In porphyria all the following drugs are safe Except
There are at least five different classes of precipitating factors in Acute intermittent porphyria: ALAS-N inducers: most precipitating factors can be related to an associated increase in the activity of ALAS-N in the liver. An overproduction of ALA then makes the paially deficient PBGD activity rate limiting. Endocrine factors: the clinical disease is more common in women, especially at the time of menses. The disease also hardly becomes manifest before pubey. Calorie intake: reduced calorie intake often leads to exacerbations of AIP. Additional calories on a diet may reduce PBG excretion and suppress clinical symptoms. Drugs and foreign chemicals: barbiturates, sex steroids, and other foreign chemicals that exacerbate porphyria have the potential to induce cytochrome P450. The resultant enhanced demand for heme synthesis may lead to induction of hepatic ALAS-N. Stress: stress is known to upregulate the heme oxygenase gene and leads to exacerbations of AIP. Similarly, other forms of stress, including intercurrent illnesses, infections, alcoholic excess, and surgery, are all known to contribute to the genesis of an acute attack of this disorder.
Propofol
Midazolam
Alfentanyl
Pentazocine
Anaesthesia of special situations