From the Guidelines
Terbinafine is generally not contraindicated for patients with a history of pulmonary embolism or hypercoagulation syndrome, as there is no established direct relationship between terbinafine and increased risk of blood clots or thromboembolic events. According to the British Association of Dermatologists' guidelines for the management of onychomycosis 1, the main contraindications for terbinafine include hepatic impairment, renal impairment, and hypersensitivity to terbinafine. The guidelines recommend a dose of 250 mg per day for 6 weeks in fingernail and 12–16 weeks in toenail infection, with baseline liver function tests and a complete full blood count recommended in adult patients with a history of hepatotoxicity or haematological abnormalities 1.
Some key points to consider when prescribing terbinafine to patients with a history of pulmonary embolism or hypercoagulation syndrome include:
- Monitoring for signs of thromboembolic events, although the risk is not increased with terbinafine use
- Informing patients about the importance of reporting any changes in their medical history or condition
- Regular monitoring of liver function, especially in patients with pre-existing liver conditions 1
- Being aware of potential side effects, including headache, gastrointestinal disturbances, and rarely liver enzyme abnormalities 1
It is essential to weigh the benefits of terbinafine treatment against the potential risks and to consider alternative treatment options if necessary. However, based on the current evidence, terbinafine can be a safe and effective treatment option for patients with onychomycosis, including those with a history of pulmonary embolism or hypercoagulation syndrome 1.
From the Research
Contraindications for Long-Term Terbinafine Use
There are no direct research papers provided to assist in answering the question about contraindications for long-term terbinafine use in patients with a history of pulmonary embolism or hypercoagulation syndrome.
Available Information on Terbinafine
- Terbinafine is an effective treatment for onychomycosis, with studies showing its efficacy against dermatophyte and non-dermatophyte mold infections 2, 3, 4.
- The medication has been compared to other antifungal agents, such as itraconazole and fluconazole, in terms of efficacy and safety 2, 5, 6.
- Factors that may influence the effectiveness of terbinafine include age, baseline severity of the infection, and presence of certain comorbidities like atherosclerosis or hyperlipidemia 4.
Lack of Relevant Information
- None of the provided studies specifically address the use of long-term terbinafine in patients with a history of pulmonary embolism or hypercoagulation syndrome.
- Therefore, it is not possible to determine contraindications for long-term terbinafine use in these patients based on the available evidence.