Is there a drug interaction between Repatha (evolocumab) and Lamisil (terbinafine)?

No Clinically Significant Drug Interaction Between Repatha and Lamisil

There is no clinically significant drug interaction between Repatha (evolocumab) and Lamisil (terbinafine), and these medications can be safely used together.

Mechanism and Metabolism

Repatha (Evolocumab)

• Evolocumab is a monoclonal antibody that binds to PCSK9 protein and is eliminated through saturable binding to its target and proteolytic degradation, not through cytochrome P450 enzymes 1.
• No clinically significant drug-drug interactions have been identified for evolocumab 2.
• The pharmacokinetic profile shows no meaningful interactions with concomitant medications, including statins 1.

Lamisil (Terbinafine)

• Terbinafine has minimal drug-drug interactions overall 3.
• The only potentially significant drug interaction with terbinafine is with drugs metabolized by the cytochrome P450 2D6 isoenzyme 3.
• Since evolocumab is not metabolized through cytochrome P450 pathways, there is no mechanistic basis for interaction 1.

Clinical Implications

• Both medications can be administered concurrently without dose adjustments 2, 1.
• No additional monitoring beyond standard recommendations for each individual drug is required when used together 3, 2.
• Terbinafine is cleared mostly by the kidney and binds 99% to plasma proteins, while evolocumab undergoes proteolytic degradation—these distinct elimination pathways further support the absence of interaction 3, 1.

Safety Considerations

For Terbinafine

• Monitor liver function tests in patients with history of heavy alcohol consumption, hepatitis, or pre-existing liver disease 3.
• Warn patients about the rare but potentially permanent taste disturbance 3.

For Evolocumab

• Monitor for hypersensitivity reactions, though these are rare 2.
• Injection site reactions occur in approximately 2.1% of patients and are generally mild 2.