From the Guidelines
Lamisil (terbinafine) is contraindicated in patients with active or chronic liver disease, severe renal impairment, or hypersensitivity to terbinafine or any component of the formulation. The contraindications for Lamisil are based on the potential for hepatotoxicity and reduced clearance in patients with severe liver or kidney disease 1. Patients with a history of liver disease should not use Lamisil, as it is metabolized in the liver and can cause hepatotoxicity. Additionally, patients with creatinine clearance less than 50 mL/min should avoid this medication due to reduced clearance.
Key Contraindications
- Active or chronic liver disease
- Severe renal impairment
- Hypersensitivity to terbinafine or any component of the formulation
- Pregnancy and breastfeeding due to insufficient safety data
Important Considerations
- Caution is needed in patients taking medications that are metabolized by CYP2D6, such as certain antidepressants, beta-blockers, and antiarrhythmics, as terbinafine can inhibit this enzyme and increase blood levels of these drugs 1.
- Patients with pre-existing hematologic disorders should be monitored closely as terbinafine has been associated with blood dyscrasias.
- Baseline liver function tests should be obtained before starting Lamisil, and patients should be monitored for signs of liver dysfunction, including fatigue, anorexia, right upper abdominal pain, dark urine, or jaundice 1.
Monitoring and Precautions
- Monitor liver function tests and complete full blood count in patients with a history of hepatotoxicity or haematological abnormalities 1.
- Discontinue the medication if signs of liver dysfunction develop.
- Consider baseline monitoring for children, as terbinafine is not licensed for use in treating pediatric onychomycosis 1.
From the FDA Drug Label
Terbinafine tablets are contraindicated in patients with: • Chronic or active liver disease [see Warnings and Precautions (5. 1)] • History of allergic reaction to oral terbinafine because of the risk of anaphylaxis [see Adverse Reactions (6.2)]
The contraindications for Lamisil (terbinafine) are:
- Chronic or active liver disease
- History of allergic reaction to oral terbinafine due to the risk of anaphylaxis 2 2 2
From the Research
Contraindications for Lamisil (Terbinafine)
- The studies provided do not give a comprehensive list of contraindications for Lamisil (Terbinafine) but do mention some conditions where caution is advised or where the drug is considered contraindicated:
- Liver disease: Terbinafine is often considered contraindicated in those with liver disease due to the risk of hepatotoxicity 3, 4.
- Autoimmune hepatitis: However, a case study suggests that terbinafine can be used safely in patients with stable autoimmune hepatitis under close monitoring and precautions 3.
- Other potential contraindications or precautions are not explicitly mentioned in the provided studies, but it is known that terbinafine can cause side effects such as gastrointestinal symptoms, allergy, and miscellaneous mild non-specific symptoms 5, 6, 7.
Precautions and Warnings
- Patients with pre-existing liver disease should be closely monitored while taking terbinafine, with baseline liver function tests and consideration of further monitoring during the treatment course 3.
- The use of terbinafine in patients with serious infections or immunological defects should be carefully evaluated, considering the potential benefits and risks 7.