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Acute Symptoms

Suggested Pharmacotherapy for the symptoms and complications of the Acute Attack

This list should be read in conjunction with the page Management of the acute attack.

Specific Suppressive Therapy for the Acute Attack

  • Haem arginate (Normosang)
  • Lyophilised haematin (Panhematin) (in the USA).


  • Oral codeine or dihydrocodeine
  • Parenteral pethidine or morphine (Note that frequent dosing is usually required).


  • Oral prochlorperazine, metaclopramide or chlorpromazine
  • Rectal prochlorperazine suppositories
  • Parenteral prochlorperazine or metaclopramide

Restlessness, Confusion Or Psychosis​​

  • Oral: promazine, chlorpromazine or trifluoroperazine
  • Parenteral chlorpromazine


  • Parenteral clonazepam or diazepam.
  • Intravenous magnesium sulphate in difficult casesHYPERTENSION
  • Beta-blockers may have some anti-porphyrinogenic effect in themselves and are thus particularly useful for the control of these autonomic manifestations.
  • Intravenous labetalol and magnesium sulphate for the adrenergic crisis.

Severe Hyponatraemia​​

  • Avoidance of hypotonic intravenous fluids
  • Intravenous hypertonic saline for severe, symptomatic hyponatraemia (with standard protocols to avoid central pontine myelinolysis).