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Oral anti-fungal medication for fungal toenails: Terbinafine / Lamisil

Terbinafine / Lamisil for Fungal Infections of Nails.

Lamisil / terbinafine for infected fungal toenails
Be sure to discuss your alcohol consumption with your doctor before using oral anti-fungal drugs.

A medication in tablet form is available that has proven to be quite effective in curing fungal toenail and finger nail infections.  The active ingredient is Terbinafine Hydrochloride. The original, trademarked name is Lamisil but generic versions of the drug are also available.  The same active ingredient is also used in a variety of topical applications for skin and nail infections.  The topical creams are available over the counter at the pharmacy but the oral medication is only available with a prescription.

In the tablet form, Terbinafine is very effective, although some manual care of the nail by a podiatrist during treatment will improve the chance of success. This is because the collection of debris that forms under an infected nail will stop the growing nail from attaching properly to the nail bed. If the nail bed is cleared of this layer at intervals of around six weeks, a better result may be attained.

Considerations before using Terbinafine / Lamisil for fungal nail infections

When thinking about taking Lamisil, we would advise you to do some preliminary research before talking to your G.P. or prescribing podiatrist.  The main issue that we believe you should be aware of, is that Terbinafine can be harsh on the liver.  Extra consideration is needed if you have known liver problems, drink or have drunk significant quantities of alcohol or take other pharmaceutical or recreational drugs that rely on the liver to metabolise them.  It is wise to have a liver function test prior to starting a course of treatment.  Most instances of liver failure and death have occurred within a month of commencing the drug.  Therefore we recommend you do a  follow up liver function test early in the course of treatment is also wise.  The blood test should assess serum transaminases.

Australian Government warning re Terbinafine and Lamisil

You may wish to read more about the Australian Government’s Therapeutic Goods Administration (TGA) warning.  It relates to the use of Terbinafine and was published in 2008.  You can read the statement here: http://news.smh.com.au/national/lamisil-pill-linked-to-liver-deaths-tga-20080204-1q1m.html

As an alternative to oral drug treatment for fungal nails, our practice is pleased to offer laser anti-fungal therapy.  You can read a full account of the pros and cons of laser treatment here.

 

Other points of interest about Terbinafine / Lamisil.

Some of the following points are a little technical.  Uncommon terms are explained as we go along.

  • Additionally, the prescription of oral Terbinafine requires a positive nail scraping to be eligible for PBS rebates.  Around 80% of scrapings return a negative result in the face of a clinically apparent infection.  When this occurs, the drug cannot be issued under the PBS. It would need to be supplied as a private script which has different pricing.
  • The soundness of the kidney (renal) and immune systems should also be considered. Terbinafine has been implicated in immunosuppression via neutropenia.  Neutropenia involves the reduction in  white blood cells called neutrophils.
  • Side effects are common. These may include: nausea, depression and (at the worst extreme) life threatening liver failure. Epidermal necrolysis – also known as Stevens-Johnson Syndrome – is a potentially fatal skin condition.
  • You must also be aware that you should control your consumption of alcohol during the treatment.  It may be safest to use other treatments when heavy alcohol use is occurring or has occurred in the past.
  • As Terbinafine reduces the activity of the CYP450-2D6 isozyme. This is an enzyme in your liver that changes molecules from one substance to another. Some drugs are predominantly broken down via this pathway.  The concentrations of these need to be carefully monitored and doses reduced accordingly.  This includes (among others) the following drug classes: tricyclic antidepressants, selective serotonin reuptake inhibitors, beta-blockers, class 1C anti-arrhythmics  and MAOIs Type B.
  • Care should be used where multiple medications are already in use.  This is, of course, a particular concern given the age range of those most commonly afflicted with onychomycosis.

 

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