Local Anaesthesia and Porphyria. Is Totalcaine Forte a Safe Drug for Porphyric Patients?

BATLLE, ALCIRA; MARTINEZ MARÍA DEL CARMEN; BUZALEH, ANA MARÍA; ZUCCOLI, JOHANNA

Burdeos

Congreso; ICPP Porphyrins and Porphyrias 2017; 2017

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 due to experimental evidence reveals that some of them are porphyrogenic in either animal models (lidocaine) or cell culture (lidocaine, prilocaine, bupivacaine), however clinical experience has shown no notable adverse effect in patients with Acute Porphyria. 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, Bernabo Laboratories) on heme metabolism. Animals (CF1 mice) received different doses (1, 5 and 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 liver, brain and blood. Results indicated that ALA-S and PBG-D activity remain unchanged at low doses. Although, in animals receiving 7 mg/kg a slight reduction of liver PBG-D was found. The induction of HO activity (67%, p