Are Antibiotics Safe for Porphyria Patients?

Bacterial infections can happen to anyone. However, when they happen to someone with porphyria physicians have to take special considerations before prescribing antibiotics.

What is porphyria?

Porphyria is a group of genetic disorders that are all related to the production of heme. Heme is a key component in hemoglobin, which transports oxygen in red blood cells. In porphyria, one of the critical proteins used to make heme is disrupted or missing. This leads to a buildup of porphyrins. Depending on where the genetic mutation occurs, it can lead to several types of porphyria, which predominantly affect the nervous system (acute porphyria), the skin (cutaneous porphyria), or both.

What are antibiotics?

Antibiotics, or antibacterials, are molecules that fight bacterial infections by making it difficult for bacteria to grow and reproduce or by killing them. There are many types of antibiotics. Each can treat different types of bacteria. Doctors usually prescribe antibiotics to treat only infections that pose a serious health risk and are not likely to clear up on their own.

How antibiotics affect porphyria patients

People with acute porphyria sometimes have acute attacks, which can lead to hospitalization. A variety of triggers can cause these attacks. These triggers could include pharmaceuticals, hormones, diet, and stress.

Most antibiotics are safe for use in patients with porphyria. However, research has reported a few, such as sulfonamide antibiotics, cause acute porphyria attacks.

Researchers think that antibiotics or other triggers cause the attack through a reduction in heme in the liver. This decreased amount of heme causes the liver to express the enzyme 5-aminolevulinic acid synthase 1 (ALAS1). ALAS1 produces the porphyrin precursors 5-aminolevulinic acid (ALA) and porphobilinogen (PBG), which happen to be neurotoxic (damaging) to nerve cells. The enzyme that normally would convert these precursors onto the next step in the heme pathway, hydroxymethylbilane synthase (HMBS), is disrupted in acute porphyria. So, these neurotoxic precursors accumulate and lead to the nervous system symptoms characteristic of an acute porphyria attack.

Make sure to confirm with your physician and pharmacist that any antibiotics they give you are safe to use with porphyria. You also can check your antibiotics on the drug database for acute porphyria website.

Who is at risk?

Only patients who have acute porphyria, including acute intermittent porphyria (AIP), ALA-dehydratase deficiency porphyria (ADP) or plumboporphyria, variegate porphyria (VP), and hereditary coproporphyria (HCP) may be affected by certain antibiotics.

Patients with cutaneous porphyria including those with porphyria cutanea tarda (PCT), erythropoietic protoporphyria (EPP), X-linked erythropoietic protoporphyria (XLEPP), and congenital erythropoietic porphyria should not be at risk of porphyria attacks from antibiotics, according to the British Porphyria Association.

Last updated: Sept. 15, 2020

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