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 Adverse Cases


Back Reported Adverse Drug Reaction Cases
Hepatic reactions with terbinafine

Oral terbinafine (Lamisil) is approved for the treatment of fungal infections of the nails and skin (ringworm) that are not responsive to topical therapy. ADRAC is concerned that in some cases the oral form of terbinafine may be selected without any trial of topical therapy, thereby putting the patient at risk of rare but serious and life-threatening toxicities such as agranulocytosis and other blood dyscrasias, Stevens-Johnson syndrome, and liver failure.

ADRAC has previously drawn attention to serious adverse reactions associated with orally administered terbinafine.1,2,3 Recently, the Committee reviewed a report describing an 81 year old female with previously normal liver function who developed cholestatic hepatitis some 3 weeks after commencing oral terbinafine treatment 250 mg daily for a fungal infection of the big toe. The patient subsequently died in hepatorenal failure.

Of the total 722 adverse event reports received up to January 2008 in connection with terbinafine (all dose forms), 70 describe hepatic reactions and most (61) implicated oral terbinafine as the sole suspected drug. Onychomycosis was the most commonly cited reason for use of terbinafine; patient age ranged from 20 to 85 (median 58) years, and men and women were affected equally. Half of the reports documented onset of hepatic reaction within the first month and 80% within 7 weeks. Most of the reports document minor abnormalities of liver function but 3 describe fatal liver failure, 10 describe hepatitis, and 12 describe jaundice. Full recovery was noted in 27 reports but 34 cases had not recovered and the outcome remained unknown in 9.

ADRAC reminds prescribers that oral terbinafine can be associated with rare but serious and life-threatening toxicities. Doctors prescribing oral terbinafine should be confident there is a clear indication for its use. Oral terbinafine should be prescribed only after topical therapy has failed and for the shortest time possible, in accordance with the current Product Information.

Reference
  1. Life threatening blood dyscrasias with oral terbinafine. Aust Adv Drug React Bull 2006; 25(4): 15.
  2. Terbinafine and blood dyscrasias. Aust Adv Drug React Bull 2004; 23(5): 19.
  3. Terbinafine a question of taste. Aust Adv Drug React Bull 1996; 15(1): 2-3.
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References:
The Australian Adverse Drug Reactions Bulletin, Volume 27, Number 1 (February 2008)

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