Acute Porphyria Drugs

Acute Porphyria Drug Database

N01AX13 - Nitrous Oxide
Propably not porphyrinogenic
PNP
Rationale
Nitrous oxide is rapidly eliminated unchanged via the lungs, and has no potential for CYP interactions. Common adverse reactions of nitrous oxide that can be confused with an acute porphyric attack are nausea and vomiting.
Chemical description
Nitrous oxide is a medicinal gas with the chemical formula N2O.
Therapeutic characteristics
Nitrous oxide has analgesic and sedative properties and is used in the management of mild to moderate pain and in general anaesthesia in combination with other anaesthetics. It has a rapid onset and offset of effect. Nitrous oxide is administered by inhalation, and should be combined with oxygen to prevent hypoxia. Common adverse reactions of nitrous oxide that can be confused with an acute porphyric attack are nausea and vomiting.
Metabolism and pharmakokinetics
Nitrous oxide is excreted unchanged via the lungs. Because of its low solubility in blood, it is rapidly distributed to the tissue giving a rapid onset of effect. No pharmacokinetic interactions between nitrous oxide and other drugs are observed or suspected.
Published experience
Reports of uneventful use: Barone 2001: used uneventfully by 1 patient with AIP. Brown 2002: used uneventfully by 1 patient with VP. Famewo 1985: used uneventfully by 1 patient with AIP. McGovern 2007: used uneventfully by two children with latent AIP. Minoda 1997: used uneventfully by 1 patient with VP: Sarantopoulos 2000: used uneventfully by 1 patient with HCP. Shipton 1984: used uneventfully by 1 patient with VP. Yamamori 1996: used uneventfully by 1 patient with HCP

References

  1. Scientific articles
  2. CD. Uneventful propofol anesthesia in a patient with coexisting hereditary coproporphyria and hereditary angioneurotic edema. Anesthesiology. 2000 Feb;92(2):607-9. #2474
  3. Shipton EA, Roelofse JAAnaesthesia in a patient with variegate porphyria undergoing coronary bypass surgery. A case report. S Afr Med J. 1984 Jan 14;65(2):53-4. #2476
  4. Barone GW, Gurley BJ,et al. The tolerability of newer immunosuppressive medications in a patient with acute intermittent porphyria. J Clin Pharmacol. 2001 Jan;41(1):113-5 #2468
  5. Becker DE, Rosenberg M. Nitrous oxide and the inhalation anesthetics. Anesth Prog. 2008 Winter;55(4):124-30 #2469
  6. Brown GJ, Welbury RR. The management of porphyria in dental practice. Br Dent J. 2002 Aug 10;193(3):145-6. PMID 12213008. #2470
  7. Famewo CE. Induction of anaesthesia with etomidate in a patient with acute intermittent porphyria. Can Anaesth Soc J. 1985 Mar;32(2):171-3. #2447
  8. McGovern E, Fleming P, et al. The dental management of five paediatric patients with a history of acute intermittent porphyria. Eur Arch Paediatr Dent. 2007 Dec;8(4):215-8. PMID 18076854. #4641
  9. Minoda Y, Oshimine KY, et al. Anesthetic management of a patient with variegate porphyria. J Anesth 1997;11:307-308. PMID 28921072. #4642
  10. Sarantopoulos CD, Bratanow NC, et al. Uneventful propofol anesthesia in a patient with coexisting hereditary coproporphyria and hereditary angioneurotic edema. Anesthesiology. 2000 Feb;92(2):607-9. #2475
  11. Yamamori Y, Sumi M, et al. Safety of isoflurane and epidural anesthesia in a patient with hereditary coproporphyria. J Anesth 1996 10:80-82 #2477
  12. Summary of Product Characteristics
  13. Norwegian medicines agency. Summary of Product Characteristics (SPC). Niontix. #2473
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