Acute Porphyria
Overview
Certain antibiotics can trigger an attack in acute porphyrias, such as:
- Acute intermittent porphyria
- Variegate porphyria
- Hereditary coproporphyria
- 5-aminolaevulinic acid dehydratase deficiency porphyria
In non-acute porphyrias most drugs are considered safe:
- Erythropoietic protoporphyria or congenital erythropoietic porphyria: Acute attacks are not encountered, therefore no unsafe drugs.
- Porphyria cutanea tarda: all drugs are safe EXCEPT chloroquine and related drugs in antimalarial doses.
Antibiotics considered SAFE in acute porphyria
The UK Porphyria Medicines Information Service maintains a list of antibiotics considered safe for use in acute porphyria. Any antibiotic not mentioned below should be avoided until discussed with an antimicrobial pharmacist or infection specialist.
Antibacterials considered SAFE in acute porphyrias
|
Drug class |
Examples |
|
Beta-lactam |
Penicillins: Amoxicillin, Benzylpenicillin, Phenoxymethylpenicillin, Co-amoxiclav, Flucloxacillin*, Piperacillin/tazobactam. *Conflicting safety advice with flucloxacillin; consider using alternative Cephalosporins: Cefaclor, Cefadroxil, Cefalexin, Cefepime, Cefixime, Cefotaxime, Cefoxitin, Cefradine, Ceftaroline, Ceftazidime, Ceftriaxone, Cefuroxime Carbapenems: Ertapenem, Imipenem, Meropenem (+/- vaborbactam) Monobactams: Aztreonam
|
|
Quinolone |
Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin |
|
Glycopeptide |
Teicoplanin, Vancomycin |
|
Aminoglycoside |
Amikacin, Gentamicin, Tobramycin |
|
Macrolide |
Azithromycin |
|
Tetracycline |
Doxycycline, Lymecycline |
|
Other |
Cycloserine, Ethambutol, Fidaxomicin, Fosfomycin, Fusidic acid, Linezolid, Metronidazole, Pyrazinamide, Sodium fusidate, Tigecycline |
Other antimicrobials SAFE in acute porphyria
|
Antiviral |
Antifungal |
Antihelmintics |
COVID-19 |
Antimalarial |
|
Aciclovir Famciclovir Ganciclovir Oseltamivir Ribavirin Valaciclovir Valganciclovir Zanamivir |
Amphotericin Caspofungin Flucytosine Nystatin Terbinafine |
Mebendazole |
Sotrovimab Dexamethasone
|
Atovaquone Chloroquine Mefloquine Primaquine Proguanil Quinine |
Antimicrobials considered UNSAFE in acute porphyria
The BNF maintains a list of antibiotics considered unsafe for use in acute porphyria. Any antibiotic listed below should be avoided unless discussed with an antimicrobial pharmacist or infection specialist.
|
Antibacterial |
Antifungal |
Antiviral |
Antimalarial |
|
Co-trimoxazole Chloramphenicol (IV) Clindamycin Erythromycin Isoniazid* Nalidixic acid Nitrofurantoin Pivmecillinam Rifabutin* Rifampicin Trimethoprim *safety uncertain; discuss with antimicrobial pharmacist or infection specialist or contact UKPMIS |
Azoles (fluconazole, itraconazole, posaconazole, voriconazole, ketoconazole) – Topical use is considered safe.
Griseofulvin |
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors |
Artemether-lumefantrine
Dapsone |
Further information
- Inclusion of a drug does not guarantee that it will be safe in all circumstances.
- For information on medication not listed and advice on the use of antiretrovirals, antineoplastics or other complex treatment scenarios either:
- Review the Porphyria Drug Database.
- Contact UKPMIS (available 24 hours a day, 7 days per week) by telephone (029 2184 2251), or see their website.