data & patient reports: Safe
HORMONES, THYROID Liothyronine Cytomel OK! web.uct.ac.za/depts/porphyria/: Use
HORMONE­LIKE

Hormones, THYROID Methimazole Tapazole No info Metab by liver, presumably by CYPs; inhibits several

hormone­like CYPs also (Drug Metab Dispos 1997;25:390)

Hormones, THYROID Propylthiouracil Procasil, Propacil, OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

hormone­like (PTU) others www.porphyria­europe.com: safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
Immunologic IMMUNOSUPPRESSIVE Sirolimus Rapamune BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic
AGENTS metab mainly by & induces CYP3A4, also CYP3A5 (Drug
Metab Disp 35:350,2007. Induces pregnane X receptor.
IMMUNOLOGIC ANTIMICROBIAL Anti­Thymocyte OK?
AGENTS VACCINES Globulin,
Lymphocyte Immune
Globulin

IMMUNOLOGIC ANTIMICROBIAL Haemophilus B OK?

AGENTS VACCINES

IMMUNOLOGIC ANTIMICROBIAL Hepatitis A OK? www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS VACCINES

IMMUNOLOGIC ANTIMICROBIAL Hepatitis B OK! www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS VACCINES

IMMUNOLOGIC ANTIMICROBIAL Influenza OK! www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS VACCINES

IMMUNOLOGIC ANTIMICROBIAL Japanese OK?

AGENTS VACCINES Encephalitis

IMMUNOLOGIC ANTIMICROBIAL Measles, Mumps & OK! www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS VACCINES Rubella

IMMUNOLOGIC ANTIMICROBIAL Meningococcal OK?

AGENTS VACCINES
IMMUNOLOGIC ANTIMICROBIAL Mumps OK!
AGENTS VACCINES

IMMUNOLOGIC ANTIMICROBIAL Pneumococcal OK!

AGENTS VACCINES

IMMUNOLOGIC ANTIMICROBIAL Polio OK!

AGENTS VACCINES

IMMUNOLOGIC ANTIMICROBIAL Rabies OK?

AGENTS VACCINES

IMMUNOLOGIC ANTIMICROBIAL Typhoid OK? www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS VACCINES

IMMUNOLOGIC ANTIMICROBIAL Typhoid VI OK? www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS VACCINES Polysaccharide

IMMUNOLOGIC ANTIMICROBIAL Varicella OK! www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS VACCINES

IMMUNOLOGIC ANTIMICROBIAL Yellow Fever OK? www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS VACCINES

IMMUNOLOGIC ANTIVENINS Antivenin Crotalidae AntiveninPolyvalent OK?

AGENTS Polyvalent

IMMUNOLOGIC ANTIVENINS Antivenin OK?

AGENTS Latrodectus Mactans

IMMUNOLOGIC ANTIVENINS Antivenin Micrurus OK?

AGENTS Fulvius

IMMUNOLOGIC ANTIVIRAL Palivizumab Synagis OK? www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS MONOCLONAL
ANTIBODIES

IMMUNOLOGIC IMMUNE GLOBULINS Cytomegalovirus OK? (web.uct.ac.za/depts/porphyria/: Use)

AGENTS

IMMUNOLOGIC IMMUNE GLOBULINS Hepatitis B OK? (web.uct.ac.za/depts/porphyria/: Use) www.drugs­

AGENTS porphyria.org: Not Porphyrinogenic

IMMUNOLOGIC IMMUNE GLOBULINS Immune Globulin IV OK? (web.uct.ac.za/depts/porphyria/: Use) www.drugs­

AGENTS porphyria.org: Not Porphyrinogenic

IMMUNOLOGIC IMMUNE GLOBULINS Rabies OK? (web.uct.ac.za/depts/porphyria/: Use)

AGENTS

IMMUNOLOGIC IMMUNE GLOBULINS Tetanus OK? (web.uct.ac.za/depts/porphyria/: Use)

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AGENTS

IMMUNOLOGIC IMMUNOMODULATORS Thalidomide Thalomid NO INFO

AGENTS

Immunologic agents IMMUNOSUPPRESSIVE Azathioprine Imuran OK? www.drugs­porphyria.org: Probably Porphyrinogenic

AGENTS web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in animals J Clin
Pharmacol 2001;41:113. Safe Not metab by CYPs
(www.clinicalpharmacology­ip.com)
Immunologic agents IMMUNOSUPPRESSIVE Cyclosporine Sandimmune OK? www.porphyria­europe.com: Safe
AGENTS web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Unsafe in animals J
Clin Pharmacol 2001;41:113. Safe Major metab by
CYP3A4,3A5. Does not transactivate pregnene X receptor
(Biochem Pharmacol 68:1889,2004; Curr Drug Metab
7:375,2006)
Immunologic agents IMMUNOSUPPRESSIVE Mycophenolate CellCept OK? J Clin Pharmacol 2001;41:113. Safe ~85% nonmetab by
AGENTS Mofetil CYP, with minor contribution of CYP3A4/5 (Clin
Pharmacokinet 46:13,2007; Therapeutic Drug Monitor
26:600,2004)
Immunologic agents IMMUNOSUPPRESSIVE Tacrolimus Prograf, Protopic BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic J
AGENTS Clin Pharmacol 2001;41:113. Safe Major metab by
CYP3A4, 3A5 (Pharmacogenetics & Genomics
19:458,2009)
Immunologic agents TOXOIDS Diphtheria + Tetanus Pediatrix OK! All component parts of this vaccine are safe individually
Toxoids & Acellular as well.
Pertussis Adsorbed,
Hepatitis B
(recombinant) &
Inactivated
Polioviruis Vaccine
Combined

NARCOTIC ­ Naloxone Narcan OK! www.drugs­porphyria.org: Possibly Porphyrinogenic.

ANTAGONISTS Opioid derivative metabolised by a series of CYPs,
mainly 3A4. Two references: Use www.porphyria­
europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
OPHTHALMIC ­ Acetylcholine Miochol OK!
AGENTS
(intraocular)

OPHTHALMIC ­ Apraclonidine Iopidine OK! www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS
(intraocular)

OPHTHALMIC ­ Betaxolol Many OK!

AGENTS
(intraocular)

OPHTHALMIC ­ Bimatoprost Lumigan OK!

AGENTS
(intraocular)

OPHTHALMIC ­ Brimonidine Alphagan OK! www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS
(intraocular)

OPHTHALMIC ­ Cyclopentolate Cyclogyl OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

AGENTS
(intraocular)

OPHTHALMIC ­ Dapiprazole Rev­Eyes OK!

AGENTS
(intraocular)

OPHTHALMIC ­ Dorzolamide Trusopt OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

AGENTS www.drugs.com: excreted primarily as unchanged drug
(intraocular)

OPHTHALMIC ­ Fluorescein Many OK! www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS
(intraocular)

OPHTHALMIC ­ Homatropine Many OK!

AGENTS
(intraocular)

OPHTHALMIC ­ Latanoprost Xalatan OK! www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS
(intraocular)

OPHTHALMIC ­ Naphazoline Many OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

AGENTS
(intraocular)

OPHTHALMIC ­ Pilocarpine Many OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

AGENTS
(intraocular)

OPHTHALMIC ­ Travoprost Travatan OK! www.drugs­porphyria.org: Not Porphyrinogenic

AGENTS
(intraocular)

OPHTHALMIC ­ Trifluridine Viroptic OK!

AGENTS
(intraocular)

OPHTHALMIC ­ Tropicamide Mydriacyl OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

AGENTS
(intraocular)

Psychiatric ANTI­DEPRESSANT Desvenlafaxine Pristiq OK? <5% metab by CYP3A4 (PDR 63:3247,2009). No

CyP3A4 inhibition. (CNS Drugs 2012:26:39)

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Psychiatric ANTI­DEPRESSANT Duloxetine Cymbalta OK? ~97% metab by CYP1A2, 2D6 (Drug Metab Disp
31:1142,2003). No effect on activity of CyP3A4 or 2C9
(CNS Drugs 2012; 26:39) 2 Patient reports:safe. Report
of questionable patient: unsafe.
Psychiatric ANTI­DEPRESSANT Mirtazapine Remeron OK! www.drugs­porphyria.org: Possibly Porphyrinogenic. 1/4
not metab, 1/3 metab by CYP2D6, rest by CYP3A4, 1A2.
Moderate activation of pregnane X receptor but low
prediction of clinical induction (Clin Pharmacogenet
38:461,2000; Cur Drug Metab 7:375,2006). Patient
reports: safe
Psychiatric ANTI­DEPRESSANT Venlafaxine Effexor OK? www.drugs­porphyria.org: Possibly porphyrinogenic.
www.porphyria.uct.ac.za: Use only with extreme
caution. Fogelman SM: Neuropsychopharm 1999;
20:480: Major metabolism via CYP2D6 (90%), 2C19
(9%); or also CYP3A4 (CNS Drugs 2012; 26:39). Sinz
M: Cur Drug Metab 2006; 7:375: No activation of
pregnane X receptor.
Psychiatric MISC. Asenapine Saphris No info Metab by CYPs; proportion by CYP3A4 unknown (Drug
Metab Disp 39:580, 2011)
Psychiatric MISC. Bupropion Wellbutrin, Zyban OK? www.drugs­porphyria.org: Unlikely Porphyrinogenic. USP
DI? Drug Info. for the Health Care Pro. ­ 26th Ed:
Metabolized primarily by CYP2B6 (also CNS Drugs 2012;
26:39) & CYP2D6; Moderately transactivates pregnane X
receptor but has low probability of inducing CYP3A4
(Curr Drug Metab 9:598,2008;
http://medicine.iupui.edu/clinpharm/ddis/)
Psychiatric MISC. Clozapine Clozaril OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic.
Metab. mainly by CYP1A2, to lesser extent by CYP3A &
other CYPs. Induces CYP 3A, 2C9. Minimal
transactivation of pregnane X receptor (Eur J Pharm Sci
20:451, 2003; Curr Drug Metab 11:516, 2010; Toxicol
Lett 82:203, 2011)
Psychiatric MISC. Dexmedetomidine Precedex OK? ~14% metab. by CYP2A6, remainder by glucuronidation.

Psychiatric MISC. Iloperidone Fenapt No info 99% metab, mainly by CYP2D6, less so by CYP3A4

(Curr Drug Metab 11:516, 2010)
Psychiatric Misc. Olanzapine Zyprexa OK? www.drugs­porphyria.org: Probably not porphyrinogenic.
www.porphyria_europe.com: Safe. Minor metab. by
CYP1A2, 2D6 ?3A4. Moderate activation of pregnane X
receptor & low prediction of clinical induction (Basic Clin
Pharmacol Toxicol 100:4,2007; Cur Drug Metab
7:375,2006; Curr Drug Metab 11:516,2010)
Psychiatric Misc. Quetiapine Seroquel BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic.
Metab. mainly by CYP3A4. No evidence for its induction.
(http://medicine.iupui.edu/clinpharm/ddis/; Basic Clin
Pharmacol Toxicol 100:4,2007) Patient report: safe
Psychiatric Misc. resperidone Resperdal, etc. OK? Major metab via CyP2D6. Weak inhibition of Cyp3A,
PXR.
Psychiatric MISC. Risperidone Risperdal OK? www.drugs­porphyria.org: Probably Porphyrinogenic.
Spina E: Basic Clin Pharmacol Toxicol 2007; 100:4:
Substrate mainly of CYP2D6, less of 3A4. Sinz M. Cur
Durg Metab 2006; 7:375: No activation of pregnane X
rerceptor. Toxicol Lett 203:82, 2011: modest activation
of pregnane X receptor (1/5 that of rifampin).
Psychiatric MISC. Trazodone Desyrel BAD? web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Unsafe in animals
Substrate of CYP3A4 (Williams DA. Drug metabolism.
In: Foye's Principles of Medicinal Chemistry, ed. Lemke
T and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007; http://medicine.iupui.edu/clinpharm/ddis/)
Psychiatric MISC. Ziprasidone Geodon BAD? www.drugs­porphyria.org: Possibly Porphyrinogenic 1/3
metabolized by CYP3A4 (www.rxlist.com; J Clin
Psychopharm 23:229,2003)
Psychiatric PHENOTHIAZINES Chlorpromazine Thorazine OK! www.drugs­porphyria.org: Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients PV Tishler
MD clinical data: Safe JAMA 1965;194:1042. Safe in
patients Substrate of CYP3A4. Does not or does
moderately transactivate pregnane X receptor. and does
transactivate constitutive androgen receptor (Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Curr Drug Metab
7:375,2006; Xenobiotica 37:1196,2007; J Pharmacol Exp
Therap 320:72, 2007)
Psychiatric SELECTIVE Citalopram Celexa OK? www.drugs­porphyria.org: Possibly Porphyrinogenic.
SEROTONIN Substrate of CYP3A. web.uct.ac.za/depts/porphyria/:
REUPTAKE Use with Caution. 1 Patient report: safe. 1 patient
INHIBITORS (SSRIs) report: unsafe

Psychiatric SELECTIVE Escitalopram Lexapro No info Major metabolism by CYP2C19, CYP3A4; no inhibition of

SEROTONIN CYP3A4 (CNS Drugs 2012; 26:39)
REUPTAKE
INHIBITORS (SSRIs)
Psychiatric SELECTIVE Fluoxetine Prozac OK! www.drugs­porphyria.org: Not Porphyrinogenic
SEROTONIN www.porphyria­europe.com: Safe
REUPTAKE web.uct.ac.za/depts/porphyria/: Use with Caution
INHIBITORS (SSRIs) www.uq.edu.au/porphyria/: Safe in patients Substrate
of CYP2C9 (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007) Does not induce pregnane X receptor (Toxicol Lett
203:82, 2011) Patient reports: safe
Psychiatric SELECTIVE Paroxetine Paxil OK? www.drugs­porphyria.org: Probably Porphyrinogenic
SEROTONIN web.uct.ac.za/depts/porphyria/: Use with Caution Does

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REUPTAKE not induce pregnane­X­receptor (Toxicol Lett 203:82,
INHIBITORS (SSRIs) 2011).

Psychiatric SSELECTIVE Fluvoxamine Luvox OK? Prob ~65% metab by CYP2D6 + alcohol dehydrogenase

SEROTONIN (Xenobiotica 37:169,2007). Inhibits CYP3A4.
REUPTAKE
INHIBITORS (SSRIs)

Psychiatric TRICYCLICS Amitriptyline Elavil OK! www.drugs­porphyria.org: Probably Porphyrinogenic

web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Probably unsafe
Substrate of many CYPs, including CYP3A4, but does not
transactivate pregnane X receptor
(http://medicine.iupui.edu/clinpharm/ddis/; Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Curr Drug Metab
7:375, 2006) patient reports: safe
Psychiatric TRICYCLICS Imipramine Tofranil OK? www.drugs­porphyria.org: Probably Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Probably unsafe
Metab by CYP2C19, 2D6, 3A4.
(http://medicine.iupui.edu/clinpharm/ddis/; Williams
DA. Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007)
Psychiatric AGENTS FOR Disulfiram Antabuse OK? www.drugs­porphyria.org: Probably Porphyrinogenic Eur
medications CHEMICAL J Clin Chem Clin Biochem 1997;35:427. Safe in patients
DEPENDENCY Major metabolism by CYP3A4/3A5. Inhibits but probably
does not induce CYPs (Alcohol Clin Exp Res
22:1212,1998; Arch Toxicol 82:667,2008)
Psychiatric AGENTS FOR Naltrexone Vivitrol OK? No CYP metabolism (PDR 63:988, 2009)
medications CHEMICAL
DEPENDENCY

Psychiatric ANTIDEMENTIA Donepezil Aricept OK? www.drugs­porphyria.org: Possibly Porphyrinogenic

medications AGENTS www.drugs.com: ~80% metab via CYP2D6, 3A4
(www.clinicalpharmacology­ip.com; Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007)
Psychiatric ANTIDEMENTIA Memantine Namenda OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
medications AGENTS www.rxlist.com: ca. 50% excreted unchanged; no
significant metabolic role for CYPs
Psychiatric MISC. Aripiprazole Abilify No info Metab mainly by CYP3A4,2D6 (Curr Drug Metab
medications 9:410,2008)

Psychiatric MISC. Dextroamphetamine Dexedrine BAD? Substrate of CYP3A4 (Williams DA. Drug metabolism.

medications In: Foye's Principles of Medicinal Chemistry, ed. Lemke
T and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007)
Psychiatric MISC. Haloperidol Haldol OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic.
medications www.porphyria­europe.com: Safe.
web.uct.ac.za/depts/porphyria/: Use.
www.uq.edu.au/porphyria/: Probably unsafe. Substrate
mainly of 3A4, also 3A5, 3A7. Moderate activation of
human pregnane X receptor & low prediction of clinical
induction. (Chem Res Toxicol 2006; 19:914; Cur Drug
Metab 2006; 7:375)
Psychiatric MISC. Lithium Eskalith, Lithobid OK! www.drugs­porphyria.org: Not Porphyrinogenic
medications www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients
PSYCHIATRIC MISC. Methylphenidate Ritalin OK? www.drugs.com: Major metabolic route probably does
MEDICATIONS not involve P450

Psychiatric MISC. Paliperidone Invega OK? 60% excreted unchanged. Small amt metab by

medications CYP2D6,?other CYPs (Drug Metab Disp 36:769,2008)

PSYCHIATRIC MISC. Phenelzine Nardil BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme

MEDICATIONS Caution www.uq.edu.au/porphyria/: Unsafe in animals

PSYCHIATRIC PHENOTHIAZINES Fluphenazine Prolixin OK! www.drugs­porphyria.org: Not Porphyrinogenic

MEDICATIONS www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
PSYCHIATRIC PHENOTHIAZINES Perphenazine Trilafon OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
MEDICATIONS web.uct.ac.za/depts/porphyria/: Use with Caution

Psychiatric PHENOTHIAZINES Prochlorperazine Compazine, OK! www.drugs­porphyria.org: Not Porphyrinogenic

medications Compro, Combid, www.porphyria­europe.com: Safe
others web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Safe in patients PV Tishler
MD clinical data: Safe
Psychiatric PHENOTHIAZINES Thioridazine Mellaril OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
medications web.uct.ac.za/depts/porphyria/: Use with Caution
www.uq.edu.au/porphyria/: Safe in patients Polish J
Pharmacol 2001;53:615. Metabolized by CYP2D6;inhibits
CYP1A2 and CYP3A2
Psychiatric SELECTIVE Sertraline Zoloft OK? www.drugs­porphyria.org: Possibly Porphyrinogenic
medications SEROTONIN Substrate of CYP3A4 but minimially transactivates
REUPTAKE pregnane X receptor (Williams DA. Drug metabolism.
INHIBITORS (SSRIs) In: Foye's Principles of Medicinal Chemistry, ed. Lemke
T and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007; Curr Drug Metab 7:375,2006.
Psychiatric TRICYCLICS Doxepin Sinequan, Adepin, OK? Medicine (Balt)1992;71:1. Safe Patient report: Safe
medications others

Psychiatric TRICYCLICS Nortriptyline Aventyl OK? www.drugs­porphyria.org: Probably Porphyrinogenic

medications web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Probably unsafe.

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Metab by CYP2D6. Does not transactivate pregnane X
receptor (http://medicine.iupui.edu/clinpharm/ddis/;
Curr Drukg Metab 7:375,2006)
Respiratory ANTIASTHMATIC AND Albuterol Ventolin, Proventil, OK! PV Tishler MD clinical data, 3 patient reports: Safe
BRONCHODILATOR others https://online.epocrates.com/front_porch/: Metabolized
AGENTS extensively by P450. Does not transactivate pregnane X
receptor (Curr Drug Metab 7:375,2006)
Respiratory ANTIASTHMATIC AND Budesonide Pulmicort, OK! www.drugs­porphyria.org: Not Porphyrinogenic PV
BRONCHODILATOR Rhinocort, Entocort Tishler MD clinical data & patient report: Safe Metab by
AGENTS CYP3A

Respiratory ANTIASTHMATIC AND Fluticasone Flovent OK! www.drugs­porphyria.org: Not Porphyrinogenic PV

BRONCHODILATOR Tishler MD clinical data & patient reports: Safe
AGENTS Substrate of CYP3A4 (Williams DA. Drug metabolism.
In: Foye's Principles of Medicinal Chemistry, ed. Lemke
T and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007)
Respiratory ANTIASTHMATIC AND Formoterol Foradil, OK? Secondary metab via 4 CYPs (PDR 63:1025,2009), inc.
BRONCHODILATOR Perforomist CYP2C9
AGENTS

Respiratory ANTIASTHMATIC AND Montelukast Singulair OK! www.drugs­porphyria.org: Possibly Porphyrinogenic

BRONCHODILATOR Substrate of CYP3A4 & CYP2C9. No inhibition of CYP2C9,
AGENTS 3A4. Moderate transactivation of pregnane X receptor
but low prediction of CYP3A4 induction (Williams DA.
Drug metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007; Curr Drug Metab
7:375, 2006) Patient report: Safe
Respiratory ANTIASTHMATIC AND Zafirlukast Accolate BAD? Substrate of CYP2C9. Induces pregnane X receptor.
BRONCHODILATOR (Williams DA. Drug metabolism. In: Foye's Principles of
AGENTS Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007)
Respiratory ANTIHISTAMINES Cetirizine Zyrtec OK! Mainly excreted unchanged. Does not induce CYPs (Cur
Med Therap 15:2193,2008; Med Letter 49:97,2007). 1
patient report: safe.
Respiratory ANTIHISTAMINES Chlorpheniramine Chlor­Trimeton, OK! www.uq.edu.au/porphyria/: Safe in patients Metab by
others CYP2D6, CYP3A4, 2D9 (Pharmacogenetics 1999;9:71; J
Pharm Pharmacol 49:257,1997) Patient report: Safe
Respiratory ANTIHISTAMINES Diphenhydramine Benadryl OK! www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use Patient reports:
Safe
Respiratory ANTIHISTAMINES Fexofenadine Allegra OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
USP DI? Drug Info. for the Health Care Pro. ­ 26th Ed.
(2006): Ca. 1% metabolized by P450, ~5% total.
Patient reports: Safe
Respiratory ANTIHISTAMINES Loratadine Claritin OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use with Caution
Substrate of CYP3A4, 2C9. Moderate transactivator of
pregnane X receptor, but low probability of inducing
CYP3A4 (Williams DA. Drug metabolism. In: Foye's
Principles of Medicinal Chemistry, ed. Lemke T and
Williams DA. Baltimore, Williams & Wilkins, 6th ed.,
2007; Curr Drug Mertab 7:375,2006) 3 Patient reports:
safe
Respiratory ANTITUSSIVES (Cough Benzonatate Tessalon, etc. OK? patient report: safe
Therapies)

Respiratory ANTITUSSIVES (Cough Dextromethorphan Many OK! www.porphyria­europe.com: Safe

Therapies) web.uct.ac.za/depts/porphyria/: Use Metab by CYP3A4.

Respiratory Asthma Treatment Fluticasone Advair OK? fluticasone = corticosteroid; salmeterol, brochodilator,

metab via CYP3A. Used by inhalation. 1 patient report:
safe.
RESPIRATORY ANTIASTHMATIC AND Aminophylline Many BAD! www.drugs­porphyria.org: Probably Porphyrinogenic
AGENTS BRONCHODILATOR web.uct.ac.za/depts/porphyria/: Avoid
AGENTS

Respiratory agents ANTIASTHMATIC AND Arformoterol Brovana OK? Secondary metab via 4 CYPs (PDR 63:2990,2009)

BRONCHODILATOR
AGENTS

Respiratory agents ANTIASTHMATIC AND Beclomethasone Beclovent, OK! www.uq.edu.au/porphyria/: Safe in patients PV Tishler

BRONCHODILATOR (Inhalant) Vanceril, others MD clinical data: Safe
AGENTS

Respiratory agents ANTIASTHMATIC AND Cromolyn Intal, others OK?

BRONCHODILATOR
AGENTS

Respiratory agents ANTIASTHMATIC AND Flunisolide Aerobid, Nasalide, No info

BRONCHODILATOR (Inhalant) Nasarel
AGENTS

Respiratory agents ANTIASTHMATIC AND Ipratropium Atrovent OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

BRONCHODILATOR http://www.bidocs.com/renetnt:/Prescribing+
AGENTS Information/PIs/Atrovent+Nasal+03/ATR03.pdf:
Metabolized via hydrolysis patient report: safe
Respiratory agents ANTIASTHMATIC AND Salmeterol Serevent OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
BRONCHODILATOR Substrate of CYP3A4 (Williams DA. Drug metabolism.
AGENTS In: Foye's Principles of Medicinal Chemistry, ed. Lemke
T and Williams DA. Baltimore, Williams & Wilkins, 6th
ed., 2007)
RESPIRATORY ANTIASTHMATIC AND Terbutaline Brethine OK! www.drugs­porphyria.org: Not Porphyrinogenic Eur. J.
AGENTS BRONCHODILATOR Clin. Pharmacol. 1993;45 :483. No metabolism in liver
AGENTS

Respiratory agents ANTIASTHMATIC AND Theophylline Many BAD? www.drugs­porphyria.org: Probably Porphyrinogenic

BRONCHODILATOR web.uct.ac.za/depts/porphyria/: Use with Extreme

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AGENTS Caution www.uq.edu.au/porphyria/: Unsafe in patients
Medicine (Balt) 1992;71:1. Safe Substrate of CYP3A4,
but does not transactivate pregnane X receptor
(Williams DA. Drug metabolism. In: Foye's Principles of
Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007; Curr Drug
Metab 7:375,2006)
Respiratory agents ANTIHISTAMINES Azatadine Optimine, Trinalin, No info
others

RESPIRATORY ANTIHISTAMINES Cyproheptadine Periactin OK! www.drugs­porphyria.org: Possibly Porphyrinogenic

AGENTS

Respiratory agents ANTIHISTAMINES Hydroxyzine Atarax, Vistaril BAD! www.drugs­porphyria.org: Porphyrinogenic

web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.uq.edu.au/porphyria/: Unsafe in patients
Respiratory agents ANTIHISTAMINES Levocetirizine Xyzal OK! Mainly excreted unchanged. Does not induce CYPs (Curr
Med Therap 15:2193, 2008; Med Letter 49:97,2007)
RESPIRATORY ANTIHISTAMINES Promethazine Phenergan OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic
AGENTS www.porphyria­europe.com: Safe
web.uct.ac.za/depts/porphyria/: Use
www.uq.edu.au/porphyria/: Probably unsafe Curr Drug
Metab 2003;4:105. Metabolized by CYP2D6
Respiratory agents ANTITUSSIVES (Cough Hydrocodone Many OK! Williams DA. Drug metabolism. In: Foye's Principles of
Therapies) Medicinal Chemistry, ed. Lemke T and Williams DA.
Baltimore, Williams & Wilkins, 6th ed., 2007. Substrate
of CYP3A4 Patient reports: Safe
Respiratory agents EXPECTORANTS Guaifenesin Robitussin OK! www.drugs­porphyria.org: Possibly Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution PV Tishler MD clinical data & patient report:
Safe
RESPIRATORY MUCOLYTICS Acetylcysteine Mucomyst OK! www.drugs­porphyria.org: Not Porphyrinogenic
AGENTS web.uct.ac.za/depts/porphyria/: Use PV Tishler MD
clinical data: Safe Eur J Clin Chem Clin Biochem
1997;35:427. Safe
RESPIRATORY NASAL AGENTS ­ Oxymetazoline Afrin OK? www.drugs­porphyria.org: Probably Not Porphyrinogenic
AGENTS SYSTEMIC AND www.uq.edu.au/porphyria/: Unsafe in patients
TOPICAL

RESPIRATORY NASAL AGENTS ­ Phenylephrine Many OK! www.drugs­porphyria.org: Probably Not Porphyrinogenic

AGENTS SYSTEMIC AND
TOPICAL

RESPIRATORY NASAL AGENTS ­ Pseudoephedrine Sudafed OK! www.porphyria­europe.com: Safe

AGENTS SYSTEMIC AND web.uct.ac.za/depts/porphyria/: Use
TOPICAL www.uq.edu.au/porphyria/: Safe in patients Patient
reports: Safe
URINARY TRACT ANALGESICS Phenazopyridine Pyridium NO INFO

URINARY TRACT ANTISPASMODICS Bethanechol Urecholine NO INFO

Urinary tract ANTISPASMODICS Darifenacin Enablex BAD? Significantly metab by CYP3A4, 2D6. No evidence of

CYP induction (Clin Pharmacokinet 45:325,2006)
Urinary tract ANTISPASMODICS Oxybutynin Oxytrol, Ditropan BAD! www.drugs­porphyria.org: Possibly Porphyrinogenic
web.uct.ac.za/depts/porphyria/: Use with Extreme
Caution www.drugs.com: Metabolized primarily in liver
by CYP3A4 Substrate of CYP3A4 (Williams DA. Drug
metabolism. In: Foye's Principles of Medicinal
Chemistry, ed. Lemke T and Williams DA. Baltimore,
Williams & Wilkins, 6th ed., 2007)
Urinary tract ANTISPASMODICS Solifenacin Vesicare OK? Metab primarily by CYP3A4. No evidence of any CYP
induction (Br J Clin Pharmacol 59:647,2004)
Urinary tract ANTISPASMODICS Tolterodine Detrol OK? www.drugs­porphyria.org: Safe in one patient, but
possibly porphyrinogenic. Metab by CYP2D6,3A4;
CYP3A4 may be increased in CYP2D6 poor metabolizers
(Drug Metab Disp 26:289,1998) Patient report to Peter
Tishler, MD ­ safe
Urinary tract PROSTATIC Dutasteride Avodart BAD? Extensively metab by CYP3A4,3A5 (PDR 63:1359,2009).
HYPERTROPHY 2 patient reports: unsafe

Urinary tract PROSTATIC Tamsulosin Flomax BAD? Extensively metab by CYP3A4,2D6 (Xenobiotica 28:909,

HYPERTROPHY 1998; PDR 63:848,2009).

Urinary tract PROSTATIC Finasteride Proscar, Propecia OK! www.drugs­porphyria.org:Possibly porphyrinogenic.

HYPERTROPHY (also www.porphyria.uct.ac.za: Use only with extreme
Baldness) caution. Metab mainly by CYP3A4. Little activation of
pregnane X receptor (Huskey SW: Drug Metab Disp
1996; 24:695; Sinz M. Cur Drug Metab 2006; 7:375)

This information is not intended as a substitute for medical professional help or advice but is to be used only as a reference.

Definitions

OK! = very likely to be safe for prolonged use by individuals with an acute porphyria, based on consistent evidence

OK? = probably safe for prolonged use by individuals with an acute porphyria, based on evidence that is either inconsistent or insufficient to be conclusive

BAD? = probably unsafe for prolonged use by individuals with an acute porphyria, based on evidence that is either inconsistent or insufficient to be conclusive

BAD! = very likely to be unsafe for prolonged use by individuals with an acute porphyria, based on consistent evidence

NO INFO = evidence insufficient for deriving any conclusion

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