Drug Safety Database Print

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Class Type Generic name Brand name Conclusion References
Psychiatric medications MISC. Aripiprazole Abilify No info Metab mainly by CYP3A4,2D6 (Curr Drug Metab 9:410,2008)
Respiratory ANTIASTHMATIC AND BRONCHODILATOR AGENTS Zafirlukast Accolate BAD? Substrate of CYP2C9. Induces 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)
Dermatologicals ACNE Isotretinoin Accutane, Sotret, Amnesteem, Claravis BAD? web.uct.ac.za/depts/porphyria/: Use with Extreme Caution Substrate of CYP3A4. Minimally transactivates 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)
Gastrointestinal H-2 ANTAGONISTS, PPIs (Reflux, Ulcer Therapies) Rabeprazole Aciphex OK? www.drugs-porphyria.org: Probably Porphyrinogenic Major metab is nonenzymatic. Minor metab via 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
ANTINEOPLASTICS (Cancer Therapies) MISC. Interferon Gamma-1B Actimmune OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution http://medicine.iupui.edu/flockhart/table.htm: Inhibitor of CYP1A2
Cardiovascular agents THROMBOLYTIC ENZYMES Alteplase Activase OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use with Caution
Bones Bisphosponates Risedronate Actonel OK? Bisphosphonates are not metabolized
Antidiabetics Thiazolidinediones/ Biguanides Pioglitazone/ Metformin Actoplus Met BAD? See Pioglitazone
Antidiabetics Thiazolidinediones Pioglitazone Actos BAD? www.drugs-porphyria.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)
ANTI-INFECTIVES ANTIVIRALS Acyclovir Acyclovir OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe www.uq.edu.au/porphyria/: Safe in cell culture Patient report: Safe
Respiratory Asthma Treatment Fluticasone Advair OK? fluticasone = corticosteroid; salmeterol, brochodilator, metab via CYP3A. Used by inhalation. 1 patient report: safe.
Central nervous system NONSTEROIDAL ANTI-INFLAMMATORY AGENTS -NSAIDs (Pain, Arthritis Therapies, etc.) Ibuprofen Advil, Motrin OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe. Metab by CYP2C9,2C8. PV Tishler MD clinical data & patient reports: Safe at low dose used intermittently, BUT one acute attack at high, prolonged dose (Drug Metab Disp 33:1567, 2005) patient reports: safe
Respiratory agents ANTIASTHMATIC AND BRONCHODILATOR AGENTS Flunisolide (Inhalant) Aerobid, Nasalide, Nasarel No info
RESPIRATORY AGENTS NASAL AGENTS - SYSTEMIC AND TOPICAL Oxymetazoline Afrin OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic www.uq.edu.au/porphyria/: Unsafe in patients
Anti-infectives ANTIRETROVIRALS Amprenavir Agenerase BAD! www.drugs-porphyria.org: Probably Porphyrinogenic. 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)
n/a n/a Proparacaine Alcaine, Ophthetic, Ophthaine, others OK!
Cardiovascular DIURETICS Spironolactone Aldactone BAD? www.drugs-porphyria.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 agents ANTIADRENERGICS Methyldopa Aldomet BAD! www.drugs-porphyria.org: Porphyrinogenic www.porphyria-europe.com: Unsafe web.uct.ac.za/depts/porphyria/: Avoid Patient report: Unsafe
Antineoplastics (Cancer Therapies) ANTIMETABOLITES Cytarabine Alexan, Cytarabin, Cytocin, others OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.rxlist.com: Not P450 substrate
Central nervous system agents NARCOTICS (Pain Therapies) Alfentanil Alfenta OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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)
ANTINEOPLASTICS (Cancer Therapies) ANTIMETABOLITES Pemetrexed Alimta NO INFO
ANTINEOPLASTICS (Cancer Therapies) NITROGEN MUSTARDS Melphalan Alkeran OK? www.drugs-porphyria.org: Possibly Porphyrinogenic. Not porphyrinogenic in experimental rat and chicken systems. Two references safe/probably safe. www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use with Caution www.uq.edu.au/porphyria/: Probably safe
Respiratory ANTIHISTAMINES Fexofenadine Allegra OK! www.drugs-porphyria.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
Gastrointestinal therapies ANTIEMETICS (Vomiting Therapies) Palonosetron Aloxi OK?
OPHTHALMIC AGENTS (intraocular) n/a Brimonidine Alphagan OK! www.drugs-porphyria.org: Not Porphyrinogenic
Cardiovascular ACE INHIBITORS Ramipril Altace OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic Patient reports: Safe
Antidiabetics Sulfonylureas Glimepiride Amaryl BAD? www.drugs-porphyria.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)
Central nervous system HYPNOTICS (Sleeping Medications) Zolpidem Ambien, Edluar, Intermezzo, Zolpimist OK! www.drugs-porphyria.org: Possibly Porphyrinogenic CYP3A substrate. Moderate transactivator of pregnane X 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 system agents MIGRAINE THERAPY Naratriptan Amerge NO INFO www.drugs-porphyria.org: Possibly Porphyrinogenic
BLOOD RELATED THERAPY HEMOSTATICS Aminocaproic Acid Amicar OK! web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
ANESTHETICS GENERAL Etomidate Amidate BAD! www.porphyria-europe.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
ANTI-INFECTIVES AMINOGLYCOSIDES Amikacin Amikin OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use PV Tishler MD clinical data: Safe
Gastrointestinal therapies GASTROINTESTINAL MOTILITY STIMULANTS Lubiprostone Amitiza OK? No CYP metabolism or induction (PDR 63:3082,2007)
ANTI-INFECTIVES ANTIFUNGALS Amphotericin B Amphotec OK! www.drugs-porphyria.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
ANTI-INFECTIVES CEPHALOSPORINS Cefazolin Ancef OK! web.uct.ac.za/depts/porphyria/: Use with Caution
ANTI-INFECTIVES ANTIFUNGALS Flucytosine Ancobon OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in cell culture www.porphyriafoundation.com: Safe
ANESTHETICS MUSCLE RELAXANTS Succinylcholine Anectine OK? Patient report: Safe
BLOOD RELATED THERAPY ANTICOAGULANTS Bivalirudin Angiomax OK? USP DI? Drug Info. for the Health Care Pro. - 26th Ed: Clearance from plasma does not seem to involve liver
Psychiatric medications AGENTS FOR CHEMICAL DEPENDENCY Disulfiram Antabuse OK? www.drugs-porphyria.org: Probably Porphyrinogenic Eur J Clin Chem Clin Biochem 1997;35:427. Safe in patients Major metabolism by CYP3A4/3A5. Inhibits but probably does not induce CYPs (Alcohol Clin Exp Res 22:1212,1998; Arch Toxicol 82:667,2008)
Antidotes n/a Physostigmine Antilirium, others OK?
IMMUNOLOGIC AGENTS ANTIVENINS Antivenin Crotalidae Polyvalent AntiveninPolyvalent OK?
Gastrointestinal ANTIEMETICS (Vomiting Therapies) Meclizine Antivert, Bonine OK! >3 patient reports: safe. Induces & inhibits constitutive androstene receptor.
Cardiovascular agents VASODILATORS Hydralazine Apresoline BAD! www.drugs-porphyria.org: Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.uq.edu.au/porphyria/: Unsafe in patients
Arthritis n/a Leflunomide Arava No info Prob metab by CYPs (www.clinicalpharmacology-ip.com)
BLOOD RELATED THERAPY ANTICOAGULANTS Argatroban Argatroban OK? USP DI? Drug Info. for the Health Care Pro. - 26th Ed: CYP3A4/5 is not an important elimination pathway
Psychiatric medications ANTIDEMENTIA AGENTS Donepezil Aricept OK? www.drugs-porphyria.org: Possibly Porphyrinogenic www.drugs.com: ~80% metab via CYP2D6, 3A4 (www.clinicalpharmacology-ip.com; Williams DA. Drug metabolism. In: Foye's Principles of Medicinal Chemistry, ed. Lemke T and Williams DA. Baltimore, Williams & Wilkins, 6th ed., 2007)
HORMONES, HORMONE-LIKE CORTICOSTEROIDS Triamcinolone Aristocort OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
Blood related ANTICOAGULANTS Fondaparinux Arixtra OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic USP DI? Drug Info. for the Health Care Pro. - 26th Ed: 77% eliminated unchanged. Patient report: safe
Central nervous system agents ANTIPARKINSON AGENTS Trihexyphenidyl Artane BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Avoid
Cardiovascular ANGIOTENSIN II RECEPTOR ANTAGONISTS Candesartan Cilexetil Atacand OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe, Metab by CYP2C9.
Respiratory agents ANTIHISTAMINES Hydroxyzine Atarax, Vistaril BAD! www.drugs-porphyria.org: Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.uq.edu.au/porphyria/: Unsafe in patients
Central nervous system agents BENZODIAZEPINES Lorazepam Ativan OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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
Cardiovascular agents ANTIHYPERLIPIDEMIC AGENTS Clofibrate Atromid-S OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use with Caution www.uq.edu.au/porphyria/: Safe in cell culture
Respiratory agents ANTIASTHMATIC AND BRONCHODILATOR AGENTS Ipratropium Atrovent OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic http://www.bidocs.com/renetnt:/Prescribing+ Information/PIs/Atrovent+Nasal+03/ATR03.pdf: Metabolized via hydrolysis patient report: safe
Anti-infectives PENICILLINS Amoxicillin/ Clavulanate Augmentin OK! patient report: safe
Antidiabetics Thiazolidinediones/ Biguanides Rosiglitazone/ Metformin Avandamet BAD? See Rosiglitazone
Antidiabetics Thiazolidinediones Rosiglitazone Avandia BAD? www.drugs-porphyria.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
Cardiovascular agents ANGIOTENSIN II RECEPTOR ANTAGONISTS Irbesartan Avapro, Avalide OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic Mostly not metab by CYPs. Some metab by CYP2C9, but 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)
ANTINEOPLASTICS (Cancer Therapies) ANGIOGENESIS INHIBITORS Bevacizumab Avastin OK?
ANTI-INFECTIVES FLUOROQUINOLONES Moxifloxacin Avelox OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic
Psychiatric medications TRICYCLICS Nortriptyline Aventyl OK? www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.uq.edu.au/porphyria/: Probably unsafe. Metab by CYP2D6. Does not transactivate pregnane X receptor (http://medicine.iupui.edu/clinpharm/ddis/; Curr Drukg Metab 7:375,2006)
Urinary tract PROSTATIC HYPERTROPHY Dutasteride Avodart BAD? Extensively metab by CYP3A4,3A5 (PDR 63:1359,2009). 2 patient reports: unsafe
ANTI-INFECTIVES MISCELLANEOUS Aztreonam Azactam OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic http://redpoll.pharmacy.ualberta.ca/drugbank/: Metabolized via hydrolysis
Cardiovascular agents CALCIUM CHANNEL BLOCKERS Amlodipine/ olmesartan Azor BAD? See amlodipine
ANTI-INFECTIVES SULFONAMIDES Sulfasalazine Azulfidine BAD! www.porphyria-europe.com: Unsafe www.uq.edu.au/porphyria/: Unsafe in patients www.porphyriafoundation.com: Unsafe Medicine (Balt) 1992;71:1. Unsafe
Anti-infectives SULFONAMIDES Sulfamethoxazole/ Trimethoprim Bactrim BAD! www.porphyria-europe.com: Unsafe www.uq.edu.au/porphyria/: Unsafe in patients www.porphyriafoundation.com: Unsafe Medicine (Balt) 1992;71:1. Unsafe. CYP2C9 substrate. Pregnane X receptor inducer.
ANTI-INFECTIVES MISCELLANEOUS Mupirocin Bactroban OK? www.drugs-porphyria.org: Possibly Porphyrinogenic. Probably not significantly absorbed. Probably not metabolized by P450
ANTIDOTES n/a Dimercaprol BAL OK! web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe
Respiratory agents ANTIASTHMATIC AND BRONCHODILATOR AGENTS Beclomethasone (Inhalant) Beclovent, Vanceril, others OK! www.uq.edu.au/porphyria/: Safe in patients PV Tishler MD clinical data: Safe
Respiratory ANTIHISTAMINES Diphenhydramine Benadryl OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use Patient reports: Safe
Arthritis n/a Probenecid Benemid BAD? www.drugs-porphyria.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)
Cardiovascular ANGIOTENSIN II RECEPTOR ANTAGONISTS Olmesartan Benicar OK! Virtually not metabolized (PDR 63:1009,2009). 1 patient report: safe
Gastrointestinal ANTISPASMODICS Dicyclomine Bental, others OK! www.uq.edu.au/porphyria/: Safe in patients Patient reports: Safe
n/a n/a Levobunolol Betagan, others OK!
Cardiovascular agents BETA BLOCKERS (includes some ophthalmic preparations) Sotalol Betapace, others OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use Medicine (Balt) 1992;71:1. Safe
Anti-infectives MACROLIDES Clarithromycin Biaxin OK? www.drugs-porphyria.org: Possibly Porphyrinogenic. Inhibitor of CYP3A4 but forms irreversible complexes less readily than erythromycin. Some clinical experience of non-porphyrinogenicity. 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
ANTINEOPLASTICS (Cancer Therapies) NITROSOUREAS Carmustine Bicnu NO INFO
ANTINEOPLASTICS (Cancer Therapies) ANTIBIOTICS Bleomycin Blenoxane OK! www.drugs-porphyria.org: Not Porphyrinogenic http://redpoll.pharmacy.ualberta.ca/drugbank/: Metabolized by CYP1A1
Cardiovascular agents BETA BLOCKERS (includes some ophthalmic preparations) Timolol Blocadren OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in cell culture Medicine (Balt)1992;71:1. Safe
Bones Bisphosphonates Ibandronate Boniva OK? Bisphosphonates are not metabolized.
RESPIRATORY AGENTS ANTIASTHMATIC AND BRONCHODILATOR AGENTS Terbutaline Brethine OK! www.drugs-porphyria.org: Not Porphyrinogenic Eur. J. Clin. Pharmacol. 1993;45 :483. No metabolism in liver
Cardiovascular agents ANTIARRHYTHMICS Bretylium Bretylol OK?
Cardiovascular agents BETA BLOCKERS (includes some ophthalmic preparations) Esmolol Brevibloc OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use
Respiratory agents ANTIASTHMATIC AND BRONCHODILATOR AGENTS Arformoterol Brovana OK? Secondary metab via 4 CYPs (PDR 63:2990,2009)
Cardiovascular agents DIURETICS Bumetanide Bumex OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients Patient report: Safe
Central nervous system agents NARCOTICS (Pain Therapies) Buprenorphine Buprenex, Suboxone, Subutex OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.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 system agents HYPNOTICS (Sleeping Medications) Butabarbital Butisol BAD! www.porphyria-europe.com: Unsafe. See phenobarbital
Antidiabetics GLP-1 Receptor Agonist Exenatide Byetta OK? Drug is a peptide, with peptide metabolism. Physicians' Desk Reference 2010; 64:648
Cardiovascular agents BETA BLOCKERS Nebivolol Bystolic OK? Extensively metab by CYP2D6 (Med Letter 50:17,2008). Patient experience: safe
Central nervous system agents MIGRAINE THERAPY Ergotamine Cafergot BAD! www.porphyria-europe.com: Unsafe 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)
ANTINEOPLASTICS (Cancer Therapies) ANTIBODIES Alemtuzumab Campath OK! www.drugs-porphyria.org: Not Porphyrinogenic http://redpoll.pharmacy.ualberta.ca/drugbank/: Not metabolized
Antineoplastics TOPOSIOMERASE INHIBITORS irinotecan Camptosar BAD? Major metab by & inhibits CYP3A4, also by CYP2B6. 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)
ANTI-INFECTIVES ANTIFUNGALS Caspofungin Cancidas OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.rxlist.com: Metabolized by hydrolysis and N-acetylation
Cardiovascular agents ACE INHIBITORS Captopril Capoten OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic. Patient report: safe No transactivation of pregnane X receptor (Curr Drug Metab 6:375,2006)
Cardiovascular CALCIUM CHANNEL BLOCKERS Nicardipine Cardene BAD! Induces CYP3A4, 2C9; inhibits 3A. Transactivates pregnane X receptor (Drug Metab Disp 29:1325,2001)
Cardiovascular CALCIUM CHANNEL BLOCKERS Diltiazem Cardizem BAD? www.drugs-porphyria.org: Probably Porphyrinogenic 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 ANTIADRENERGICS Doxazosin Cardura OK! www.drugs-porphyria.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 agents ANTIADRENERGICS Clonidine Catapres BAD! www.drugs-porphyria.org: Probably Porphyrinogenic www.porphyria-europe.com: Unsafe web.uct.ac.za/depts/porphyria/: Avoid www.uq.edu.au/porphyria/: Unsafe in patients and cell culture
ANTI-INFECTIVES CEPHALOSPORINS Cefaclor Ceclor OK! web.uct.ac.za/depts/porphyria/: Use with Caution
ANTINEOPLASTICS (Cancer Therapies) NITROSOUREAS Lomustine Ceenu BAD! www.drugs-porphyria.org: Probably Porphyrinogenic http://redpoll.pharmacy.ualberta.ca/drugbank: CYP3A4 substrate
ANTI-INFECTIVES CEPHALOSPORINS Cefotetan Cefotan OK! USP DI? Drug Info. for the Health Care Pro. - 26th Ed. (2006): Not metabolized by P450
Arthritis n/a Celecoxib Celebrex BAD? www.drugs-porphyria.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)
Psychiatric SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Citalopram Celexa OK? www.drugs-porphyria.org: Possibly Porphyrinogenic. Substrate of CYP3A. web.uct.ac.za/depts/porphyria/: Use with Caution. 1 Patient report: safe. 1 patient report: unsafe
Immunologic agents IMMUNOSUPPRESSIVE AGENTS Mycophenolate Mofetil CellCept OK? J Clin Pharmacol 2001;41:113. Safe ~85% nonmetab by CYP, with minor contribution of CYP3A4/5 (Clin Pharmacokinet 46:13,2007; Therapeutic Drug Monitor 26:600,2004)
Central nervous system agents ANTICONVULSANTS Methsuximide Celontin BAD! www.uq.edu.au/porphyria/: Unsafe in patients Neurology 1981;31:480. Unsafe in animals
Central nervous system agents ANTICONVULSANTS Fosphenytoin Cerebyx BAD! www.drugs-porphyria.org: Porphyrinogenic Metab mainly by CYP2C9, also CYP3A4, others. Induces CYP2C9,3A4 (Clin Therapeutics 30:1385,2008. Same as Phenytoin.
Antidotes SMOKING CESSATION Varenicline Chantix OK? J Clin Pharmacol 2006; 46:991: not a human P450 substrate; mostly excreted unchanged in animals.
Respiratory ANTIHISTAMINES Chlorpheniramine Chlor-Trimeton, others OK! www.uq.edu.au/porphyria/: Safe in patients Metab by CYP2D6, CYP3A4, 2D9 (Pharmacogenetics 1999;9:71; J Pharm Pharmacol 49:257,1997) Patient report: Safe
CONTRAST MEDIA n/a Iodipamide Meglumine Chlorografin, Sinografin OK!
Cardiovascular agents IMPOTENCE AGENTS Tadalafil Cialis OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic www.premiumdrugs.com/globalcart/ html/media/docs/cialis-pi-us.pdf: metabolized primarily by CYP3A4
Arthritis n/a Certolizumab Pegol Cimzia OK! Protein + polyethylene glycol. Not metab by CYPs (PDR 63:3127,2009)
Anti-infectives FLUOROQUINOLONES Ciprofloxacin Cipro OK! www.drugs-porphyria.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
ANESTHETICS LOCAL Prilocaine Citanest OK! www.drugs-porphyria.org: Possibly Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Unsafe in patients Medicine (Balt) 1992;71:1. Safe
Anti-infectives CEPHALOSPORINS Cefotaxime Claforan OK? Probably not metab by CYP
Respiratory ANTIHISTAMINES Loratadine Claritin OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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
Anti-infectives MISCELLANEOUS Clindamycin Cleocin BAD? www.drugs-porphyria.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
Cardiovascular agents CALCIUM CHANNEL BLOCKERS Clevidipine Cleviprex OK? Unlikely inducer of CYPs at therapeutic doses (Drug Metab Disp 34:734,2006)
Central nervous system agents NONSTEROIDAL ANTI-INFLAMMATORY AGENTS -NSAIDs (Pain, Arthritis Therapies, etc.) Sulindac Clinoril OK! www.drugs-porphyria.org: Possibly Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in animals Minimal CYP2D9 metab (Drug Metab Disp 33:1567,2005)
HORMONES, HORMONE-LIKE OVULATION STIMULANTS Clomiphene Clomid OK! web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
Psychiatric MISC. Clozapine Clozaril OK? www.drugs-porphyria.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)
Central nervous system agents ANTIPARKINSON AGENTS Benztropine Cogentin NO INFO
Cardiovascular ANTIHYPERLIPIDEMIC AGENTS Colestipol Colestid OK! Not absorbed. Patient reports: safe
Arthritis n/a Colchicine Colsalide OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use 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)
n/a n/a Timolol Combigan, Timolide, Cosopt OK!
Psychiatric medications PHENOTHIAZINES Prochlorperazine Compazine, Compro, Combid, others OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients PV Tishler MD clinical data: Safe
Central nervous system agents ANTIPARKINSON AGENTS Entacapone Comtan, Stalevo OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic. Not metab by CYPs (PDR 63:2208, 2009)
Cardiovascular agents BETA BLOCKERS (includes some ophthalmic preparations) Nadolol Corgard OK! web.uct.ac.za/depts/porphyria/: Use
Cardiovascular agents DOPAMINE D1 RECEPTOR AGONISTS Fenoldopam Corlopam No info
Cardiovascular agents ANTIARRHYTHMICS Ibutilide Corvert OK? www.drugs-porphyria.org: Possibly Porphyrinogenic Circulation 1998;97:493. Metabolic pathway does not seem to involve CYP3A4 or CYP2D6
Antineoplastics (Cancer Therapies) ANTIBIOTICS Actinomycin D or Dactinomycin Cosmegen OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.uq.edu.au/porphyria/: Safe in animals
BLOOD RELATED THERAPY ANTICOAGULANTS Warfarin Coumadin OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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
Cardiovascular ANGIOTENSIN II RECEPTOR ANTAGONISTS Losartan Cozaar OK! www.drugs-porphyria.org: Possibly Porphyrinogenic. >2 clinical reports: safe. Substrate of mainly CYP2C9, 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 ANTIHYPERLIPIDEMIC AGENTS Rosuvastatin Crestor OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe. Metab by CYP2C9; not metab. by CYP3A4,5. patient report: safe
Anti-infectives ANTIRETROVIRALS Indinavir Crixivan BAD! www.drugs-porphyria.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
ANTI-INFECTIVES MISCELLANEOUS Daptomycin Cubicin NO INFO
Arthritis n/a Penicillamine Cuprimine OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: use www.uq.edu.au/porphyria/: Safe in patients
OPHTHALMIC AGENTS (intraocular) n/a Cyclopentolate Cyclogyl OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic
Antidiabetics Dopamine Agonist Bromocriptine Cycloset BAD! See Bromocriptine, brand name Parlodel, in Central Nervous System Agents, Antiparkinson agents.
Psychiatric ANTI-DEPRESSANT 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.
HORMONES, HORMONE-LIKE THYROID Liothyronine Cytomel OK! web.uct.ac.za/depts/porphyria/: Use
Gastrointestinal therapies PROSTAGLANDINS Misoprostol Cytotec OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic Not metab by and does not affect CYPs (www.clinicalpharmacology-ip.com)
ANTI-INFECTIVES ANTIVIRALS Ganciclovir Cytovene OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
Antineoplastics NITROGEN MUSTARDS Cyclophosphamide Cytoxan OK? www.drugs-porphyria.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
Central nervous system agents BENZODIAZEPINES Flurazepam Dalmane BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.uq.edu.au/porphyria/: Unsafe in patients
Hormones, hormone-like ANDROGENS Danazol Danocrine BAD! www.drugs-porphyria.org: Probably Porphyrinogenic www.porphyria-europe.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
ANTI-INFECTIVES ANTIMALARIALS Pyrimethamine Daraprim OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
HORMONES, HORMONE-LIKE PITUITARY Desmopressin DDAVP OK! www.drugs-porphyria.org: Not Porphyrinogenic
ANTI-INFECTIVES ANTIFUNGALS Carbamide Peroxide Debrox OK? www.drugs-porphyria.org: Not Porphyrinogenic
HORMONES, HORMONE-LIKE ANDROGENS Nandrolone Deca-Durabolin BAD! www.drugs-porphyria.org: Porphyrinogenic www.uq.edu.au/porphyria/: Probably unsafe
Hormones CORTICOSTEROIDS Dexamethasone Decadron OK? www.drugs-porphyria.org: Possibly Porphyrinogenic www.porphyria-europe.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)
ANTI-INFECTIVES TETRACYCLINES Demeclocycline Declomycin NO INFO www.drugs-porphyria.org: Probably Porphyrinogenic
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
Central nervous system agents NARCOTICS (Pain Therapies) Meperidine Demerol OK! PV Tishler MD clinical data: Safe JAMA 1965;194:1037. Safe in patients
Central nervous system ANTICONVULSANTS Valproic Acid Depakene, Stavzor OK? www.drugs-porphyria.org: Porphyrinogenic 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 system agents ANTICONVULSANTS Divalproex Depakote OK? Dimer of valproic acid. See Valproic acid.
ANTIDOTES n/a Deferoxamine Desferal OK! www.drugs-porphyria.org: Not Porphyrinogenic www.rxlist.com: Mostly metabolized by plasma enzymes
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/)
Urinary tract ANTISPASMODICS Tolterodine Detrol OK? www.drugs-porphyria.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
Psychiatric medications MISC. Dextroamphetamine Dexedrine BAD? 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 system agents AMPHETAMINES Dextroamphetamine Dexedrine OK?
Cardiovascular agents DIURETICS Acetazolamide Diamox OK! web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients & cell culture
Anti-infectives ANTIFUNGALS Fluconazole Diflucan BAD! www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution Inhibits Cyt3A,2C9, and pregnane X receptor. 3 Patient reports: Unsafe.
Central nervous system ANTICONVULSANTS Phenytoin Dilantin BAD! www.drugs-porphyria.org: Porphyrinogenic www.porphyria-europe.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 system agents NARCOTICS (Pain Therapies) Hydromorphone Dilaudid OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic
Cardiovascular ANGIOTENSIN II RECEPTOR ANTAGONISTS Valsartan Diovan OK! www.drugs-porphyria.org: Not Porphyrinogenic USP DI? Drug Info. for the Health Care Pro. - 26th Ed: Some metabolism by CYP2C9. Patient reports: Safe
Gastrointestinal therapies ANTI-INFLAMMATORY AGENTS Olsalazine Dipentum OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic metab to mesalamine which has no CYP metab
ANESTHETICS GENERAL Propofol Diprivan OK! www.porphyria-europe.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
Cardiovascular agents VASOPRESSORS Dobutamine Dobutrex, others OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
Anti-infectives PENEM ANTIBIOTICS Doripenem Doribax OK! Not a CYP substrate (Clin Therapeut 31:42,2009)
Antineoplastics TROPOISOMERASE INHIBITORS Doxorubicin Doxil, Adriamycin OK! Does not induce CYPs or transactivate pregnane X receptor(Canad J Physiol Pharmacol 77:589,1999; Cancer Chemother Pharmacol 64:35,2009). Publ. report: safe (Exp Opin Drug Saf 2008; 7:159)
Gastrointestinal therapies ANTIEMETICS (Vomiting Therapies) Dimenhydrinate Dramamine BAD! www.porphyria-europe.com: unsafe web.uct.ac.za/depts/porphyria/: Avoid www.uq.edu.au/porphyria/: Unsafe in patients
ANTINEOPLASTICS (Cancer Therapies) MISC. Dacarbazine Dtic-Dome BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic. Not porphyrinogenic in chick embryo model. Like chloroambucil, melphalan, may be safer than other alkylating agents.
Gastrointestinal LAXATIVES Bisacodyl Dulcolax OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use with Caution PV Tishler MD clinical data: Safe
Central nervous system NARCOTICS (Pain Therapies) Fentanyl Duragesic OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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
Anti-infectives TETRACYCLINES Minocycline Dynacin, Minocin No info www.uq.edu.au/porphyria/: Safe in cell culture
CARDIOVASCULAR AGENTS DIURETICS Triamterene Dyrenium OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
Cardiovascular agents DIURETICS Ethacrynic Acid Edecrin OK! www.uq.edu.au/porphyria/: Safe in patients http://www.emedicine.com/MED/topic1880.htm: Safe in porphyria
Psychiatric ANTI-DEPRESSANT Venlafaxine Effexor OK? www.drugs-porphyria.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 TRICYCLICS Amitriptyline Elavil OK! www.drugs-porphyria.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
Antineoplastics (Cancer Therapies) MISC. oxaliplatin Eloxatin OK? No evidence for CYP metabolism (PDR 63:2731,2009)
ANTINEOPLASTICS (Cancer Therapies) ENZYMES Asparaginase Elspar OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
ANTINEOPLASTICS (Cancer Therapies) HORMONAL AGENTS Estramustine Emcyt BAD? www.drugs-porphyria.org: Probably Porphyrinogenic
Central nervous system agents ANTIPARKINSON AGENTS Selegiline Emsam, Eldepryl, Zelapar BAD? www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution Metab by CYP2B6, which may involve pregnane X receptor
Anti-infectives ANTIRETROVIRALS Emtricitabine Emtriva, Truvada OK? Blum MR: C Clin Pharm 2007; 47:751 - Primarily eliminated via renal excretion; 60-70% recovered unchanged.
Urinary tract ANTISPASMODICS Darifenacin Enablex BAD? Significantly metab by CYP3A4, 2D6. No evidence of CYP induction (Clin Pharmacokinet 45:325,2006)
Arthritis n/a etanercept Enbrel OK! Protein. Not metab by CYPs (PDR 63:569,2009)
CONTRAST MEDIA n/a Ferumoxides Endorem OK!
Gastrointestinal therapies GASTROINTESTINAL MOTILITY STIMULANTS Alvimopan Entereg OK? Hepatic/CYP metab unlikely (Clin Pharmacol Therap 83:770,2008; PDR 63:3293,2009; pkg insert)
ANTI-INFECTIVES ANTIRETROVIRALS Lamivudine Epivir OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.drugs.com: 70% excreted as unchanged drug in urine
BLOOD RELATED THERAPY HEMATOPOIETICS Epoetin Alfa Epogen OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe
Antineoplastics MITOTIC INHIBITORS Etoposide Eposin, Etopophos, Vepesid BAD? www.drugs-porphyria.org: Probably Porphyrinogenic 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 30; 1385,2008; Cancer Chemother Pharmacol 64:35,2009)
ANTINEOPLASTICS (Cancer Therapies) ANTIBODIES Cetuximab Erbitux OK?
Antineoplastics (Cancer Therapies) IMMUNOMODULATORS Levamisole Ergamisol No info
HORMONES, HORMONE-LIKE PITUITARY Ergonovine Ergotrate OK!
Psychiatric medications MISC. Lithium Eskalith, Lithobid OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
CONTRAST MEDIA n/a Ethiodized Oil Ethiodol OK!
Cardiovascular agents ANTIARRHYTHMICS Moricizine Ethmozine No info
ANESTHETICS LOCAL Ethyl chloride Ethyl Chloride OK!
ANTINEOPLASTICS (Cancer Therapies) URINARY TRACT PROTECTIVE AGENTS Amifostine Ethyol OK! www.drugs-porphyria.org: Not Porphyrinogenic http://redpoll.pharmacy.ualberta.ca/drugbank/: No P450 metabolism
Antineoplastics (Cancer Therapies) ANTIANDROGENS Flutamide Eulexin BAD! www.drugs-porphyria.org: Possibly Porphyrinogenic. Possibly metabolised by P450. Possibly ALAS-inducer. 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
Hormones, hormone-like SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMs) Raloxifene Evista BAD? www.drugs-porphyria.org: Probably Porphyrinogenic. Chang: Drug Metab Disp 2006; 34:2073: bound to P-gycoprotein & activated by CYP3A4. Sinz M: Cur Drug Metab 2006; 7:375: Little activation of human pregnane X receptor & low prediction of clinical induction.
ANTI-INFECTIVES ANTIVIRALS Famciclovir Famvir OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
Central nervous system agents ANTICONVULSANTS Felbamate Felbatol BAD! www.drugs-porphyria.org: Probably Porphyrinogenic www.porphyriafoundation.com: Unsafe Metab mainly by CYP3A4, also 2C9, others. Induces CYP3A4 but does not transactivate pregnane X receptor (Fundam Clin Pharmacol 14:301,2000; Curr Drug Metab 7:375,2006; Clin Therapeutics 30:1385,2008)
Antineoplastics (Cancer Therapies) AROMATASE INHIBITORS Letrozole Femara BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic. 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)
Psychiatric MISC. Iloperidone Fenapt No info 99% metab, mainly by CYP2D6, less so by CYP3A4 (Curr Drug Metab 11:516, 2010)
HORMONES, HORMONE-LIKE PITUITARY Urofollitropin Fertinorm OK!
Central nervous system agents HYPNOTICS (Sleeping Medications) Butalbital Fiorinal BAD! See phenobarbital
Anti-infectives ANTIFUNGALS Metronidazole Flagyl BAD? www.drugs-porphyria.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
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
Urinary tract PROSTATIC HYPERTROPHY Tamsulosin Flomax BAD? Extensively metab by CYP3A4,2D6 (Xenobiotica 28:909, 1998; PDR 63:848,2009).
HORMONES, HORMONE-LIKE CORTICOSTEROIDS Fludrocortisone Florinef OK! www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
Respiratory ANTIASTHMATIC AND BRONCHODILATOR AGENTS Fluticasone Flovent OK! www.drugs-porphyria.org: Not Porphyrinogenic PV Tishler MD clinical data & patient reports: 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)
Anti-infectives Penicillins flucloxacillin Floxapen, etc. BAD? Not metabolizd by or inhibits CYP3A, 2C9, but induces CYP3A, PXR
Antineoplastics (Cancer Therapies) ANTIMETABOLITES Fludarabine Fludara, others OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.rxlist.com: Not P450 substrate
Respiratory ANTIASTHMATIC AND BRONCHODILATOR AGENTS Formoterol Foradil, Perforomist OK? Secondary metab via 4 CYPs (PDR 63:1025,2009), inc. CYP2C9
ANESTHETICS GENERAL Isoflurane Forane OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use with Caution www.uq.edu.au/porphyria/: Unsafe in animals
Anti-infectives CEPHALOSPORINS Ceftazidime Fortaz OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution. Patient report: safe
ANTI-INFECTIVES ANTIRETROVIRALS Saquinavir Fortovase BAD! www.drugs-porphyria.org: Possibly Porphyrinogenic. CYP 3A4-metabolized. 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
BONES BISPHOSPHONATES Alendronate Fosamax OK! USP DI? Drug Info. for the Health Care Pro. - 26th Ed. (2006): Not metabolized Patient reports: safe
ANTI-INFECTIVES CMV AGENTS Foscarnet Foscavir OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic USP DI? Drug Info. for the Health Care Pro. - 26th Ed. (2006): No P450 metabolism
BLOOD RELATED THERAPY ANTICOAGULANTS Dalteparin Fragmin OK! www.drugs-porphyria.org: Not Porphyrinogenic
ANTINEOPLASTICS (Cancer Therapies) ANTIMETABOLITES Floxuridine FUDR OK?
ANTI-INFECTIVES ANTIRETROVIRALS Enfuvirtide Fuzeon OK?
Diagnostic Imaging Gadobutrol Gadavist OK! MRI contrast agent that is not metabolized
Psychiatric MISC. Ziprasidone Geodon BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic 1/3 metabolized by CYP3A4 (www.rxlist.com; J Clin Psychopharm 23:229,2003)
ANTI-INFECTIVES PENICILLINS Carbenicillin Geopen NO INFO
Antineoplastics ENZYME INHIBITORS Imatinib Gleevac OK? www.drugs-porphyria.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)
Antidiabetics Biguanides Metformin Glucophage, others OK! www.drugs-porphyria.org: Not porphyrinogenic. www.porphyria-europe.com: Safe. web.uct.ac.za/depts/porphyria/: Use. www.uq.edu/au/porphyria/: Safe in animals. Excreted largely unchanged; no hepatic metab (www.clinicalpharmacology-ip.com). Inhibits pregnane X receptor
Antidiabetics Sulfonylureas Glipizide Glucotrol BAD? www.drugs-porphyria.org: Possibly porphyrinogenic. www.porphyria-europe.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/ Biguanides Glyburide/ Metformin Glucovance OK? See Glyburide
Central nervous system agents ANTIMYASTHENIC AGENTS Guanidine Guanidine NO INFO
Central nervous system BENZODIAZEPINES Triazolam Halcion OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic 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.
Psychiatric medications MISC. Haloperidol Haldol OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic. www.porphyria-europe.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)
ANTI-INFECTIVES ANTIVIRALS Adefovir Hepsera OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic http://redpoll.pharmacy.ualberta.ca/drugbank/: Not a P450 substrate
ANTI-INFECTIVES ANTIRETROVIRALS Zalcitabine Hivid OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
Arthritis n/a adalimumab Humira OK! Protein. Not metab by CYPs (PDR 63:442,2009)
Antineoplastics TOPOISOMERASE I INHIBITORS Topotecan Hycamtin BAD? www.drugs-porphyria.org: Probably Porphyrinogenic. Does induce CYP3A4 and transactivate pregnane X receptor (Cancer Chemother Pharmacol 64:35,2009)
ANTINEOPLASTICS (Cancer Therapies) MISC. Hydroxyurea Hydrea OK? S Afr Med J 1984;65:924. Safe in patients
CONTRAST MEDIA n/a Diatrizoate Meglumine Hypaque OK!
Cardiovascular agents MISC. Diazoxide Hyperstat OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in cell culture
Cardiovascular agents ANTIADRENERGICS Terazosin Hytrin OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution No transactivation of pregnane X receptor (Curr Drug Metab 6:375,2009)
Antineoplastics (Cancer Therapies) ANTIBIOTICS Idarubicin Idamycin BAD? www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution
Antineoplastics (Cancer Therapies) NITROGEN MUSTARDS Ifosfamide Ifex BAD? www.drugs-porphyria.org: Probably Porphyrinogenic 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)
Cardiovascular agents ANTIANGINAL AGENTS Isosorbide Dinitrate Imdur OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
Central nervous system MIGRAINE THERAPY Sumatriptan Imitrex OK? www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution 2 patient reports: safe
GASTROINTESTINAL THERAPIES ANTIDIARRHEAL AGENTS Loperamide Imodium OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in cell culture Patient report: Safe
Immunologic agents IMMUNOSUPPRESSIVE AGENTS Azathioprine Imuran OK? www.drugs-porphyria.org: Probably Porphyrinogenic 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.clinicalpharmacology-ip.com)
Cardiovascular agents BETA BLOCKERS (includes some ophthalmic preparations) Propranolol Inderal OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use PV Tishler MD clinical data & patient report: Safe Safe (Br J Clin 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/)
Central nervous system agents NONSTEROIDAL ANTI-INFLAMMATORY AGENTS -NSAIDs (Pain, Arthritis Therapies, etc.) Indomethacin Indocin OK! web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Probably safe. ~50% metab by CYP2C9 (Drug Metab Disp 33:1567, 2005). Medicine (Balt) 71:1, 1992 - Safe in some, not safe in others
Cardiovascular agents DIURETICS Eplerenone Inspra BAD? ~95% metab, mainly 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; J Clin Pharmacol 45:810,2005; Am J Therapeutics 16:255,2009)
Antidiabetics Insulins Insulins Insulin OK! www.drugs-porphyria.org: Not porphyrinogenic. www.porphyria-europe.com: Safe. web.uct.ac.za/depts/porphyria/: Use. www.uq.au/porphyria/: Safe in patients
Respiratory agents ANTIASTHMATIC AND BRONCHODILATOR AGENTS Cromolyn Intal, others OK?
Blood related therapy ANTICOAGULANTS Eptifibatide Integrilin OK! www.drugs-porphyria.org: Not Porphyrinogenic Clin Ther 1998;20:307. Polypeptide; deamidation probably via hydrolysis, not inlving P450
ANTINEOPLASTICS (Cancer Therapies) MISC. Interferon Alfa-2B Intron A OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution http://medicine.iupui.edu/flockhart/table.htm: Inhibitor of CYP1A2
Cardiovascular agents VASOPRESSORS Dopamine Intropin, others OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
Anti-infectives PENEM ANTIBIOTICS Ertapenem Invanz OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic www.rxlist.com: Does not appear to undergo hepatic metabolism
Psychiatric medications MISC. Paliperidone Invega OK? 60% excreted unchanged. Small amt metab by CYP2D6,?other CYPs (Drug Metab Disp 36:769,2008)
OPHTHALMIC AGENTS (intraocular) n/a Apraclonidine Iopidine OK! www.drugs-porphyria.org: Not Porphyrinogenic
Antineoplastics Mitotic Inhibitors Gefitinib Iressa OK? Well absorbed. Metabolized by CYP3A. Does not induce/inhibit CYP3a, 2C9.
Anti-infectives ANTIRETROVIRALS Raltegravir Isentress OK? No CYP meetabolism or induction (Drug Metab Disp 35:1657,2007)
Antineoplastics (Cancer Therapies) MISC. Ixabepilone Ixempra BAD? Highly metab by and induces CYP3A4; weakly transactivates pregnane X receptor (Clin Cancer Res 14:2701,2008; S Mani, pers commun)
Antidiabetics DPP-4 Inhibitors/ Biguanidess Sitagliptin/ Metformin Janumet OK? See Sitagliptin
Antidiabetics DPP-4 Inhibitors Sitagliptin Januvia OK? ~80% not metab; rest mainly by CYP3A4 (Drug Metab Disp 35:523,2007)
Anti-infectives ANTIRETROVIRALS Lopinavir/Ritonavir Kaletra BAD! Lopinavir www.drugs-porphyria.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.drugs-porphyria.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
GASTROINTESTINAL THERAPIES ANTIDIARRHEAL AGENTS Kaolin-Pectin Kaopectate OK! web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
Gastrointestinal POTASSIUM REMOVING RESINS Sodium Polystyrene Sulfonate Kayexalate OK! patient report: safe
ANTI-INFECTIVES CEPHALOSPORINS Cephalexin Keflex OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution Patient reports: Safe
ANTINEOPLASTICS (Cancer Therapies) KERATINOCYTE GROWTH FACTOR Palifermin Kepivance OK?
Central nervous system agents ANTICONVULSANTS Levetiracetam Keppra OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe Not a substrate for & does not induce CYPs (Fundam Clin Pharmacol 14:301,2000; Clin Therapeutics 30:1385,2008)
ANESTHETICS GENERAL Ketamine Ketalar BAD! www.drugs-porphyria.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
Central nervous system agents ANTICONVULSANTS Clonazepam Klonopin BAD! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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)
Antidiabetics DPP-4 Inhibitors/ Biguanides Saxagliptin/ Metformin Kombiglyze XR No info See Saxagliptin
Arthritis Gout Treatment Pegloticase Krystexxa OK! Protein enzyme, with no metabolic problem
Anti-infectives ANTIFUNGALS Terbinafine Lamisil BAD? www.drugs-porphyria.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.)
Cardiovascular agents CARDIAC GLYCOSIDES Digoxin Lanoxin OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.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
ANTINEOPLASTICS (Cancer Therapies) ANTIMETABOLITES Thioguanine Lanvis OK! S Afr Med J 1984;65:924. Safe in patients
ANTI-INFECTIVES ANTIMALARIALS Mefloquine Lariam OK! www.drugs-porphyria.org: Possibly Porphyrinogenic. Substrate for CYP 3A4. No clinical observations pointing to CYP-induction. Compare the other methanolquinoline quinine: Inducer of CYPs 1A1, 1A2 and 2C9. Activator/stimulator of CYP 3A4. Inhibitor of CYPs e.g. 1A1 (potent).
Cardiovascular DIURETICS Furosemide Lasix OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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
Anti-infectives MISCELLANEOUS Dapsone Leprostatic BAD! www.porphyria-europe.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
Cardiovascular ANTIHYPERLIPIDEMIC AGENTS Fluvastatin Lescol OK? Mainly metab by CYP2C9, also 3A4. Minimal transactivation of pregnane X receptor (Clin Pharmacol Therap 80:565,2006; Curr Drug Metab 7:375,2006)
ANTINEOPLASTICS (Cancer Therapies) NITROGEN MUSTARDS Chlorambucil Leukeran BAD! www.drugs-porphyria.org: Possibly Porphyrinogenic. 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 (Cancer Therapies) ANTIMETABOLITES Cladribine Leustatin OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic http://redpoll.pharmacy.ualberta.ca/drugbank/: Not P450 substrate
Anti-infectives FLUOROQUINOLONES Levofloxacin Levaquin OK? www.drugs-porphyria.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
Antidiabetics Insulin Insulin detmir Levemir OK! Insulin analog; insulins are ok.
Cardiovascular agents IMPOTENCE AGENTS Vardenafil Levitra No info Major metab by CYP3A4, 3A5 (Drug Metab Disp 36:986,2008)
HORMONES, HORMONE-LIKE THYROID Levothyroxine Levoxyl, Synthroid OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use PV Tishler MD clinical data & patient reports: Safe
Gastrointestinal ANTISPASMODICS Hyoscyamine Levsin, others OK! 3 patient reports: safe
Psychiatric SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Escitalopram Lexapro No info Major metabolism by CYP2C19, CYP3A4; no inhibition of CYP3A4 (CNS Drugs 2012; 26:39)
ANTI-INFECTIVES CMV AGENTS Fosamprenavir Lexiva BAD?
Central nervous system agents BENZODIAZEPINES Chlordiazepoxide Librium BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.uq.edu.au/porphyria/: Unsafe in patients Medicine (Balt) 1992;71:1. Safe
Cardiovascular ANTIHYPERLIPIDEMIC AGENTS Atorvastatin Lipitor OK? www.drugs-porphyria.org: Patient report - safe Mainly 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
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.
GASTROINTESTINAL THERAPIES ANTIDIARRHEAL AGENTS Diphenoxylate Lomotil OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
Cardiovascular agents ANTIHYPERLIPIDEMIC AGENTS Gemfibrozil Lopid OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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 BETA BLOCKERS (includes some ophthalmic preparations) Metoprolol Lopressor OK! web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients PV Tishler MD clinical data & patient report: Safe Medicine (Balt)1992;71:1. Safe. Induces CYP3A.
Cardiovascular agents ACE INHIBITORS Benazepril Lotensin OK! Patient report: safe
BLOOD RELATED THERAPY ANTICOAGULANTS Enoxaparin Lovenox OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
OPHTHALMIC AGENTS (intraocular) n/a Bimatoprost Lumigan OK!
Central nervous system agents ANTICONVULSANTS Phenobarbital Luminal BAD! www.drugs-porphyria.org: Porphyrinogenic www.porphyria-europe.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 system agents HYPNOTICS (Sleeping Medications) Eszopiclone Lunesta OK? 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, HORMONE-LIKE LHRH/GNRH AGONISTS Leuprolide Lupron OK? Protein, metabolized by proteolysis
Psychiatric SSELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Fluvoxamine Luvox OK? Prob ~65% metab by CYP2D6 + alcohol dehydrogenase (Xenobiotica 37:169,2007). Inhibits CYP3A4.
Central nervous system ANTICONVULSANTS Pregabalin Lyrica OK! >90% non-metabolized (PDR 63:2527,2009). Patient reports: safe
Blood related Bleeding retardant Tranexamic acid Lystela, etc. OK! Mostly excreted unchanged
Anti-infectives URINARY ANTI-INFECTIVES Nitrofurantoin Macrodantin, Macrobid BAD! www.drugs-porphyria.org: Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.uq.edu.au/porphyria/: Probably Unsafe
CONTRAST MEDIA n/a Gadopentetate Dimeglumine Magnevist OK!
Anti-infectives ANTIMALARIALS Proguanil Malarone (also contains atovaquone) OK! www.drugs-porphyria.org: Possibly Porphyrinogenic, substrate of CYP2C19, 1A2, 3A4; no clinical observations pointing to CYP induction web.uct.ac.za/depts/porphyria/: Use
Anti-infectives 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
Anti-infectives 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
Anti-infectives ANTIMALARIALS Quinine Sulfate Many OK? www.drugs-porphyria.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
ANTI-INFECTIVES ANTIMYCOBACTERIAL AGENTS Isoniazid Many BAD! www.drugs-porphyria.org: Probably Porphyrinogenic. 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
ANTI-INFECTIVES ANTIMYCOBACTERIAL AGENTS Pyrazinamide Many BAD! www.porphyria-europe.com: Unsafe web.uct.ac.za/depts/porphyria/: Avoid www.uq.edu.au/porphyria/: unsafe in patients www.porphyriafoundation.com: Unsafe
Anti-infectives ANTIFUNGALS Nystatin Many OK! www.drugs-porphyria.org: Not Porphyrinogenic USP DI? Drug Info. for the Health Care Pro. - 26th Ed. (2006): No P450 metabolism
Anti-infectives ANTIMALARIALS Chloroquine Many OK? www.drugs-porphyria.org: Possibly Porphyrinogenic, Compare the 8-aminoquioline primaquine: Inducer of CYPs 1A1, 1A2 and 1B1. No data pointing to clinically significant CYP-inducing properties. Conflicting references. One report of possible porphyrinogenicity. www.porphyria-europe.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
Anti-infectives ANTIFUNGALS Ketoconazole Many BAD! www.drugs-porphyria.org: Porphyrinogenic www.porphyria-europe.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.
Anti-infectives ANTIFUNGALS Griseofulvin Many BAD! www.porphyria-europe.com: Unsafe web.uct.ac.za/depts/porphyria/: Avoid www.uq.edu.au/porphyria/: Unsafe in patients www.porphyriafoundation.com: Unsafe. Induces CYP3A
ANESTHETICS LOCAL Benzocaine Many NO INFO
ANESTHETICS LOCAL Bupivacaine Many OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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 Procaine Many OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
ANESTHETICS LOCAL Tetracaine Many OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in animals
Anesthetics MUSCLE RELAXANTS Baclofen Many OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic http://www.bio.net/bionet/hypermail/neur-sci/2005-July/060879.html: Ca. 85% is excreted unchanged, and ca. 15% of the dose is metabolized primarily by deamination
ANTI-INFECTIVES AMINOGLYCOSIDES Gentamicin Many OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients and animals
ANTI-INFECTIVES AMINOGLYCOSIDES Neomycin Many OK?
ANTI-INFECTIVES AMINOGLYCOSIDES Streptomycin Many OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe www.porphyriafoundation.com: Safe
ANTI-INFECTIVES AMINOGLYCOSIDES Tobramycin Many OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use S Afr Med J 1984;65:924. Safe in patients
ANTI-INFECTIVES MISCELLANEOUS Bacitracin Many OK?
Anti-infectives MISCELLANEOUS Chloramphenicol Many BAD! www.drugs-porphyria.org: Porphyrinogenic www.porphyria-europe.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
ANTI-INFECTIVES PENICILLINS Ampicillin Many OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
ANTI-INFECTIVES MISCELLANEOUS Polymyxin B Many OK?
Anti-infectives MACROLIDES Erythromycin Many BAD! www.drugs-porphyria.org: Porphyrinogenic www.porphyria-europe.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
ANTI-INFECTIVES 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
Anti-infectives TETRACYCLINES Tetracycline Many OK? web.uct.ac.za/depts/porphyria/: Use with Extreme Caution. Induces CYP3A. 1 patient report: safe
Anti-infectives URINARY ANTI-INFECTIVES Methenamine Mandelate Many OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use patient report: safe
Anti-infectives PENICILLINS Amoxicillin Many OK! www.drugs-porphyria.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.
ANTI-INFECTIVES SULFONAMIDES Sulfadiazine Many BAD! www.porphyria-europe.com: Unsafe www.uq.edu.au/porphyria/: Unsafe in patients www.porphyriafoundation.com: Unsafe Medicine (Balt) 1992;71:1. Unsafe
Anti-infectives PENICILLINS Dicloxacillin Many OK? www.drugs-porphyria.org: Not Porphyrinogenic. Induces CYP3A.
Anti-infectives PENICILLINS Nafcillin Many OK? http://medicine.iupui.edu/flockhart/table.htm: CYP3A inducer.
ANTI-INFECTIVES PENICILLINS Oxacillin Many OK? http://www.rxlist.com/cgi/generic3/oxacillin_cp.htm: Rapidly excreted as unchanged drug
ANTI-INFECTIVES PENICILLINS Penicillin Many OK! web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients Patient report: Safe
Antineoplastics ANTIMETABOLITES Fluorouracil, 5-Fluorouracil Many OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic 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
ANTIDOTES n/a Edetate Many OK!
ANTIDOTES n/a Ipecac Many OK?
Arthritis n/a 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.
ANTINEOPLASTICS (Cancer Therapies) HORMONAL AGENTS Diethylstilbestrol Many NO INFO
Central nervous system agents NONSTEROIDAL ANTI-INFLAMMATORY AGENTS -NSAIDs (Pain, Arthritis Therapies, etc.) Aspirin Many OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients www.porphyriafoundation.com: Safe PV Tishler MD clinical data & patient reports: Safe
Central nervous system agents NARCOTICS (Pain Therapies) Morphine Many OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients PV Tishler MD clinical data: Safe
Central nervous system agents NARCOTICS (Pain Therapies) Codeine Many OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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 system agents ANTIPARKINSON AGENTS Levodopa Many OK! web.uct.ac.za/depts/porphyria/: Use with Caution USP 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
Hormones, hormone-like ANDROGENS Testosterone Many BAD! www.drugs-porphyria.org: Porphyrinogenic Substrate of 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, HORMONE-LIKE CORTICOSTEROIDS Betamethasone Many OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
HORMONES, HORMONE-LIKE CORTICOSTEROIDS Cortisone Many OK!
Hormones, hormone-like CORTICOSTEROIDS Hydrocortisone Many OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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, hormone-like CORTICOSTEROIDS Prednisolone Many OK? Substrate 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, hormone-like CORTICOSTEROIDS Prednisone Many OK! www.drugs-porphyria.org: Possibly Porphyrinogenic 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, HORMONE-LIKE ESTROGENS Estrogens, Conjugated Many OK! www.drugs-porphyria.org: Possibly Porphyrinogenic
Hormones PROGESTINS Progesterone Many BAD! www.drugs-porphyria.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 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 CONTRACEPTIVES Birth Control Pills Many BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme 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 estradiol-desogestrel (Orthocoept), ethinyl estradiol-norgestimate (Orcho Cyclen) unsafe
Hormones PROGESTINS Levonorgestrel Many BAD! www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution. Metab by CYP3A4.
HORMONES, HORMONE-LIKE ANDROGENS Methyltestosterone Many BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme Caution
GASTROINTESTINAL THERAPIES ANTISPASMODICS Atropine Many OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients www.porphyriafoundation.com: Safe
GASTROINTESTINAL THERAPIES ANTISPASMODICS Belladonna Alkaloids Many BAD? web.uct.ac.za/depts/porphyria/: Avoid
Cardiovascular agents VASOPRESSORS Ephedrine Many OK! www.drugs-porphyria.org: Not Porphyrinogenic
Cardiovascular agents VASODILATORS Minoxidil Many BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution
Cardiovascular agents THROMBOLYTIC ENZYMES Streptokinase Many OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
Central nervous system NARCOTICS (Pain Therapies) Methadone Many OK! www.drugs-porphyria.org: Possibly Porphyrinogenic www.porphyria-europe.com: safe web.uct.ac.za/depts/porphyria/: Use Metab by CYP3A, less by 2C9.
Central nervous system HYPNOTICS (Sleeping Medications) Chloral Hydrate Many OK! www.porphyria-europe.com: Safe www.uq.edu.au/porphyria/: Safe in patients Peter V. Tishler, MD, clinical experience: safe patient report: safe
Cardiovascular agents ANTIHYPERLIPIDEMIC AGENTS Niacin Many No info USP DI? Drug Info. for the Health Care Pro. - 26th Ed: Not P450 substrate
Cardiovascular agents ANTIARRHYTHMICS Quinidine Many OK? www.drugs-porphyria.org: Probably Porphyrinogenic 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 agents BETA BLOCKERS (includes some ophthalmic preparations) Betaxolol Many OK! www.drugs-porphyria.org: Possibly Porphyrinogenic
Cardiovascular agents BETA BLOCKERS (includes some ophthalmic preparations) Carteolol Many OK! web.uct.ac.za/depts/porphyria/: Use
Cardiovascular agents BETA BLOCKERS (includes some ophthalmic preparations) Acebutolol Many OK! web.uct.ac.za/depts/porphyria/: Use Medicine (Balt)1992; 71:1. Safe biocomp.health.unm.edu/p450/metabP450diseasep4.pdf: Substrate/inhibitor of CYP2D6
Cardiovascular agents DIURETICS Hydrochlorothiazide Many OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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
BLOOD RELATED THERAPY ANTICOAGULANTS Heparin Many OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
BLOOD RELATED THERAPY HEMATOPOIETICS Multivitamins Many OK!
Cardiovascular agents ANTIANGINAL AGENTS Nitroglycerin Many OK? Not a CYP substrate (Biochem. J 1993; 292:545)
Cardiovascular agents ANTIARRHYTHMICS Adenosine Many OK! www.drugs-porphyria.org: Not Porphyrinogenic USP DI? Drug Info. for the Health Care Pro. - 26th Ed. (2006): Not metabolized by P450
Cardiovascular agents ANTIARRHYTHMICS Amiodarone Many BAD? www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Avoid 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)
RESPIRATORY AGENTS ANTIASTHMATIC AND BRONCHODILATOR AGENTS Aminophylline Many BAD! www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Avoid
Respiratory agents ANTIASTHMATIC AND BRONCHODILATOR AGENTS Theophylline Many BAD? www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme 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 ANTITUSSIVES (Cough Therapies) Dextromethorphan Many OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use Metab by CYP3A4.
RESPIRATORY AGENTS NASAL AGENTS - SYSTEMIC AND TOPICAL Phenylephrine Many OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic
Respiratory agents ANTITUSSIVES (Cough Therapies) Hydrocodone Many OK! 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 Patient reports: Safe
OPHTHALMIC AGENTS (intraocular) n/a Fluorescein Many OK! www.drugs-porphyria.org: Not Porphyrinogenic
OPHTHALMIC AGENTS (intraocular) n/a Homatropine Many OK!
OPHTHALMIC AGENTS (intraocular) n/a Naphazoline Many OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic
OPHTHALMIC AGENTS (intraocular) n/a Pilocarpine Many OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic
OPHTHALMIC AGENTS (intraocular) n/a Betaxolol Many OK!
HORMONES, HORMONE-LIKE SPERMICIDES (VAGINAL) Nonoxynol-9 Many NO INFO
Gastrointestinal ANTIEMETICS (Vomiting Therapies) Dronabinol Marinol BAD? Major metab by CYP3A4 & 2C9 (Williams DA. Induces pregnane X receptor. Drug metabolism. In: Foye's Principles of Medicinal Chemistry, ed. Lemke T and Williams DA. Baltimore, Williams & Wilkins, 6th ed., 2007)
Cardiovascular agents ACE INHIBITORS Trandolapril Mavik OK!
Central nervous system agents MIGRAINE THERAPY Rizatriptan Maxalt OK? www.drugs-porphyria.org: Possibly Porphyrinogenic No significant interaction with CYPs. Primary metabolism does not involve CYPs (PDR 63:2056,2009; www.cbg-meb.nl/uk/docs/nieuws/par-maxalt.pdf)
ANTI-INFECTIVES CEPHALOSPORINS Cefepime Maxipime OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
Hormones CORTICOSTEROIDS Methylprednisolone Medrol,others OK? www.drugs-porphyria.org: Possibly Porphyrinogenic www.porphyria-europe.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)
ANTI-INFECTIVES CEPHALOSPORINS Cefoxitin Mefoxin OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
ANTINEOPLASTICS (Cancer Therapies) ANTIESTROGENS Megestrol Megace BAD!
Psychiatric medications PHENOTHIAZINES Thioridazine Mellaril OK! www.drugs-porphyria.org: Possibly Porphyrinogenic 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
ANTI-INFECTIVES ANTIMALARIALS Atovaquone Mepron OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe http://www.pharmgkb.org/: Not much is metabolized
Gastrointestinal therapies ANTIEMETICS (Vomiting Therapies) Cyclizine Merezine OK! www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
Anti-infectives MISCELLANEOUS Meropenem Meronem OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.rxlist.com: 70% excreted as unchanged drug
ANTINEOPLASTICS (Cancer Therapies) URINARY TRACT PROTECTIVE AGENTS Mesna Mesnex OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic
Central nervous system agents ANTIMYASTHENIC AGENTS Pyridostigmine Mestinon OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution. Patient report: safe
Antidiabetics Sulfonylureas/ Biguanides Glipizide/ Metformin Metaglip BAD? See Glipizide
HORMONES, HORMONE-LIKE PITUITARY Methylergonovine Methergine OK!
Cardiovascular Antihyperlipidemic Agents Lovastatin Mevacor, etc BAD? Readily absorbed by liver. Metabolized by & induces CYP3A, 2C9. Induces PXR.
Cardiovascular agents ANTIARRHYTHMICS Mexiletine Mexitil OK? www.drugs-porphyria.org: Possibly Porphyrinogenic. Metabolized by CYP2D6, 1A2. No data pointing to CYP-induction (Clin Pharmacokinet 46:985,2007)
Hormones, hormone-like PARATHYROID Calcitonin Miacelcin, Calcimar, Fortical OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use www.porphyria-europe.com: Safe Patient report: Safe
Cardiovascular ANTIOGENSIN RECEPTOR ANTAGONISTS Telmisartan Micardis OK! Only metabolite is glucuronide (J Clin Pharm 2000: 40 (12 pt 1), 1312.
Antidiabetics Sulfonylureas Glyburide Micronase, Diabeta, others OK? Medicine (Balt) 71:1,1992 - Safe. Major metab by 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)
Cardiovascular agents DIURETICS Amiloride Midamor, Moduretic, others OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
Central nervous system agents MIGRAINE THERAPY Isometheptene/ Dichloralphenazone Midrin, others BAD? Isometheptene www.uq.edu.au/porphyria/: Unsafe in animals Dichloralphenazone www.uq.edu.au/porphyria/: Unsafe in patients
Cardiovascular agents ANTIADRENERGICS Prazosin Minipress OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Probably safe Medicine (Balti) 1992:71:1. Safe
OPHTHALMIC AGENTS (intraocular) n/a Acetylcholine Miochol OK!
Central nervous system agents ANTIPARKINSON AGENTS Pramipexole Mirapex OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.rxlist.com: ~90% excreted unchanged. No CYP metab (Eur J Neurol 7 Suppl 1:15,2000)
ANTINEOPLASTICS (Cancer Therapies) ANTIBIOTICS Plicamycin Mithracin NO INFO
Anti-infectives ANTIFUNGALS Miconazole Monistat, others BAD? www.drugs-porphyria.org: Probably Not Porphyrinogenic/Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Avoid www.uq.edu.au/porphyria/: Unsafe in cell culture
Anti-infectives MISCELLANEOUS Fosfomycin Monurol OK? Mainly not metabolized (Ann Pharmacother 32:215,1998) patient report: safe
RESPIRATORY AGENTS MUCOLYTICS Acetylcysteine Mucomyst OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use PV Tishler MD clinical data: Safe Eur J Clin Chem Clin Biochem 1997;35:427. Safe
Anti-infectives anthelmintics albendazole multiple BAD? poorly absorbed from GI tract; but signif metabolsim by CyP3A4. Poor data.(Eur. J. Clin Pharm 71:528, 2011)
Anti-infectives anthelmintics mebendazole multiple No info Poorly absorbed from GI tract. Probably metabolised by P450.
ANTINEOPLASTICS (Cancer Therapies) NITROGEN MUSTARDS Mechlorethamine Mustargen NO INFO
ANTINEOPLASTICS (Cancer Therapies) ANTIBIOTICS Mitomycin Mutamycin BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution Insufficient data on metabolism. Little systemic resorption; probably safe for intravesical installation
ANTI-INFECTIVES ANTIMYCOBACTERIAL AGENTS Ethambutol Myambutol OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
Anti-infectives ANTIFUNGALS Micafungin Mycamine OK? Metab by and weakely inhibits CYP3A. 3A is not major path.
Anti-infectives ANTIMYCOBACTERIAL AGENTS Rifabutin Mycobutin BAD! www.drugs-porphyria.org: Probably Porphyrinogenic 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)
OPHTHALMIC AGENTS (intraocular) n/a Tropicamide Mydriacyl OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic
Antineoplastics (Cancer Therapies) ALKYLATING AGENTS Busulfan Myleran BAD! www.drugs-porphyria.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 of CYP3A4
Arthritis n/a Gold Sodium Thiomalate Myochrysin BAD! www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.uq.edu.au/porphyria/: Unsafe in animals
Central nervous system agents ANTICONVULSANTS Primidone Mysoline BAD! www.drugs-porphyria.org: Porphyrinogenic www.porphyria-europe.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 system agents ANTIMYASTHENIC AGENTS Ambenonium Mytelase OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic
Psychiatric medications ANTIDEMENTIA AGENTS Memantine Namenda OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic www.rxlist.com: ca. 50% excreted unchanged; no significant metabolic role for CYPs
Central nervous system agents NONSTEROIDAL ANTI-INFLAMMATORY AGENTS -NSAIDs (Pain, Arthritis Therapies, etc.) Naproxen Naprosyn, Aleve OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients and animals 20-40% metab by CYP2C9 (<50% of this), other CYPs Patient reports: Safe (Drug Metab Disp 33:1567,2005)
NARCOTIC ANTAGONISTS n/a Naloxone Narcan OK! www.drugs-porphyria.org: Possibly Porphyrinogenic. 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
PSYCHIATRIC MEDICATIONS MISC. Phenelzine Nardil BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.uq.edu.au/porphyria/: Unsafe in animals
ANESTHETICS LOCAL Ropivacaine Naropin OK? www.drugs-porphyria.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
ANTINEOPLASTICS (Cancer Therapies) ALKYLATING AGENTS Procarbazine Natulan BAD! web.uct.ac.za/depts/porphyria/: Use with Extreme Caution S Afr Med J 1984;65:924. Safe in patients
ANTINEOPLASTICS (Cancer Therapies) MITOTIC INHIBITORS Vinorelbine Navelbine BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic. Substrate for CYP 3A4. No reports of CYP-induction in humans. Other vinca alkaloids have shown to be porphyrinogenic in vitro. Drug Metab Dispos 2000;28:1121. Major interaction with CYP3A4
Central nervous system agents HYPNOTICS (Sleeping Medications) Pentobarbital Nembutal BAD! www.porphyria-europe.com: Unsafe Patient report: Unsafe See Phenobarbital
ANESTHETICS LOCAL Chloroprocaine Nesacaine NO INFO
Blood related therapy HEMATOPOIETICS Filgrastim (G-CSF) Neupogen OK! (G-C web.uct.ac.za/depts/porphyria/) www.drugs-porphyria.org: Not Porphyrinogenic
Central nervous system agents ANTIPARKINSON AGENTS Rotigotine Neupro (patch) OK? Metab by multiple CYPs. Does not induce CYP3A4, 2C9 (PDR 63:3149,2009)
Central nervous system ANTICONVULSANTS Gabapentin Neurontin OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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)
Antineoplastics (Cancer Therapies) ENZYME INHIBITORS Sorafenib Nexavar No info ~50% metab by CYP3A4, ~50% not metab (PDR 63:784,2009)
Gastrointestinal therapies H-2 ANTAGONISTS, PPIs (Reflux, Ulcer Therapies) Esomeprazole Nexium OK! www.drugs-porphyria.org: Possibly Porphyrinogenic. www.porphyria.uct.ac.za: Use with extreme caution. PV 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) .
Cardiovascular agents CALCIUM CHANNEL BLOCKERS Nimodipine Nimotop BAD! www.drugs-porphyria.org: Probably Porphyrinogenic 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)
ANTINEOPLASTICS (Cancer Therapies) MISC. Pentostatin Nipent NO INFO
Cardiovascular agents VASODILATORS Nitroprusside Nipride OK? web.uct.ac.za/depts/porphyria/: Use with Caution Redox Rep 2004;9:360: No P450 metabolism
Antineoplastics ANTIESTROGENS Tamoxifen Nolvadex BAD? www.drugs-porphyria.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)
Arthritis n/a none none
Antineoplastics (Cancer Therapies) Thyroid Cancer-Specific Radioactive Iodine (I-131) none OK! Patient experience
Anti-infectives antimycobacterial rifampicin none
Anti-infectives ANTIFUNGALS Clotrimazole none OK? www.drugs-porphyria.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.
IMMUNOLOGIC AGENTS IMMUNE GLOBULINS Cytomegalovirus none OK? (web.uct.ac.za/depts/porphyria/: Use)
IMMUNOLOGIC AGENTS IMMUNE GLOBULINS Hepatitis B none OK? (web.uct.ac.za/depts/porphyria/: Use) www.drugs-porphyria.org: Not Porphyrinogenic
IMMUNOLOGIC AGENTS IMMUNE GLOBULINS Immune Globulin IV none OK? (web.uct.ac.za/depts/porphyria/: Use) www.drugs-porphyria.org: Not Porphyrinogenic
IMMUNOLOGIC AGENTS IMMUNE GLOBULINS Rabies none OK? (web.uct.ac.za/depts/porphyria/: Use)
IMMUNOLOGIC AGENTS IMMUNE GLOBULINS Tetanus none OK? (web.uct.ac.za/depts/porphyria/: Use)
IMMUNOLOGIC AGENTS ANTIVENINS Antivenin Latrodectus Mactans none OK?
IMMUNOLOGIC AGENTS ANTIVENINS Antivenin Micrurus Fulvius none OK?
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Anti-Thymocyte Globulin, Lymphocyte Immune Globulin none OK?
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Haemophilus B none OK?
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Hepatitis A none OK? www.drugs-porphyria.org: Not Porphyrinogenic
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Hepatitis B none OK! www.drugs-porphyria.org: Not Porphyrinogenic
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Influenza none OK! www.drugs-porphyria.org: Not Porphyrinogenic
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Japanese Encephalitis none OK?
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Measles, Mumps & Rubella none OK! www.drugs-porphyria.org: Not Porphyrinogenic
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Meningococcal none OK?
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Mumps none OK!
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Pneumococcal none OK!
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Polio none OK!
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Rabies none OK?
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Typhoid none OK? www.drugs-porphyria.org: Not Porphyrinogenic
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Typhoid VI Polysaccharide none OK? www.drugs-porphyria.org: Not Porphyrinogenic
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Varicella none OK! www.drugs-porphyria.org: Not Porphyrinogenic
IMMUNOLOGIC AGENTS ANTIMICROBIAL VACCINES Yellow Fever none OK? www.drugs-porphyria.org: Not Porphyrinogenic
ANESTHETICS MUSCLE RELAXANTS Vecuronium Norcuron OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
Cardiovascular BETA BLOCKERS (includes some ophthalmic preparations) Labetalol Normodyne, Trandate OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients patient report: safe
Anti-infectives FLUOROQUINOLONES Norfloxacin Noroxin OK? www.drugs-porphyria.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
Cardiovascular agents ANTIARRHYTHMICS Disopyramide Norpace BAD? www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution www.uq.edu.au/porphyria/: Probably safe
Cardiovascular CALCIUM CHANNEL BLOCKERS Amlodipine Norvasc OK? www.drugs-porphyria.org: Probably Porphyrinogenic 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, Williams & Wilkins, 6th ed., 2007. Induces pregnane X receptor. 4 patient reports: Safe, certainly at 5 mg/day.
Anti-infectives ANTIRETROVIRALS Ritonavir Norvir BAD! www.drugs-porphyria.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)
ANTINEOPLASTICS (Cancer Therapies) ANTIBIOTICS Mitoxantrone Novantrone BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic. Insufficient data on metabolism Largely unmetabolized. web.uct.ac.za/depts/porphyria/: Use with Extreme Caution
ANTI-INFECTIVES ANTIFUNGALS Posaconazole Noxafil NO INFO
Central nervous system agents NARCOTICS (Pain Therapies) Nalbuphine Nubain OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
ANESTHETICS LOCAL Dibucaine Nupercainal NO INFO
ANESTHETICS MUSCLE RELAXANTS Doxacurium Nuromax NO INFO
Hormones, hormone-like ESTROGENS Estropipate Ogen, Ortho-est No info
CONTRAST MEDIA n/a Iohexol Omnipaque OK! www.drugs-porphyria.org: Not Porphyrinogenic
Antineoplastics (Cancer Therapies) MITOTIC INHIBITORS Vincristine Oncovin OK? www.drugs-porphyria.org: Possibly Porphyrinogenic. Porphyrinogenic in vitro. Administered in low weekly dose, probably insignificant hepatic exposure. Some clinical reports of non-porphyrinogenicity. 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)
Antidiabetics DPP-4 Inhibitors Saxagliptin Onglyza, Kombiglyze XR No info Primarily metab. by CYP3A4/5 (Clin Pharmacokinet 49:573, 2010)
Respiratory agents ANTIHISTAMINES Azatadine Optimine, Trinalin, others No info
Arthritis n/a Abatacept Orencia OK! Protein. Not metab by CYPs (PDR 63:921,2009)
Central nervous system agents NONSTEROIDAL ANTI-INFLAMMATORY AGENTS -NSAIDs (Pain, Arthritis Therapies, etc.) Ketoprofen Orudis, Oruvail, others OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use with Caution Probably not metab by CYPs PV Tishler MD clinical data: Safe (Drug Metab Disp 33:1567,2005)
HORMONES, HORMONE-LIKE ANDROGENS Oxandrolone Oxandrin BAD?
Central nervous system agents NARCOTICS (Pain Therapies) Oxycodone Oxycontin, Percocet, Percodan, others OK! www.drugs-porphyria.org: Possibly Porphyrinogenic www.uq.edu.au/porphyria/: Unsafe in animals PV Tishler MD clinical data & patient reports: Safe
Urinary tract ANTISPASMODICS Oxybutynin Oxytrol, Ditropan BAD! www.drugs-porphyria.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)
Antineoplastics ALKYLATING AGENTS Carboplatin Paraplatin OK! www.drugs-porphyria.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)
Central nervous system agents ANTIPARKINSON AGENTS Bromocriptine Parlodel BAD! www.drugs-porphyria.org: Probably Porphyrinogenic 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)
ANESTHETICS MUSCLE RELAXANTS Pancuronium Pavulon OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Probably safe
Psychiatric SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Paroxetine Paxil OK? www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution Does not induce pregnane-X-receptor (Toxicol Lett 203:82, 2011).
Anti-infectives ANTIRETROVIRALS nirmatrelvir tablets and ritonavir tablets PAXLOVID BAD! PAXLOVID ( nirmatrelvir tablets; ritonavir tablets has not been approved, but has been authorized for emergency use by FDA under an EUA, for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death. see comments on ritonavir in the drug database.
Immunologic agents TOXOIDS Diphtheria + Tetanus Toxoids & Acellular Pertussis Adsorbed, Hepatitis B (recombinant) & Inactivated Polioviruis Vaccine Combined Pediatrix OK! All component parts of this vaccine are safe individually as well.
Anti-infectives ANTIVIRALS Ribavirin Pegetron (also contains peginterferon) OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic USP DI? Drug Info. for the Health Care Pro. - 26th Ed: 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
Anesthetics GENERAL Thiopental Pentothal BAD! www.drugs-porphyria.org: Porphyrinogenic www.porphyria-europe.com: Unsafe web.uct.ac.za/depts/porphyria/: Avoid See Phenobarbital
Gastrointestinal H-2 ANTAGONISTS, PPIs (Reflux, Ulcer Therapies) Famotidine Pepcid OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution www.uq.edu.au/porphyria/: Safe in patients Patient reports: Safe
RESPIRATORY AGENTS ANTIHISTAMINES Cyproheptadine Periactin OK! www.drugs-porphyria.org: Possibly Porphyrinogenic
Central nervous system agents ANTIPARKINSON AGENTS Pergolide Permax No info metab by CYP3A4 (Clin Therapeutics 28:2065,2006)
BLOOD RELATED THERAPY ANTICOAGULANTS Dipyridamole Persantine OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in cell culture
RESPIRATORY AGENTS ANTIHISTAMINES Promethazine Phenergan OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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
HORMONES, HORMONE-LIKE PITUITARY Oxytocin Pitocin OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
HORMONES, HORMONE-LIKE PITUITARY Vasopressin Pitressin OK!
Central nervous system agents HYPNOTICS (Sleeping Medications) Ethchlorvynol Placidyl BAD!
ANTI-INFECTIVES ANTIMALARIALS Hydroxychloroquine Plaquenil OK? www.drugs-porphyria.org: Possibly Porphyrinogenic. Partly CYP-metabolized. Compare the 8-aminoquinoline primaquine: Inducer of CYPs 1A1, 1A2 and 1B1
Antineoplastics (Cancer Therapies) ALKYLATING AGENTS Cisplatin Platinol, Blastolem, others OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.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).
Blood related therapy ANTICOAGULANTS Clopidogrel Plavix OK? Metab by a number of CYPs. CYP3A4 and 2C19 are 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)
Cardiovascular CALCIUM CHANNEL BLOCKERS Felodipine Plendil BAD? www.drugs-porphyria.org: Probably Porphyrinogenic 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)
Blood related ANTICOAGULANTS Dabigatran Pradaxa OK! No appreciable P450 metab. (Drug Metab Disp 36:386, 2008)
Antidiabetics Meglitinides/ Biguanides Repaglinide/ Metformin PrandiMet OK? See Repaglinide
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)
Cardiovascular ANTIHYPERLIPIDEMIC AGENTS Pravastatin Pravachol OK? www.drugs-porphyria.org: Possibly Porphyrinogenic 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
Gastrointestinal therapies H-2 Antagonists, PPIs (Reflux, Ulcer Therapies) Lansoprazole Pravacid OK? www.drugs-porphyria.org: Probably porphyrinogenic. www.porphyria.uct.ac.za: Use but with caution. Metabolsim mainly via CYP2C19. Sinz M: Cur Drug Metab 2006; 7:375: Moderate activation of pregnane X receptor but low prediction of clinical induction.
Psychiatric MISC. Dexmedetomidine Precedex OK? ~14% metab. by CYP2A6, remainder by glucuronidation.
HORMONES, HORMONE-LIKE PITUITARY Chorionic Gonadotropin Pregnyl OK! www.drugs-porphyria.org: Possibly Porphyrinogenic
Anti-infectives Animycobacterial agents Rifapentine Priftin BAD! Induces CyP3A, 2C9, ALA synthase (analogous to rifampicin)
Gastrointestinal H-2 ANTAGONISTS, PPIs (Reflux, Ulcer Therapies) Omeprazole Prilosec OK! www.drugs-porphyria.org: Possibly Porphyrinogenic www.porphyria-europe.com: Safe 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
Cardiovascular agents PHOSPHODIESTERASE INHIBITORS Milrinone Primacor No info
ANTI-INFECTIVES ANTIMALARIALS Primaquine Primaquine OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
Anti-infectives PENEM ANTIBIOTICS Imipenem/Cilastatin Primaxin OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic USP DI? Drug Info. for the Health Care Pro. - 26th Ed. (2006): Not metabolized by P450
Cardiovascular ACE INHIBITORS Lisinopril Prinivil OK! www.drugs-porphyria.org: Not Porphyrinogenic P4 atient reports: Safe No transactivation of pregnane X receptor (Curr Drug Metab 6:375,2006)
Cardiovascular agents MISC. Tolazoline Priscoline OK! www.uq.edu.au/porphyria/: Safe in patients http://www.emedicine.com/MED/topic1880.htm: Safe in porphyria
Psychiatric ANTI-DEPRESSANT Desvenlafaxine Pristiq OK? <5% metab by CYP3A4 (PDR 63:3247,2009). No CyP3A4 inhibition. (CNS Drugs 2012:26:39)
Cardiovascular CALCIUM CHANNEL BLOCKERS Nifedipine Procardia, Adalat BAD! www.drugs-porphyria.org: Probably Porphyrinogenic 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
Hormones, hormone-like THYROID Propylthiouracil (PTU) Procasil, Propacil, others OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
Immunologic agents IMMUNOSUPPRESSIVE AGENTS Tacrolimus Prograf, Protopic BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic J Clin Pharmacol 2001;41:113. Safe Major metab by CYP3A4, 3A5 (Pharmacogenetics & Genomics 19:458,2009)
ANTINEOPLASTICS (Cancer Therapies) INTERLEUKINS Aldesleukin Proleukin OK?
PSYCHIATRIC MEDICATIONS PHENOTHIAZINES Fluphenazine Prolixin OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
Cardiovascular agents ANTIARRHYTHMICS Procainamide Pronestyl OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in cell culture
Urinary tract PROSTATIC HYPERTROPHY (also Baldness) Finasteride Proscar, Propecia OK! www.drugs-porphyria.org:Possibly porphyrinogenic. www.porphyria.uct.ac.za: Use only with extreme 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)
Central nervous system agents BENZODIAZEPINES Estazolam Prosom OK? www.uq.edu.au/porphyria/: Cell cuture - probably safe PV Tishler MD clinical data: Safe Metab. almost exclusively by CYP3A4 (https://online.epocrates.com/front_porch/; Xenobiotica 35:455,2005)
Central nervous system agents ANTIMYASTHENIC AGENTS Neostigmine Prostigmine OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
BLOOD RELATED THERAPY ANTICOAGULANTS Protamine Protamine OK!
Gastrointestinal therapies H-2 ANTAGONISTS, PPIs (Reflux, Ulcer Therapies) Pantoprazole Protonix OK! www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution 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
HORMONES, HORMONE-LIKE PROGESTINS Medroxyprogesterone Provera BAD! www.drugs-porphyria.org: Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution
Diagnostic n/a Methacholine Provocholine, others OK!
Psychiatric SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Fluoxetine Prozac OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use with Caution 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
Respiratory ANTIASTHMATIC AND BRONCHODILATOR AGENTS Budesonide Pulmicort, Rhinocort, Entocort OK! www.drugs-porphyria.org: Not Porphyrinogenic PV Tishler MD clinical data & patient report: Safe Metab by CYP3A
URINARY TRACT ANALGESICS Phenazopyridine Pyridium NO INFO
Cardiovascular agents ANTIHYPERLIPIDEMIC AGENTS Cholestyramine Questran OK! Not absorbed from GI tract
Immunologic IMMUNOSUPPRESSIVE AGENTS Sirolimus Rapamune BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic metab mainly by & induces CYP3A4, also CYP3A5 (Drug Metab Disp 35:350,2007. Induces pregnane X receptor.
ANTI-INFECTIVES ANTIVIRALS Interferon alfa-2B/Ribavirin Rebetron OK! ???
Blood related therapy ANTICOAGULANTS Lepirudin Refludan OK! Polypeptide. Not metab by CYPs
Gastrointestinal therapies GASTROINTESTINAL MOTILITY STIMULANTS Metoclopramide Reglan OK? www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution www.uq.edu.au/porphyria/: Probably unsafe www.porphyriafoundation.com: Unsafe Lancet 1981;2:91 Not safe However, ~80% not metab by CYP (www.clinicalpharmacology-ip.com)
ANTI-INFECTIVES ANTIVIRALS Zanamivir Relenza OK! www.drugs-porphyria.org: Not Porphyrinogenic http://redpoll.pharmacy.ualberta.ca/drugbank/: Not metabolized
Psychiatric ANTI-DEPRESSANT Mirtazapine Remeron OK! www.drugs-porphyria.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
Gastrointestinal therapies ANTI-INFLAMMATORY AGENTS Infliximab Remicade OK! www.drugs-porphyria.org: Not Porphyrinogenic Protein; no CYP metab
GASTROINTESTINAL THERAPIES PHOSPHATE BINDER AGENTS Sevelamer Renagel OK? www.drugs-porphyria.org: Not Porphyrinogenic
BLOOD RELATED THERAPY ANTICOAGULANTS Abciximab Reopro OK! www.drugs-porphyria.org: Not Porphyrinogenic
HORMONES, HORMONE-LIKE PITUITARY Menotropins Repronex OK!
Anti-infectives ANTIRETROVIRALS Delavirdine Rescriptor BAD! www.drugs-porphyria.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
Psychiatric Misc. resperidone Resperdal, etc. OK? Major metab via CyP2D6. Weak inhibition of Cyp3A, PXR.
Central nervous system BENZODIAZEPINES Temazepam Restoril OK! www.porphyria-europe.com: Safe 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
ANTINEOPLASTICS (Cancer Therapies) RETINOIDS Tretinoin Retin-A OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic Williams DA: Op. Cit.: Substrate of CYP3A4
ANTI-INFECTIVES ANTIRETROVIRALS Zidovudine Retrovir BAD? www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.uq.edu.au/porphyria/: Safe in patients
OPHTHALMIC AGENTS (intraocular) n/a Dapiprazole Rev-Eyes OK!
Anti-infectives 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
Cardiovascular agents ANTIARRHYTHMICS Propafenone Rhthmol BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic Metabolized by CYP2D6, 3A4, others; relative importances not known (Curr Drug Metab 5:543,2004; Clin Pharmacokinet 46:985,2007)
Arthritis n/a Auranofin Ridaura OK? www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.uq.edu.au/porphyria/: Unsafe in patients
Anti-infectives ANTIMYCOBACTERIAL AGENTS Rifampin Rifadin BAD! Substrate of CYP3A4. Induces CYP3A4 via transactivation of pregnane X receptor (Cur Drug Metab 7:375,2006; Arch Toxicol 82:667,2008)
Psychiatric MISC. Risperidone Risperdal OK? www.drugs-porphyria.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 MEDICATIONS MISC. Methylphenidate Ritalin OK? www.drugs.com: Major metabolic route probably does not involve P450
ANTINEOPLASTICS (Cancer Therapies) ANTIBODIES Rituximab Rituxan OK! www.drugs-porphyria.org: Not Porphyrinogenic http://redpoll.pharmacy.ualberta.ca/drugbank/: No liver metabolism
Respiratory agents EXPECTORANTS Guaifenesin Robitussin OK! www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution PV Tishler MD clinical data & patient report: Safe
ANTI-INFECTIVES CEPHALOSPORINS Ceftriaxone Rocephin OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
ANTINEOPLASTICS (Cancer Therapies) MISC. Interferon Alfa-2A Roferon-A OK! www.drugs-porphyria.org: Not Porphyrinogenic 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
Central nervous system ANTIPARKINSON AGENTS Ropinirole Roquid OK? ~90% metab by CYP1A2, small amt by CYP3A (Clin Pharmacokinet 39:243,2000). 1 patient report: safe.
Gastrointestinal therapies ANTI-INFLAMMATORY AGENTS Mesalamine Rowasa, Pentasa, Asacol, others OK! <30% absorbed; not metab by CYPs
Central nervous system agents HYPNOTICS (Sleeping Medications) Ramelteon Rozerem BAD? Patient report - bad. Minor metab. by CYP3A4.
Central nervous system Antispasmodic Trospium Sanctura OK! Ester hydrolysis, with probably littel/no P450 metabolism. 1 patient report: safe.
Immunologic agents IMMUNOSUPPRESSIVE AGENTS Cyclosporine Sandimmune OK? www.porphyria-europe.com: Safe 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)
HORMONES, HORMONE-LIKE SOMATOSTATIC AGENTS Octreotide Sandostatin OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
Psychiatric MISC. Asenapine Saphris No info Metab by CYPs; proportion by CYP3A4 unknown (Drug Metab Disp 39:580, 2011)
Central nervous system agents HYPNOTICS (Sleeping Medications) Secobarbital Seconal BAD! www.porphyria-europe.com: Unsafe Induces CYP3A4 (Arch Toxicol 82:667,2008) See Phenobarbital
Anti-infectives ANTIRETROVIRALS Maraviroc Selzentry OK? ~50% meetab but does not induce CYP3A4 (Brit J Clin Pharmacol 65S:5,2008; and 66:498,2008)
GASTROINTESTINAL THERAPIES LAXATIVES Senna Senokot OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients
Central nervous system agents BENZODIAZEPINES Oxazepam Serax OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic 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)
Respiratory agents ANTIASTHMATIC AND BRONCHODILATOR AGENTS Salmeterol Serevent OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic 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)
Psychiatric Misc. Quetiapine Seroquel BAD? www.drugs-porphyria.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
Central nervous system agents Anti-Glaucoma Brinzolamide/ Brimonidine Simbrinza BAD! Brinzolamide is a sulfonamide, and thus this is contraindicated
Arthritis n/a Golimumab Simponi OK! Protein. No CYP metabolism
Central nervous system agents ANTIPARKINSON AGENTS Levodopa/ Carbidopa Sinemet OK!
Psychiatric medications TRICYCLICS Doxepin Sinequan, Adepin, others OK? Medicine (Balt)1992;71:1. Safe Patient report: Safe
Respiratory ANTIASTHMATIC AND BRONCHODILATOR AGENTS Montelukast Singulair OK! www.drugs-porphyria.org: Possibly Porphyrinogenic Substrate of CYP3A4 & CYP2C9. No inhibition of CYP2C9, 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
Arthritis n/a Aurothioglucose Solganal OK! www.drugs-porphyria.org: Not Porphyrinogenic
Central nervous system agents HYPNOTICS (Sleeping Medications) Zaleplon Sonata BAD! www.drugs-porphyria.org: Possibly Porphyrinogenic 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
Dermatologicals ANTIPSORIATICS - SYSTEMIC Acitretin Soriatane BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution
Anti-infectives ANTIFUNGALS Itraconazole Sporanox BAD! www.drugs-porphyria.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
Central nervous system agents NARCOTICS (Pain Therapies) Butorphanol Stadol OK!
ANTI-INFECTIVES ANTIPARASITICS Ivermectin Stromectol BAD? Xenabiotica 1998; 28: 313. Metabolized extensively by CYP3A4
RESPIRATORY AGENTS NASAL AGENTS - SYSTEMIC AND TOPICAL Pseudoephedrine Sudafed OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in patients Patient reports: Safe
Anesthetics GENERAL Desflurane Suprane OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic
Anesthetics General Thiamylal Surital BAD! Barbiturate drug
Anti-infectives ANTIRETROVIRALS Efavirenz Sustiva BAD? www.drugs-porphyria.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).
Antineoplastics (Cancer Therapies) ENZYME INHIBITORS Sunitinib Sutent OK? ~30% metab by CYP3A4, ~40% not metab (PDR 63:2540,2009; Medical Letter 49:18,2007). Does not induce CYPs (Clin Therapeutics 30:1385,2008)
Central nervous system agents ANTIPARKINSON AGENTS Amantadine Symmetrel OK! www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use
IMMUNOLOGIC AGENTS ANTIVIRAL MONOCLONAL ANTIBODIES Palivizumab Synagis OK? www.drugs-porphyria.org: Not Porphyrinogenic
HORMONES, HORMONE-LIKE LHRH/GNRH AGONISTS Nafarelin Synarel OK! www.drugs-porphyria.org: Possibly Porphyrinogenic www.porphyria-europe.com: Safe
Gastrointestinal H-2 ANTAGONISTS, PPIs (Reflux, Ulcer Therapies) Cimetidine Tagamet OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution 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)
Central nervous system agents NARCOTICS (Pain Therapies) Pentazocine Talwin BAD! web.uct.ac.za/depts/porphyria/: Avoid www.uq.edu.au/porphyria/: Unsafe in patients
Cardiovascular agents ANTIARRHYTHMICS Flecainide Tambocor, others OK! www.drugs-porphyria.org: Possibly Porphyrinogenic. Metabolized by CYP2D6. No data pointing to CYP-induction (http://medicine.iupui.edu/clinpharm/ddis/)
Anti-infectives ANTIVIRALS Oseltamivir Tamiflu OK? www.drugs-porphyria.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
Hormones, hormone-like THYROID Methimazole Tapazole No info Metab by liver, presumably by CYPs; inhibits several CYPs also (Drug Metab Dispos 1997;25:390)
Antineoplastics (Cancer Therapies) ENZYME INHIBITORS Erlotinib Tarceva OK? Williams DA. ~70% metab by CYP3A4. Modestly transactivates pregnane X receptor but does not induce CYP3A4 (Eur J Clin Pharmacol 64:31,2008; Cancer Chemother Pharmacol 64:35,2009)
Anti-infectives ANTIRETROVIRALS Nilotinib Tasigna No info ~30% metab by CYP3A4 (Clin Therapeutics 30:1956,2008)
Antineoplastics MITOTIC INHIBITORS Paclitaxel Taxol BAD? www.drugs-porphyria.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 MITOTIC INHIBITORS Docetaxel Taxotere, etc. OK? www.drugs-porphyria.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.
Anti-infectives CEPHALOSPORIN Ceftaroline Fosamil Teflaro No info Incomplete information re metabolism (Drugs 69:809, 2009)
Central nervous system ANTICONVULSANTS Carbamazepine Tegretol BAD! www.drugs-porphyria.org: Porphyrinogenic www.porphyria-europe.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)
Cardiovascular agents ANTIHYPERTENSIVE- DUAL AGENT Aliskiren/ Amlodipine Tekamlo BAD? See individual drug listings.
Cardiovascular agents ANTIHYPERTENSIVE - RENIN INHIBITOR Aliskiren Tekturna OK? ~20% metab, mainly by CYP3A4; does not induce CYP3A4 (Pharmacol Rpts 60:623,2008; J clin Pharmacol 48:1323,2008)
CONTRAST MEDIA n/a Iopanoic Acid Telepaque OK!
Cardiovascular agents BETA BLOCKERS (includes some ophthalmic preparations) Atenolol Tenormin OK! www.drugs-porphyria.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 Medicine (Balt) 1992;71:1. Safe
Central nervous system agents ANTIMYASTHENIC AGENTS Edrophonium Tensilon OK!
Anti-infectives ANTIFUNGALS Terconazole Terazol No info Induces pregnane X receptor.
ANTINEOPLASTICS (Cancer Therapies) HORMONAL AGENTS Testolactone Teslac NO INFO
Respiratory ANTITUSSIVES (Cough Therapies) Benzonatate Tessalon, etc. OK? patient report: safe
Cardiovascular ANGIOTENSIN RECEPTOR ANTAGONISTS Eprosartan Teveten OK! 98% excreted unchanged, 2% as glucuronide.
IMMUNOLOGIC AGENTS IMMUNOMODULATORS Thalidomide Thalomid NO INFO
ANTINEOPLASTICS (Cancer Therapies) ALKYLATING AGENTS Thiotepa Thioplex NO INFO
Psychiatric PHENOTHIAZINES Chlorpromazine Thorazine OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.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)
Diagnostic drugs Thyrotropin THYROTROPIN ALFA inj pdr OK!
ANTI-INFECTIVES PENICILLINS Ticarcillin Ticar OK! www.uq.edu.au/porphyria/: Safe in patients
Blood related therapy ANTICOAGULANTS Ticlopidine Ticlid OK? www.drugs-porphyria.org: Probably Porphyrinogenic http://medicine.iupui.edu/flockhart/table.htm: Similar to (and see discussion of) clopidogrel
Gastrointestinal therapies ANTIEMETICS (Vomiting Therapies) Trimethobenzamide Tigan No info
Anti-infectives ANTIPARASITICS Tinidazole Tindamax BAD? ~75% metab by CYP3A4. Porphyrinogenic in vitro (Eur J Clin Pharmacol 59:429,2003)
Cardiovascular agents THROMBOLYTIC ENZYMES Tenecteplase Tnkase OK! www.drugs-porphyria.org: Not Porphyrinogenic
Psychiatric TRICYCLICS Imipramine Tofranil OK? www.drugs-porphyria.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)
Cardiovascular agents ANTIARRHYTHMICS Tocainide Tonocard No info
Dermatologicals Dermatosis, allergy, psoriasis desoximetasone topicort OK? Topical corticosteroid. 1 patinet report: safe
Central nervous system ANTICONVULSANTS Topiramate Topomax BAD? www.drugs-porphyria.org: Probably porphyrinogenic. www.porphyria.uct.ac.za: Use only with extreme caution. 30-40% 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 system agents NONSTEROIDAL ANTI-INFLAMMATORY AGENTS -NSAIDs (Pain, Arthritis Therapies, etc.) Ketorolac Tromethamine Toradol BAD! www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution Eksp Klin Farmakol. 2005;68:56. CYP2C substrate
Gastrointestinal therapies ANTIEMETICS (Vomiting Therapies) Thiethylperazine Torecan OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic
Antidiabetics DPP-4 Inhibitor Linagliptin Tradjenta, Jentadueto OK? >75% excreted unchanged. Major meteabolite created via CYP3A4, which is not induced (Drug Metab Disp 2010; 38:667).
Gastrointestinal therapies ANTIEMETICS (Vomiting Therapies) Scopolamine Transderm-Scop, Scopace, Meldemar, others OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use
BLOOD RELATED THERAPY HEMOSTATICS Aprotinin Trasylol OK! www.drugs-porphyria.org: Not Porphyrinogenic
OPHTHALMIC AGENTS (intraocular) n/a Travoprost Travatan OK! www.drugs-porphyria.org: Not Porphyrinogenic
Antineoplastics ANTIMETABOLITES Methotrexate Trexall, Rheumatrex, others OK? www.drugs-porphyria.org: Probably Not 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 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)
PSYCHIATRIC MEDICATIONS PHENOTHIAZINES Perphenazine Trilafon OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
Central nervous system agents ANTICONVULSANTS Oxcarbazepine Trileptal BAD! www.drugs-porphyria.org: Probably Porphyrinogenic www.porphyria-europe.com: Unsafe web.uct.ac.za/depts/porphyria/: Avoid Induces CYP3A4 (Fundam Clin Pharmacol 14:301,2000)
ANTINEOPLASTICS (Cancer Therapies) MISC. Arsenic Trioxide Trisenox NO INFO
OPHTHALMIC AGENTS (intraocular) n/a Dorzolamide Trusopt OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.drugs.com: excreted primarily as unchanged drug
ANTI-INFECTIVES MISCELLANEOUS Tigecycline Tygacil NO INFO
Antineoplastics (Cancer Therapies) ENZYME INHIBITORS Lapatinib Tykerb OK? Metab mainly by CYP3A4,3A5. No evidence for CYP induction (Drugs 67:2101,2007)
Central nervous system NONSTEROIDAL ANTI-INFLAMMATORY AGENTS -NSAIDs (Pain, Arthritis Therapies, etc.) Acetaminophen Tylenol OK! www.porphyriafoundation.com: Safe PV Tishler MD clinical data & patient reports: Safe Induces constitutive androstene receptor.
Anti-infectives antiretroviral Telbivudine Tyzeka OK? Not metabolized; no P450 interaction (Medical Letter 49:11, 2007; Micromedex
ANESTHETICS GENERAL Sevoflurane Ultane OK! www.drugs-porphyria.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)
Central nervous system NARCOTICS (Pain Therapies) Tramadol Ultram, Ultracet, Ryzolt, etc. No info Largely metab by CYP3A4,2D6 (Eur J Clin Pharm 62:513,2006). Patient report: safe
CONTRAST MEDIA n/a Iopromide Ultravist OK! www.drugs-porphyria.org: Not Porphyrinogenic
ANTI-INFECTIVES PENICILLINS Ampicillin/Sulbactam Unasyn NO INFO
URINARY TRACT ANTISPASMODICS Bethanechol Urecholine NO INFO
ANTI-INFECTIVES CMV AGENTS Valganciclovir Valcyte OK! USP DI? Drug Info. for the Health Care Pro. - 26th Ed. (2006): Undergoes hydrolysis
Central nervous system BENZODIAZEPINES Diazepam Valium OK? www.drugs-porphyria.org: Probably Porphyrinogenic 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 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
Anti-infectives ANTIVIRALS Valacyclovir Valtrex OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use patient report: safe
Anti-infectives MISCELLANEOUS Vancomycin Vancocin, Others OK! www.drugs-porphyria.org: Not Porphyrinogenic www.porphyria-europe.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
Anti-infectives CEPHALOSPORINS Cefpodoxime Proxetil Vantin OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution. Patient report: safe
Cardiovascular agents CALCIUM CHANNEL BLOCKERS Bepridil Vascor BAD! www.uq.edu.au/porphyria/: Unsafe in cell culture Williams DA: Op. Cit.: Substrate of CYP3A4
Cardiovascular ACE INHIBITORS Enalapril (Enalaprilat) Vasotec OK! www.drugs-porphyria.org: Not Porphyrinogenic 2 Patient reports: Safe No transactivation of pregnane X receptor (Curr Drug Metab 6:375,2006)
Antineoplastics (Cancer Therapies) MITOTIC INHIBITORS Vinblastine Velban BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic 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 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)
Respiratory ANTIASTHMATIC AND BRONCHODILATOR AGENTS Albuterol Ventolin, Proventil, others OK! PV Tishler MD clinical data, 3 patient reports: Safe https://online.epocrates.com/front_porch/: Metabolized extensively by P450. Does not transactivate pregnane X receptor (Curr Drug Metab 7:375,2006)
Cardiovascular CALCIUM CHANNEL BLOCKERS Verapamil Verapamil, Tarka OK? Metab by & inhibits induction of CYP3A4.(http://medicine.iupui.edu/clinpharm/ddis/; Amer J Therap 16:155, 2009; Curr Drug Metab 5:543,2004)
Anti-infectives ANTIPARASITICS Mebendazole Vermox OK? www.drugs-porphyria.org: Possibly Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
Anesthetics GENERAL Midazolam Versed OK? www.drugs-porphyria.org: Possibly Porphyrinogenic www.porphyria-europe.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)
Urinary tract ANTISPASMODICS Solifenacin Vesicare OK? Metab primarily by CYP3A4. No evidence of any CYP induction (Br J Clin Pharmacol 59:647,2004)
Anti-infectives ANTIFUNGALS Voriconazole Vfend BAD! www.drugs-porphyria.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.
Cardiovascular IMPOTENCE AGENTS Sildenafil Viagra BAD? www.drugs-porphyria.org: Possibly Porphyrinogenic Major metab by CYP3A4, less by CYP2C9; weak inhibitors of both (Drug Metab Disp 36:986,2008). Patient report: Safe
Anti-infectives TETRACYCLINES Doxycycline Vibramycin, others OK? www.drugs-porphyria.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
Central nervous system agents NARCOTICS (Pain Therapies) Hydrocodone Vicodin, others OK! see Respiratory Agents/antitussive Agents
Antidiabetics GLP-1 Receptor Agonist Liraglutide Victoza OK? Polypeptide-fatty acid, metabolized enzymatically. Drug Metab Disp 2010; 38:1944.
ANTINEOPLASTICS (Cancer Therapies) ANTIMETABOLITES Azacitidine Vidaza NO INFO
ANTI-INFECTIVES ANTIRETROVIRALS Didanosine Videx OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic
Anti-infectives ANTIRETROVIRALS Nelfinavir Viracept BAD? www.drugs-porphyria.org: Probably Porphyrinogenic Williams DA: Op. Cit.: Substrate & inducer of CYP3A4, 2C9
Anti-infectives ANTIRETROVIRALS Nevirapine Viramune BAD! www.drugs-porphyria.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)
Anti-infectives ANTIRETROVIRALS Tenofovir Viread, Truvada OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic USP DI? Drug Info. for the Health Care Pro. - 26th Ed: 70-80% eliminated as unchanged drug http://redpoll.pharmacy.ualberta.ca/drugbank/: Not substrate of CYP3A4 or CYP2C9
OPHTHALMIC AGENTS (intraocular) n/a Trifluridine Viroptic OK!
Contrast media n/a Iodixanol Visipaque OK! www.drugs-porphyria.org: Not Porphyrinogenic www.fda.gov/medwatch/SAFETY/ 2003/03DEC_PI/Visipaque_PI.pdf: No metabolism
Cardiovascular agents BETA BLOCKERS (includes some ophthalmic preparations) Pindolol Visken OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use
ANTI-INFECTIVES CMV AGENTS Cidofovir Vistide OK?
BLOOD RELATED THERAPY HEMATOPOIETICS Cyanocobalamin Vitamin B12 OK! www.drugs-porphyria.org: Probably Porphyrinogenic PV Tishler, MD clinical data: Safe
Psychiatric medications AGENTS FOR CHEMICAL DEPENDENCY Naltrexone Vivitrol OK? No CYP metabolism (PDR 63:988, 2009)
Central nervous system agents NONSTEROIDAL ANTI-INFLAMMATORY AGENTS -NSAIDs (Pain, Arthritis Therapies, etc.) Diclofenac Voltaren BAD? www.drugs-porphyria.org: Probably Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Extreme Caution www.uq.edu.au/porphyria/: Unsafe in patients www.porphyriafoundation.com: Unsafe PV Tishler MD clinical data: Safe Biomed Pharmacother 43:135,1989 - Unsafe in cell culture Limited metab by CYP2C9, ?2C8 (Drug Metab Disp 33:1567, 2005)
Blood related Plasma Replacement Hydroxyethyl starch Voluven OK! Not metabolized in any injurious way.
Psychiatric MISC. Bupropion Wellbutrin, Zyban OK? www.drugs-porphyria.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/)
HORMONES, HORMONE-LIKE ANDROGENS Stanozolol Winstrol BAD? www.drugs-porphyria.org: Not Porphyrinogenic
OPHTHALMIC AGENTS (intraocular) n/a Latanoprost Xalatan OK! www.drugs-porphyria.org: Not Porphyrinogenic
Central nervous system BENZODIAZEPINES Alprazolam Xanax OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic 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
Antineoplastics (Cancer Therapies) ANTIMETABOLITES Capecitabine Xeloda OK? Not metab by CYP. Metab to 5-fluorouracil, which does not induce CYPs (Drug Metab Disp 32:762,2004; Canad J Physiol Pharmacol 74:150,1996)
ANTINEOPLASTICS (Cancer Therapies) ANTIMETABOLITES Capecitabine Xeloda NO INFO
Antineoplastics MISC. Denosumab Xgeva OK! Antibody for skeletal mets., osteoporosis.
Gastrointestinal ANTIDIARRHEAL AGENTS Rifaximin Xifaxan OK! >99% excreted in feces unabsorbed/unchanged (PDR 65:2911, 2011). Induces pregnane X receptor.
ANTI-INFECTIVES SEPSIS SYNDROME AGENTS - NON-ANTIBIOTIC Drotrecogin alfa Xigris OK? www.drugs-porphyria.org: Not Porphyrinogenic
Cardiovascular agents ANTIARRHYTHMICS Lidocaine Xylocaine OK? www.drugs-porphyria.org: Porphyrinogenic metab by 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)
Respiratory agents ANTIHISTAMINES Levocetirizine Xyzal OK! Mainly excreted unchanged. Does not induce CYPs (Curr Med Therap 15:2193, 2008; Med Letter 49:97,2007)
ANTI-INFECTIVES ANTIPARASITICS Iodoquinol Yodoxin NO INFO
ANTINEOPLASTICS (Cancer Therapies) NITROSOUREAS Streptozocin Zanosar NO INFO
Gastrointestinal H-2 ANTAGONISTS, PPIs (Reflux, Ulcer Therapies) Ranitidine Zantac OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution www.uq.edu.au/porphyria/: Probably unsafe www.porphyriafoundation.com: Safe PV Tishler MD clinical data: Safe
Central nervous system agents ANTICONVULSANTS Ethosuximide Zarontin BAD? www.drugs-porphyria.org: Probably Porphyrinogenic www.porphyria-europe.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)
Cardiovascular agents DIURETICS Metolazone Zaroxolyn BAD? web.uct.ac.za/depts/porphyria/: Use with Extreme Caution
ANTI-INFECTIVES ANTIRETROVIRALS Stavudine Zerit NO INFO www.drugs-porphyria.org: Possibly Porphyrinogenic. Furanosyl pyrimidine derivative. No P450 metabolism
Cardiovascular agents ANTIHYPERLIPIDEMIC AGENTS Ezetimibe Zetia, Vitorin OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic 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
ANTI-INFECTIVES ANTIRETROVIRALS Abacavir Ziagen OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic USP DI? Drug Info. for the Health Care Pro. - 26th Ed. (2006): No P450 metabolism
ANTI-INFECTIVES CEPHALOSPORINS Cefuroxime Zinacef OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use with Caution
Anti-infectives MACROLIDES Azithromycin Zithromax OK? www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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
Cardiovascular ANTIHYPERLIPIDEMIC AGENTS Simvastatin Zocor, others OK? www.drugs-porphyria.org: Patient experience - safe 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
Gastrointestinal therapies ANTIEMETICS (Vomiting Therapies) Ondansetron Zofran OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.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)
HORMONES, HORMONE-LIKE LHRH/GNRH AGONISTS Goserelin Zoladex OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic
Psychiatric medications SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Sertraline Zoloft OK? www.drugs-porphyria.org: Possibly Porphyrinogenic Substrate of CYP3A4 but minimially 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.
BONES BISPHOSPHONATES Zoledronic Acid Zometa OK! www.drugs-porphyria.org: Not Porphyrinogenic USP DI? Drug Info. for the Health Care Pro. - 26th Ed: No P450 inhibition in vitro
Central nervous system agents MIGRAINE THERAPY Zolmitriptan Zomig OK? www.drugs-porphyria.org: Possibly Porphyrinogenic. 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 system agents ANTICONVULSANTS Zonisamide Zonegran BAD? Major metab by CYP3A4; also CYP2C19. (Williams DA. 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)
Anti-infectives PENICILLINS Piperacillin Zosyn, etc. OK! www.drugs-porphyria.org: Not Porphyrinogenic web.uct.ac.za/depts/porphyria/: Use. Patient report: safe
Arthritis n/a Allopurinol Zyloprim OK! www.drugs-porphyria.org: Probably Not Porphyrinogenic www.porphyria-europe.com: Safe web.uct.ac.za/depts/porphyria/: Use www.uq.edu.au/porphyria/: Safe in animals Patient reports: Safe
Psychiatric Misc. Olanzapine Zyprexa OK? www.drugs-porphyria.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)
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.
ANTI-INFECTIVES MISCELLANEOUS Linezolid Zyvox OK? www.drugs-porphyria.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

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