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NEUROLOGY 1981;31:480-484
© 1981 American Academy of Neurology

Safety of anticonvulsants in hepatic porphyrias

Norman C. Reynolds, Jr., M.D. and Robert M. Miska, B.A.

From the Section of Neurology, Department of Medicine, University of Wisconsin Medical School, Milwaukee, WI.

Address correspondence and reprint requests to Dr. Reynolds, Department of Medicine, University of Wisconsm Medical School, 950 North 12 Street, Milwaukee, WI 53233.

Because acute attacks of porphyria may be precipitated by anticonvulsants, a therapeutic dilemma arises when seizures complicate hepatic porphyria. The list of unsafe agents includes barbiturates, primidone, phenytoin, mephenytoin, ethotoin, ethosuximide, methsuximide, phensuximide, and trimethadione. Agents are considered unsafe if they induce experimental porphyria in animals, and short trials in patients are unreliable for screening. Using drug incubation in chick-embryo hepatocyte culture, we found that porphyrin was increased by carbamazepine, clonazepam, and valproate. These agents should probably be avoided or used with caution in porphyric patients. Alternative approaches to acute porphyric attacks with seizures are discussed.

Acknowledgments The authors are grateful to the Employees Civic and Chartable Organization of General Electric's Medical Systems Division (Milwaukee) for its contribution to this research, and to Lynda Fleming for her technical advice and graphic assistance.

Accepted for publication July 30, 1980.






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