Many medications can trigger acute porphyria attacks by increasing the production of porphyrins. Common culprits include certain antibiotics, hormones, and antiseizure drugs. Even some over-the-counter medications can be problematic. It's crucial for porphyria patients to consult with their doctors before starting any new medication, and to carry a list of safe and unsafe drugs.

Hormonal changes can be a significant trigger, especially for women with acute porphyrias. Attacks may occur during the luteal phase of the menstrual cycle when progesterone levels rise. Pregnancy and hormonal contraceptives can also increase the risk of attacks. Some women may need to avoid hormonal birth control methods and work closely with their doctors during pregnancy.

Several lifestyle factors can contribute to porphyria attacks or symptom flare-ups. Stress is a common trigger for many types of porphyria. Fasting or extreme dieting can also provoke attacks in acute porphyrias. For cutaneous porphyrias, sun exposure is a major trigger for skin symptoms. Alcohol consumption can exacerbate symptoms in some types of porphyria, particularly porphyria cutanea tarda.

By identifying and avoiding personal triggers, many people with porphyria can significantly reduce their risk of attacks and improve their quality of life.