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Treatment of specific disorders in porphyria

In Brief: Prescribing for Some Other Conditions

The following guidelines are provided in good faith to assist you in finding the most appropriate medication for your patients. Please note that we do not, and cannot, guarantee that any drug or drug regimen will prove safe in all patients and under all circumstances.

Anaesthesia

Thiopentone must never be used. Our experience is that ketamine, midazolam and propofol are acceptable agents for induction. Both halothane and nitrous oxide have proved safe in practice. There are fewer data on enflurane, isoflurane and sevoflurane, but initial clinical experience suggests that they may be used. Lignocaine in small doses infiltrated locally for minor procedures is acceptable. Bupivacaine is suitable for regional, spinal and epidural anesthesia. Though some lists suggest that these agents are contraindicated, widespread clinical use has shown that they are safe.

Contrast Media​

Water-soluble contrast media used in urography are safe, as are barium and Gastrografin. There is no evidence on newer intravenous contrast media, though we are unaware of any adverse outcome resulting from their use.

Ulcer Eradication Therapy​​

The safest regimen appears to be pantoprazole and clarithromycin. We have frequently prescribed this in patients with VP without incident.