Table 4 Medication cautions

From: Patient care standards for primary mitochondrial disease: a consensus statement from the Mitochondrial Medicine Society

Medication

Common uses

Concern in mitochondrial disease

Acetaminophen

Analgesic, fever prevention, headaches

Chronic or frequent use may deplete glutathione and cause hepatopathy

Aminoglycosides

Antibiotic

Hearing loss

Antiretrovirals

HIV therapy

Impaired mtDNA replication and worsening peripheral neuropathy, liver dysfunction, or myopathy

Botulinum toxin

Dystonia, spasticity

Worsening of weakness

Butterbur

Headache

May contain pyrrolizidine alkaloids (oxidants) and cause hepatopathy

Metformin

Diabetes

Lactic acidosis

Topiramate

Epilepsy, headache, intracranial hypertension

Lactic acidosis

Statins

Hypercholesterolemia

Worsening myopathy and elevated creatine kinase

Valproic acid

Epilepsy, headache, mood disorders, movement disorders, tone abnormalities

Irreversible liver failure and onset of hepatoencephalopathy, especially in POLG-related disorders; worsening of seizures

Vigabatrin

Epilepsy

Inhibition of the mitochondrial nucleoside salvage pathway and worsening of mtDNA depletion disorders

  1. mtDNA, mitochondrial DNA.
  2. With the exception of valproic acid in POLG-related disorders, these medications are not contraindicated and may be used with caution.
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