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Safe prescribing in the autosomal dominant acute porphyrias: a practical approach: Part II

SummaryThe autosomal dominant acute hepatic porphyrias – principally acute intermittent porphyria, variegate porphyria, and hereditary coproporphyria – can present with potentially fatal acute neurological crisis as a consequence of exposure to various precipitants including legal and illegal drugs. Part 1 of this review covered the assessment of drugs’ porphyinogenicity and described grading systems that are in use worldwide. Part 2 covers the complex safety assessments that should be undertaken when deciding whether drug treatment is appropriate or not. A clinical porphyria specialist can provide help in these circumstances.