National Acute

Porphyria Service

2020 SAFE LIST (by category): Drugs that are considered to be SAFE for use in the acute porphyrias
This safe list was produced jointly by the UK Porphyria Medicines Information Service (UKPMIS) and Cardiff Porphyria Service and is supported by the
National Acute Porphyria Service (NAPS). We gratefully acknowledge the clinical impact of the evidence-based drug safety assessments provided on
the comprehensive Drug Database for Acute Porphyria (http://www.drugs-porphyria.org) on the range of available medicines for porphyria patients.

This list is based on the best information available to us at the time of compilation and provides guidance on drugs to use first line. It is not intended to
be comprehensive. Inclusion of a drug does not guarantee that it will be safe in all circumstances. For information on medication not listed and advice
on the use of antiretrovirals, antineoplastics or other complex treatment scenarios please contact UKPMIS by telephone (029 2184 2251), or see our
website https://www.wmic.wales.nhs.uk/specialist-services/drugs-in-porphyria/. Unfortunately we are unable to accept enquiries via e-mail.
Healthcare professionals requiring clinical advice on management of acute porphyria attacks should contact NAPS on 029 2184 7747
– available 24 hours a day, 7 days a week.
All topical preparations (including topical antifungals, lice treatments & eye drops) are considered safe, when applied to intact skin or mucosa.

Anaesthesia & peri-operative drugs Flucloxacillin 3 Ertugliflozin Antimuscarinic agents

Articaine Fosfomycin Exenatide Atropine
Atracurium Fusidic acid Glipizide Glycopyrronium
Atropine Gentamicin Glucagon Hyoscine butylbromide
Bupivacaine Imipenem Insulins Hyoscine hydrobromide
Cisatracurium Levofloxacin Linagliptin Ipratropium bromide
Desflurane Linezolid Liraglutide
Isoflurane Lymecycline Lixisenatide Antiobesity agents
Lidocaine 1 Meropenem Metformin Orlistat
Mepivacaine Meropenem with vaborbactam Nateglinide
Anti-Parkinson agents
Midazolam 2 Metronidazole Pioglitazone
Amantadine
Mivacurium Moxifloxacin Repaglinide
Co-beneldopa
Neostigmine Ofloxacin Saxagliptin
Co-careldopa
Nitrous oxide Phenoxymethylpenicillin Sitagliptin
Entacapone
Pancuronium Piperacillin with tazobactam Vildagliptin
Pramipexole
Prilocaine Pyrazinamide
Propofol 2 Sodium fusidate Antidotes
Antipsychotics
Remifentanil Teicoplanin Acetylcysteine
Amisulpride
Rocuronium Tigecycline Flumazenil
Aripiprazole
Suxamethonium Tobramycin Naloxone
Clozapine
Vancomycin Fluphenazine
Analgesics Antiemetics
Cyclizine Haloperidol
Alfentanil Anticoagulants & antiplatelets
Domperidone Olanzapine
Aspirin Apixaban
Granisetron Paliperidone
Buprenorphine Aspirin
Hyoscine hydrobromide Quetiapine
Celecoxib Clopidogrel
Levomepromazine Sulpiride
Codeine phosphate Dabigatran
Metoclopramide Trifluoperazine
Diamorphine Dalteparin
Diclofenac Danaparoid Ondansetron
Antirheumatic & gout agents
Dihydrocodeine Dipyridamole Prochlorperazine
Abatacept
Etoricoxib Fondaparinux Adalimumab
Antifungal & anthelmintic agents
Fentanyl Heparin, unfractionated Allopurinol
Amphotericin
Ibuprofen Prasugrel Azathioprine
Anidulafungin
Indometacin Ticagrelor Belimumab
Caspofungin
Ketoprofen Tinzaparin Certolizumab
Flucytosine
Meloxicam Tirofiban Chloroquine
Mebendazole
Methadone Warfarin Ciclosporin
Nystatin
Morphine Colchicine
Anticonvulsants Terbinafine
Naproxen Etanercept
Oxycodone Clobazam Antihistamines & histamine Golimumab
Paracetamol Clonazepam analogues Infliximab
Pethidine Gabapentin Betahistine Leflunomide
Tramadol Lacosamide Cetirizine Methotrexate
Lamotrigine Chlorphenamine Penicillamine
Antibacterial agents Levetiracetam Desloratadine Quinine
Amikacin Paraldehyde Diphenhydramine Rituximab
Amoxicillin Pregabalin Fexofenadine Tocilizumab
Ampicillin Vigabatrin Loratadine
Azithromycin Zonisamide Antiviral agents
Mizolastine
Aztreonam Aciclovir
Promethazine
Benzylpenicillin Antidepressants Famciclovir
Cefaclor Amitriptyline Antimalarial agents Ganciclovir
Cefadroxil Citalopram Atovaquone Oseltamivir
Cefalexin Duloxetine Chloroquine Valaciclovir
Cefepime Escitalopram Mefloquine Valganciclovir
Cefixime Fluoxetine Primaquine Zanamivir
Cefotaxime Fluvoxamine Proguanil
Cefoxitin Mirtazapine Quinine Bisphosphonates & calcium-
Cefradine Nortriptyline regulatng agents
Ceftaroline Paroxetine Antimigraine agents Alendronic acid
Ceftazidime Sertraline Almotriptan Cinacalcet
Ceftriaxone Trazodone Eletriptan Ibandronic acid
Cefuroxime Venlafaxine Metoprolol Pamidronate disodium
Ciprofloxacin Nadolol Risedronate
Co-amoxiclav Antidiabetics Naratriptan Sodium clodronate
Co-fluampicil 3 Alogliptin Propranolol Strontium
Cycloserine Canagliflozin Rizatriptan Zoledronic acid
Doxycycline Dapagliflozin Sumatriptan
Ertapenem Dulaglutide Timolol Bronchodilators
Ethambutol Empagliflozin Zolmitriptan Aclidinium bromide
Aminophylline
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 Formoterol CNS stimulants Genito-urinary agents Neutropenia agents
Glycopyrronium Atomoxetine Mirabegron Filgrastim
Ipratropium bromide Methylphenidate Sildenafil G-CSF
Salbutamol Sodium bicarbonate Lenograstim
Salmeterol Contrast media Solifenacin Lipegfilgrastim
Terbutaline Barium sulphate Tadalafil Pegfilgrastim
Theophylline Contrast media – gadolinium-based Tamsulosin
Tiotropium Contrast media – Gastrografin® Tolterodine Obstetric & Gynaecology agents
Umeclidinium Contrast media – iodine-based Carboprost
Haematology agents Dinoprostone
Cardiovascular agents Corticosteroids Darbepoetin Gemeprost
Acebutolol Beclometasone Desferrioxamine Misoprostol
Adenosine Betamethasone Epoetin Oxytocin
Adrenaline Budesonide Tranexamic acid
Amiloride Ciclesonide Ocular agents
Amlodipine Deflazacort Hypnotics & anxiolytics Acetazolamide
Aspirin Dexamethasone Diazepam Aflibercept
Atenolol Fludrocortisone Lorazepam
Fluticasone Melatonin Phosphate-binding agents
Bendroflumethiazide
Hydrocortisone Temazepam Calcium salts
Betaxolol
Methylprednisolone Zopiclone Sevelamer
Bisoprolol
Bumetanide Mometasone
Immunoglobulins Potassium-binding agents
Candesartan Prednisolone
Immunoglobulins Calcium polystyrene sulfonate
Captopril Triamcinolone
Sodium zirconium cyclosilicate
Carvedilol Immunosuppressants
Cough & Cold remedies
Clonidine Abatacept Substance dependence
Dextromethorphan
Clopidogrel Adalimumab Acamprosate
Phenylephrine
Dabigatran Alemtuzumab Nicotine replacement therapy
Pseudoephedrine
Digoxin Anakinra
Dipyridamole Supplements, vitamins & minerals
Dementia agents Azathioprine
Dobutamine Alfacalcidol
Galantamine Basiliximab
Dopamine Alpha tocopheryl / tocopherol
Memantine Belatacept
Doxazosin Aluminium salts
Rivastigmine Belimumab
Enalapril Ascorbic acid
Benralizumab
Enoxaparin Endocrine agents Calcitriol
Bevacizumab
Epinephrine Demeclocycline Calcium salts
Canakinumab
Eplerenone Tetracosactide Colecalciferol
Certolizumab
Eprosartan Tolvaptan Ergocalciferol
Cetuximab
Esmolol Glucosamine
Ciclosporin
Felodipine Fibrinolytic agents Iron salts
Denosumab
Fondaparinux Alteplase Magnesium salts
Eculizumab
Fosinopril Streptokinase Menadiol
Etanercept
Furosemide Tenecteplase Multivitamins
Golimumab
Glyceryl trinitrate Urokinase Nicotinamide
Infliximab
Heparin, unfractionated Phosphate salts
Gastro-intestinal agents Methotrexate
Irbesartan Phytomenadione
Alginates (e.g. Gaviscon®, Peptac®) Mycophenolate mofetil
Isosorbide dinitrate Pyridoxine
Arachis oil enema Mycophenolic acid
Isosorbide mononitrate Riboflavin
Balsalazide Natalizumab
Ivabradine Thiamine
Bisacodyl Ofatumumab
Labetalol Vitamin A
Cimetidine Palivizumab
Lercanidipine Vitamin B
Dicycloverine Panitumumab
Levobunolol Vitamin C
Dimeticone Rituximab
Lisinopril Vitamin D
Esomeprazole Siltuximab
Losartan Vitamin E
Glycerol suppositories Tacrolimus
Metoprolol Vitamin K
Hyoscine butylbromide Tildrakizumab
Midodrine Zinc preparations
Ispaghula husk Tocilizumab
Moxonidine Lactulose Trastuzumab Thyroid & antithyroid agents
Nadolol Lansoprazole Ustekinumab Carbimazole
Naftidrofuryl Linaclotide Vedolizumab Levothyroxine
Nebivolol Liquid paraffin enema Liothyronine
Nifedipine Lipid lowering agents
Loperamide Propylthiouracil
Nimodipine Atorvastatin
Macrogols
Noradrenaline Bezafibrate Vaccines
Magnesium citrate with sodium
Norepinephrine Colesevelam BCG vaccine
picosulfate
Perindopril arginine Colestipol Diphtheria/tetanus/pertussis/polio
Mebeverine
Perindopril erbumine Colestyramine vaccine
Mesalazine
Pindolol Ezetimibe Diphtheria/tetanus/pertussis/polio/
Methylcellulose
Prasugrel Fenofibrate Hib/hepatitis B vaccine
Methylnaltrexone bromide
Prazosin Fluvastatin Hepatitis A vaccine
Octreotide
Propranolol Gemfibrozil Hepatitis B vaccine
Omeprazole
Quinapril Pravastatin Hib/Meningococcal group C vaccine
Pantoprazole
Ramipril Rosuvastatin Human papillomavirus (HPV) vaccine
Phosphate enema
Rivaroxaban Simvastatin Influenza vaccine (inactivated)
Prucalopride
Sotalol Rabeprazole Influenza vaccine (live attenuated) 4
Telmisartan Mood stabilisers
Ranitidine Measles, mumps and rubella vaccine 4
Terazosin Lamotrigine
Senna Meningococcal group B vaccine
Ticagrelor Lithium carbonate
Simeticone Meningococcal groups A, C, W, Y
Timolol Lithium citrate
Sodium citrate enema vaccine
Tirofiban Sodium picosulfate Neuromuscular agents Palivizumab
Trandolapril Sterculia Baclofen Pneumococcal conjugate vaccine
Valsartan Ursodeoxycholic acid Pyridostigmine Pneumococcal polysaccharide vaccine
Shingles vaccine 4
Tetanus/diphtheria/polio vaccine

1. Intravenous doses should be used with caution.
2. Clinical safety has not been assessed for continuous use of these preparations.
Written May 2020; Review May 2021
3. Conflicting safety advice for flucloxacillin. Consider an alternative in high risk patients.
Contact UKPMIS for further advice.
4. An acute attack has been reported following yellow fever vaccine, so caution should be
observed when using any live vaccine in adults.
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