Acute Porphyria Drugs

Acute Porphyria Drug Database

N01AX10 - Propofol
Not porphyrinogenic
NP
Rationale
No interactions with CYP- metabolism of other drugs noted. Thus no evidence pointing to capacity for CYP-induction or mechanism based CYP inhibition. Vast clinical experience of tolerance in acute porphyria.
Chemical description
Diisopropylphenol.
Therapeutic characteristics
General anaesthetic used for induction and maintenance of general anaesthesia, sedation of ventilated patients under intensive care and sedation under surgical or diagnostic procedures.
Metabolism and pharmakokinetics
Rapidly metabolized mainly by CYP2B6 to inactive conjugates which are excreted by urine. Substrate of CYPs 1A2, 2A6, 2C18, 2C19, 2C8, 2B6, 2C9, 2E1, 3A4. Inhibitor of CYPs 1A1, 1A2, 1B1, 2C9, 2D6, 2E1, 3A4 (Rendic, S., 2002). No molecular groupings or other evidence of possible mechanism based CYP-inhibition. No interactions with CYP-metabolism of other drugs noted.
Personal communication
Thunell, S. Many reports of tolerance in acute porphyria.
Published experience
Used uneventfully as an anaesthetic induction agent in 13 patienets with PV. No significant increase of porphyrin precursors or porphyrins were detected by urinary monitoring over a period from before administration to 5 days after (Meissner, P.N. et al, 1991). Used uneventfully to manage status epilepticus in 12 year old male with active AIP (Bhatia, R. et al, 2008). Used uneventfully on two occasions in 43 year old female with AIP (Mitterschiffthaler, G. et al, 1988). Used uneventfully to manage status epilepticus in 26 year old female with active AIP (Pandey, C.K. et al, 2003). Uneventful use in 30 year old female with latent AIP (Pazvanska, E.E. et al, 1999). Used uneventfully on two occasions as anaesthesia in 35 year old female with HCP (Sarantopoulos, C.D. et al, 2000). Used uneventfully on two occasions to induce anaesthesia in 57 year old female with latent AIP (Shaw I.H. & McKeith I.G., 1998). Used unevntfully in 63 year old AIP woman (McLouglin, C, 1989). Female PV patient experienced rise in urinary excretion of porphyrins without associated clinical manifestations following sedation with propofol (Bichel, T. et al, 1993).
IPNet drug reports
Uneventful use reported in 4 patients with acute porphyria.

References

  1. Scientific articles
  2. McLouglin, C. Use of propofol in a patient with porphyria. Br J of Anaesth 1989; 62(1):114. #2459
  3. Pandey CK, Singh N, Bose N, Sahay S, Gabapentin and propofol for treatment of status epilepticus in acute intermittent porphyria. J Postgrad Med. 2003; 49(3):285. PMID 14597800. #4640
  4. Rendic, S. Summery of information on human CYP enzymes: human P450 metabolism. Drug metabolism reviews 2002; 34(1&2), 83-448. #1025
  5. Sarantopoulos, C.D.; Bratanow, N.C.; Stowe, D. F.; Kampine, J.P. Uneventful Propofol Anesthesia in a Patient with Coexisting Hereditary Coproporphyria and Hereditary Angioneurotic Edema. Anesthesiology: 2000; 92(2):607. PMID 31831506. #2465
  6. Bhatia R, Vibha D, Srivastava MV, Prasad K, Tripathi M, Bhushan Singh M. Use of propofol anesthesia and adjunctive treatment with levetiracetam and gabapentin in managing status epilepticus in a patient of acute intermittent porphyria. Epilepsia. 2008 May;49(5):934-6. #2457
  7. Bichel T, Joris J, Jacquet N, Lamy M. Total intravenous anesthesia in South-African genetic porphyria (variegate porphyria). Acta Anaesthesiol Belg. 1993;44(1):25-9. PMID 8342401. #2458
  8. Meissner PN, Harrison GG, Hift RJ. Propofol as an i. v. anaesthetic induction agent in variegate porphyria. Br J Anaesth. 1991 Jan;66(1):60-5. PMID 1997060. #4639
  9. Mitterschiffthaler G, Theiner A, Hetzel H, Fuith LC. Safe use of propofol in a patient with acute intermittent porphyria. Br J Anaesth. 1988;60(1):109-11. #2461
  10. Pazvanska EE, Hinkov OD, Stojnovska LV. Uneventful propofol anaesthesia in a patient with acute intermittent porphyria. Eur J Anaesthesiol. 1999;16(7):485-92. #2464
  11. Shaw IH, McKeith IG. Propofol and electroconvulsive therapy in a patient at risk from acute intermittent porphyria. Br J Anaesth. 1998;80(2):260-2. #2466
  12. Drug reference publications
  13. Sweetman SC, editor. Martindale: The complete drug reference. Propofol. Pharmaceutical Press 2009. #2467
  14. Summary of Product Characteristics
  15. Norwegian medicines agency. Summary of Product Characteristics (SPC). Propofol-Lipuro. #2462
Similar drugs
Explore alternative drugs in similar therapeutic classes N01A / N01AX or go back.
 
© NAPOS 2024
An unhandled error has occurred. Reload 🗙