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Table 1: Recommendations regarding the prescription of drugs commonly used in clinical practice and the respective porphyrinogenic risk. |
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|
|
Not porphyrinogenic |
Probably not porphyrinogenic |
Possibly porphyrinogenic |
Probably porphyrinogenic |
Porphyrinogenic |
Still without classification |
|
Anesthetics |
Propofol |
Midazolam, desflurane, sevoflurane, nitrous oxide |
Dexmedetomidine, ketamine |
|
Etomidate, thiopental |
|
|
Analgesics |
Morfine, meperidine, pethidine |
Fentanyl, remifentanil, alfentanil, sufentanil, acetaminophen, tramadol, ketorolac, diclofenac, ibuprofen, parecoxib |
|
Metamizole |
|
|
|
Local anesthetics |
Bupivacaine |
Levobupivacaine, ropivacaine, lidocaine |
|
|
|
|
|
Muscle relaxants |
Rocuronium, cisatracurium, suxamethonium |
Atracurium, vecuronium |
|
|
|
Dantrolene |
|
Neuromuscular blockade reversers |
|
Sugammadex, neostigmine, glycopyrrolate, pyridostigmine |
|
|
|
|
|
Antiemetics, antacids |
Omeprazole |
Ondansetron, droperidol, metoclopramide, esomeprazole, ranitidine |
Dexamethasone |
|
|
|
|
Vasopressors, positive ionotropic and chronotropic drugs |
Ephedrine, dopamine, adrenaline, noradrenaline |
Phenylephrine |
|
|
|
Isoprenaline |
|
Antihypertensive, negative ionotropic and chronotropic drugs |
Propranolol, esmolol, labetalol, isosorbide, dinitrate, digoxin, adenosine |
Nifedipine |
|
Methyldopa, hydralazine |
Methyldopa, hydralazine |
|
|
Others |
Intralipid, tranexamic, acid |
Naloxone |
Flumazenil, hydrocortisone |
|
|
Clemastine |
|
Porphyrinogenic: prescribe only in urgent situations, with precautions in all cases; probably porphyrinogenic: prescribe only in strong and urgent indications; possibly porphyrinogenic: use only in the absence of safer alternatives; probably not porphyrinogenic e not porphyrinogenic: use as first choice. Adapted from references 6 to 8. |
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