Ramipril: One reference stating non porphyrinogenicity. Hydrochlorthiazide: Not metabolised. Probably no CYP-affinity. Clinical experience of non-porphyrinogenicity. Conflicting evidence

Ramipril: Alanine derivative which is hydrolyzed in the liver giving rise to the ACE- inhibitor ramiprilate. Also other metabolites are produced. Hydrochlorthiazide: thiazide diuretic, sulfonamide congener. Eliminated in urine in unchanged form. Probably no CYP-affinity. Ramipril: South African list: use with care. Hydrochlorthiazide: South African list: use. French list: authorized. Australian list: unsafe associated with attacks. Thunell, patient report (n=1): tolerated. Andersson, patient reports (n=10): tolerated. Martindale: Hydrochlorthiazide has been associated with acute attacks of porphyria and is considred unsafe in porphyric patients. EPI-list: sulfonamides on the unsafe list.