Inherited disorders: Porphyria

Last updated: Tuesday, September 07, 2021

These pages about porphyria were prepared in partnership with BIPNET, the British and Irish Porphyria Network, and the UK Porphyria Medicines Information Service, Cardiff. We'd like to thank these partners for contributing their clinical expertise and support.

Porphyrias are a group of inherited metabolic disorders of the haem biosynthesis pathway, caused by a fault with one of the enzymes involved. Haem is a molecule created by human metabolism and is used to build bigger molecules such as haemoglobin, myoglobin, and cytochrome. Porphyrias lead to accumulation of neurotoxic and/or phototoxic haem precursors, so these conditions are characterised by acute neurological and visceral symptoms ('neurovisceral crises') and/or skin lesions.

What type of porphyria?

It is important to understand the type of porphyria your patient has been diagnosed with, and in particular whether it is acute porphyria or non-acute porphyria.

In practice, acute intermittent porphyria (AIP), variegate porphyria (VP) and hereditary coproporphyria (HCP) are the conditions that pharmacists may see presenting as an acute attack. Many factors can precipitate an acute attack by increasing the body's need for haem, and they act cumulatively. In patients with porphyria the haem is produced, but precursors in the pathway may accumulate and cause the symptoms of an acute attack. Some example precipitating factors are shown below:

Early symptoms of an acute attack can include: tachycardia, acute severe abdominal pain, nausea and vomiting, constipation, peripheral motor neuropathy, and paraesthesia. This may progress to severe cardiovascular, neurological and psychiatric symptoms, and a progressive, irreversible neuropathy. Ultimately, this can be fatal if untreated.