Brun A1, Pomp E1, Thunell S2
1Norwegian Porphyria Centre, Haukeland University Hospital, Bergen, Norway, 2Porphyria Centre Sweden, Huddinge University Hospital, Stockholm, Sweden
It is well known that certain drugs may precipitate attacks in acute porphyrias. Thus it is essential to identify those drugs which may precipitate the acute crisis and avoid prescribing them, except where no safer alternative exists and the indications outweighs the risks. A new and comprehensive drug database will be presented which is meant as an aid for doctors in the task of selecting the right drugs for these patients. The database takes into account the varying vulnerability to drugs among the gene carriers of acute porphyrias. This database is a collaborative work of the Norwegian and Swedish national porphyria centres. The porphyrinogenicity of the drugs are classified according to the newly revised Swedish drug list for acute porphyria. The Norwegian National Porphyria Centre has developed the database which has several advantages compared to other porphyria drug lists on the Internet.
• The database is not a list, but function as a search engine. It is user friendly since either the trade name or the generic name of the drug may be used.
• The database takes into account that porphyric patients have a varying sensitivity to the same drug. The vulnerability of the porphyria gene carrier is estimated from age, gender, previous and current disease activity, and current exogenous or endogenous porphyric burden. In the database information about the vulnerability of the patient is combined with the porphyrinogenicity of the drug. A clear counsel about the use of the drug for that particular patient is then given by the database.
• The classification in the database is based on the pharmaceutical ATC system recommended by WHO. The database has the option "Show alternative drugs" which is a helpful tool in the search for a safer drug in the situation when your first drug of choice is classified as a porphyrogenic drug.
• The newly revised Swedish drug list for acute porphyria has been extended to cover all substances included in the Swedish Pharmacopeia 2003. It is now the most comprehensive of the different porphyria drug lists.
• For all drugs that are classified as more or less porphyrinogenic in the database, information is also given about the evidence behind its classification.