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When the diagnosis of a mitochondrial disease is made, you (as a patient) may be confronted with medication/drugs to be used. Up to now there is no treatment for mitochondrial disorders. There are no therapies which can solve the primary problem: the lack of energy. However, it is possible to deal with specific complaints with so called symptomatic treatments. For example: a mitochondrial disorder can lead to epileptic seizures, which can be treated with anti-epileptics or in case of cardiomyopathy (when the heart muscle is affected) specific heart medication can be given. Additionally, you can be confronted with medication when you have to undergo surgery or medical investigation and need anaesthesia.

It is of the utmost importance to realise that certain drugs may be potentially harmful for patients with mitochondrial disorders. The cause of the possible larger risk of unwanted negative effects of certain drugs with mitochondrial disorders in general lies in the fact that the drugs have a negative impact on the mitochondrial function. The (group of) drugs of which it is scientifically known that there is an (possible) increased risk on harmful effects with mitochondrial patients are listed in the table below. The kind of scientific evidence for negative effects on the mitochondrial function differs per (group of) drugs. We labelled the (group of) drugs based on the kind of scientific evidence, while we do not aim to restrict important drugs in a condition where treatment options are already so limited. In the majority it concerns experimental data, marked as yellow. These drugs may be used under strict monitoring of side effects. For other drugs scientific evidence concerns experimental data and single case reports, marked as orange. These drugs should be used with caution, discuss with specialist. Or a few drugs scientific evidence is profound, marked as red. These drugs are contraindicated.

The list only covers drugs which are prescribed relatively often. For other drugs it is recommendable to strictly monitor the effects.

In order to prevent (seriously) harmful effects, you as a patient must communicate with your doctor and pharmacist that you have been diagnosed with a mitochondrial disorder. Only under this condition the responsible team which is treating you can make a deliberate and safe choice, if drugs need to be prescribed.

Category

Generic name

Brand name *

Analgesics - Antipyretics

acetaminophen

Paracetamol, Tylenol, Actamin

 

salicylates

Aspirin, Aspegic

 

tramadol

Tramal, Tramalgetic

NSAIDs

diclofenac, indomethacin, naproxen

Voltaren, Indocin, Aleve

Antipsychotic neuroleptic drugs

chlorpromazine

Thorazine

 

fluphenazine

Permitil, Prolixin

 

haloperidol

Haldol, Decanoate

 

risperidone

Risperdal

 

clozapine

Clozaril, Clopine

Antidepressants

fluoxetine

Prozac

Antiepileptic drugs

valproic acid

Depakine, Depakote

 

carbamazepine, oxcarbazepine, phenobarbital, zonisamide, topiramate, gabapentin, vigabatrin

Tegretol, Trileptal, Luminal, Zonegran, Topamax, Neurontin, Sabril

 

phenytoin

Dilantin, Epanutin

(Local) anesthetics

bupivacaine

Marcaine

 

lidocaine

Xylocaine

 

propofol (longterm anesthesia > 48 hours)

Diprivan, Propoven

 

thiopental

Pentothal

Inhalation anesthetics

isoflurane, sevoflurane

Forane, Ultane

Muscle relaxants

Cis-atracurium, mivacurium

No brand names

Antidiabetic drugs

biguanide drugs (metformin)

Glucophage

 

thiazolidinedione (glitazones)

Avandia

Anticancer drugs

Mitomycin C, doxorubicin, cisplatin, cyclophosphamide

Mitosol, Platinol, Cytoxan

Fibrate drugs

clofibrate, ciprofibrate

Modalim

Statins

cerivastatin, simvastatin

Lipobay, Zocor

Antiarrhytmics

amiodarone

Cordarone

 

beta-blockers (metoprolol, propranolol)

Lopressor, Inderal

Antiretroviral drugs

zidovudine, abacavir

Retrovir, Ziagen

Antibiotics

aminoglycosides

Amikacin, Gentamicin

 

chloramphenicol

Chloromycetin

 

tetracyclines

Minocin, Sumycin

 

linezolide

Zyvox

 

quinolones

Floxin, Ciproxin

Corticosteroids

Hydrocortisone, dexamethason, prednisone

Cortef, Decadron

* The examples mentioned represent commercial branding names, which can change on a daily basis and varies between countries / parts of the world. Thus, this list is by no means complete. The active substances mentioned are leading.

Red = contraindicated

Orange = use with caution, discuss with specialist

Yellow = may be used under strict monitoring

Sources:

- “Risico’s van medicatie bij mitochondriele aandoeningen”, 2010, UMC St. Radboud, Nijmegen Centre for Mitochondrial Disease, Prof.dr. J. Smeitink and drs. M.C. de Vries

- “Medications to be avoided”, June 2013, Newcastle University, Wellcome Trust Centre for Mitochondrial Research, Dr Andy Schaefer and Catherine Feeney 

- “Mitochondrial toxicity”, May 2010, Mitochondrial Disease Action Committee – MitoAction, Massachusetts General Hospital, Dr. Katherine Sims

- “Dangerous drugs for mitochondrial patients”, Università Cattolica del Sacro Cuore, Rome, Prof. S. Servidei

- “Potentially harmful drugs for mitochondrial patients” (this version) revised by drs. M.C. de Vries of the UMC St. Radboud, Nijmegen Centre for Mitochondrial Disease

- Katie Chan, Don Truong, Drug-induced mitochondrial toxicity, Expert Opin Drug Metab Toxicol 2005; 1(4): 655-669

- Sumit Parikh, Russel Saneto. A modern approach to the treatment of mitochondrial disease. Cur Treat Opt Neur 2009; 11(6): 414-430

- Josef Finsterer, Liane Segall. Drugs interfering with mitochondrial disorders. Drug Chem Tox 2010; 33 (2):138-151

- Schirris TJ, Renkema. Statin-induced myopathy is associated with mitochondrial complex III inhibition. Cell Metab 2015; 22(3): 399-407

- Josef Finsterer, Sinda Zarrouk Mahjoub. Mitochondrial toxicity of antiepileptic drugs and their tolerability in mitochondrial disorders. Expert Opin Drug Metab Toxicol 2012; 8(1):, 71-79

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