Reynolds N C, Miska R M
Neurology. 1981 Apr;31(4):480-4. doi: 10.1212/wnl.31.4.480.
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.
由于卟啉症的急性发作可能由抗惊厥药诱发，当癫痫并发肝卟啉症时就会出现治疗困境。不安全药物包括巴比妥类、扑米酮、苯妥英、甲妥英、乙苯妥英、乙琥胺、甲琥胺、苯琥胺和三甲双酮。如果药物在动物中诱发实验性卟啉症，则被认为是不安全的，而在患者中进行的短期试验对于筛查并不可靠。通过在鸡胚肝细胞培养中进行药物孵育，我们发现卡马西平、氯硝西泮和丙戊酸盐可使卟啉增加。在卟啉症患者中，这些药物可能应避免使用或谨慎使用。本文讨论了针对伴有癫痫发作的急性卟啉症发作的替代方法。
