Local anaesthesia and Porphyria. Is Totalcaine forte a safe drug for porphyric patients?

MIKULSKYJ S.J; SCOLNIK O.S; CARABAJAL WALDHUTER T; MARTINEZ MARIA DEL CARMEN; ZUCCOLI, JOHANNA; BUZALEH ANA MARIA

Mar del Plata

Congreso; LXIII Reunión Anual de la Sociedad Argentina de Investigación Clínica.; 2018

SAIC

Acute attacks of Porphyria may be precipitated by exogenous drugs including anaesthetics. There is limited information in the literature about the use of some dental medicines in the acute Porphyrias. The safety of local anaesthetic agents remains a controversial issue because experimental evidence reveals that some of them are porphyrogenic either in animal models (lidocaine) or cell culture (lidocaine, prilocaine, bupivacaine), however clinical experience has shown that its use in patients with acute Porphyria had no notable adverse effects. Articaine (carticaine, methyl-4-methyl-3-(2-propylaminopropionamide)thiophene-2-carboxylate hydrochloride) is a relatively new local anaesthetic and still untried in acute Porphyria, although some reports established its safety and others classified this drug as unsafe. The aim was to investigate the effect of a commercial preparation, Totalcaina Forte (carticaine chlorhidrate:L-adrenaline, Bernabó Laboratories) on heme metabolism in CF1 mice. Animals received different doses (1, 5, 7 mg/kg, s.c.) and were sacrificed at different times (30 and 60 minutes) after injection. 5-Aminolevulinic acid synthetase (ALA-S), Porphobilinogen deaminase (PBG-D) and Heme oxygenase (HO) were measured in different tissues. No variations of ALA-S specific activity was observed with any of the doses and times assayed. PBG-D activity was unchanged for 1 or 5 mg/kg of Totalcaina, independently of the tissue; although a significant reduction of liver activity (35%, p