Psychotropic drugs in acute intermittent porphyria

Acute intermittent porphyria is one of a group of metabolic diseases called the porphyrias that may lead to symptoms of the central nervous system dur ing an acute exacerbation. Certain drugs such as barbiturates are known to precipitate attacks of acute intermittent porphyria, but unfortunately ther e is little information regarding the safety of many psychotropic drugs in this disorder, especially the newer antidepressants and atypical antipsycho tics, We report a case of an elderly patient with acute intermittent porphy ria who was treated with a variety of psychotropic agents for a severe depr ession with psychotic features. Although many of the agents did not improve the psychiatric status of the patient, all the drugs were tolerated withou t precipitating an episode of acute intermittent porphyria, To our knowledg e, this is the first report of the safe use of sertraline, venlafaxine, ola nzapine, risperidone, clozapine, buspirone, trazodone, lorazepam, and clona zepam in a patient with documented acute intermittent porphyria, Our report also supports the safety of trifluoperazine. Although response and sensiti vity to drugs may vary greatly among patients with this disorder, clinician s may want to consider the possibility of the above drugs to treat psychiat ric symptoms in patients with acute intermittent porphyria.