Acute Intermittent Porphyria - Relief of Severe Pain after Treatment with Chlorpromazine Hydrochloride

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THE intense pain that accompanies acute intermittent porphyria is often so severe and incapacitating that its alleviation becomes a primary therapeutic objective. Melby, Street, and Watson,1 and Melby and Watson2 reported that chlorpromazine hydrochloride* was an effective agent in this regard. Lee and Lucas3 stated that trifluoperazine dihydrochloride (another phenothiazine) gave dramatic relief of pain in a patient having acute intermittent porphyria. The purpose of this paper is to report the efficacy of chlorpromazine in abolishing pain, after other agents were ineffective.

Report of a Case

A 26-year-old woman was admitted to the Cleveland Clinic Hospital on March 12, I960, because of severe abdominal cramps, and pain in the back, in association with acute intermittent porphyria. She stated she had not felt well since the normal delivery of a healthy child in January, 1959. In October of that year she was thought to have mumps; one month later she experienced severe suprapubic colicky pain, low back pain, and first noted dark urine. Pertinent facts in her family history are: her father had had repeated episodes of abdominal pain but had received no specific treatment; her mother, five brothers, two sisters, and two sons were asymptomatic.

On November 20, 1959, she was admitted to another hospital where a diagnosis of acute porphyria was made. During that hospitalization she was disoriented, with intense abdominal pain, and had quadriplegia. Phenobarbital was taken in a dosage of 1 ½ gr., at bedtime, on eight consecutive nights. Prochlorperazine, in a dosage of 10 mg. administered . . .



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