Terbinafine and Seizure Threshold
Based on available evidence, terbinafine does NOT appear to lower seizure threshold and is not documented as a seizurogenic medication.
Evidence Assessment
The provided evidence does not establish any link between terbinafine and seizure risk:
No documented seizure risk: The British Association of Dermatologists' comprehensive safety profile for terbinafine does not list seizures or lowered seizure threshold among its known adverse effects 1
Known side effects are primarily non-neurological: The most common adverse effects include gastrointestinal disturbances (49% of reported side effects), dermatological events (23%), and rare hepatic toxicity—with no mention of neurological or seizure-related complications 1
Contrast with Medications That DO Lower Seizure Threshold
The evidence clearly documents which medications lower seizure threshold, and terbinafine is notably absent:
Antiviral medications: Amantadine shows an increased incidence of seizures in patients with seizure disorders, requiring close observation 2
Antibiotics: Amoxicillin is specifically noted to interact with "bupropion and other agents lowering seizure threshold" 2, and beta-lactams like meropenem have documented pro-convulsive activity 3
Psychotropic drugs: Antidepressants and antipsychotics are well-established seizure threshold reducers, with seizure incidence rates of 0.1-1.5% at therapeutic doses 4
Clinical Implications
Safe in seizure-prone patients: Unlike amantadine, rimantadine, or psychotropic medications, terbinafine does not require special monitoring or dose adjustments in patients with seizure disorders 1, 5, 6, 7
Low drug interaction potential: Terbinafine has a relatively low potential for drug interactions overall, which further supports its safety profile 6, 7, 8
Primary monitoring concerns: When prescribing terbinafine, focus on hepatic function (baseline liver function tests in high-risk patients) and renal function (contraindicated in renal impairment), not seizure risk 1