Can Statins and Terbinafine Be Taken Together?
Yes, statins and terbinafine can be safely taken together, as terbinafine does not inhibit CYP3A4 (the primary metabolic pathway for most statins) and has minimal drug-drug interactions with statins. 1, 2
Why This Combination Is Safe
The key to understanding this interaction lies in the metabolic pathways:
Terbinafine is NOT a CYP3A4 inhibitor - Unlike azole antifungals (itraconazole, posaconazole, voriconazole) which are potent CYP3A4 inhibitors and cause dangerous interactions with statins, terbinafine does not inhibit this enzyme 3, 2
Terbinafine primarily inhibits CYP2D6 - This affects drugs like tricyclic antidepressants and tamoxifen, but not statins 2
Guidelines specifically list "various anti-fungal agents" as problematic - but this refers to azole antifungals, not terbinafine 1
Evidence Supporting Safe Coadministration
The British Association of Dermatologists explicitly states that terbinafine has "minimal drug-drug interactions" and can be used safely in older and multimorbid patients, unlike azole antifungals 1
A case report documenting statin-associated rhabdomyolysis with itraconazole specifically recommends terbinafine as a safe alternative: when antifungal treatment is needed in patients on statins, clinicians should use "a non-CYP3A4-inhibiting antifungal drug such as terbinafine" 3
Practical Management
No dose adjustment of either medication is required 1, 2
Standard monitoring applies:
- Evaluate muscle symptoms (pain, soreness, tenderness, weakness) before starting therapy and at 6-12 weeks 1
- Obtain CK measurement only if muscle symptoms develop 1
- Baseline liver function tests if the patient has history of heavy alcohol consumption or hepatitis 1
Warn patients to report immediately:
- Unexplained muscle pain, tenderness, weakness, or cramping 4
- Dark or cola-colored urine 4
- Severe muscle pain interfering with daily activities 4
Critical Distinction: Terbinafine vs. Azole Antifungals
This is NOT the same as combining statins with azole antifungals (itraconazole, posaconazole, voriconazole), which are potent CYP3A4 inhibitors and cause dangerous elevations in statin levels, leading to rhabdomyolysis 3
If an azole antifungal is required in a patient on a CYP3A4-metabolized statin (simvastatin, atorvastatin, lovastatin), you must either:
- Switch to a non-CYP3A4 statin (pravastatin, rosuvastatin, pitavastatin) 1, 3
- Temporarily discontinue the statin 3
- Use topical antifungal administration if possible 3
Common Pitfall to Avoid
Do not confuse terbinafine with azole antifungals - The ACC/AHA guidelines listing "various anti-fungal agents" as relative contraindications refer specifically to azole antifungals that inhibit CYP3A4, not to terbinafine 1, 3