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Modern Treatments for Fungal Nail Infections
Lamisil Tablets are a safe, effective option for people
seeking to treat onychomicosis.
 By RealAge, Inc., a leader in providing health information
to help people live healthier, longer lives.
Modern medicine includes many checks and balances to help ensure the medications
you use to treat a condition are appropriate and safe. The U.S. Food and Drug Administration
helps make sure safe and effective medications make it to market. Healthcare providers
help you determine which medications best fit your medical needs with minimum risks.
And pharmacists help ensure the medications your doctor prescribes are appropriately
dispensed to you.
But there is a fourth step in ensuring the safety and appropriateness of your medication:
you, the consumer. Armed with the best information, you can make informed decisions
that will help maximize the safety and effectiveness of your medications.
In treating fungal nail infections, you have many choices. Historically, the condition
has been difficult to treat. Early medications, such as itraconazole (Sporanox®),
topical creams and lotions, or griseofulvin (Grisactin®, Fulvicin®), often produce
disappointing results or have a high relapse rate. Some of these medications also
have a high potential for causing undesirable side effects or interacting with other
medications -- an important consideration because studies suggest as many as 40%
of people use other medications along with their antifungal nail treatment.
Now there are newer, safer, more effective medication choices. New oral medications
can produce good results in a relatively short period -- 6 to 12 weeks. Examples
include terbinafine (Lamisil®) and fluconazole (Diflucan®). Oral terbinafine is
considered a first-line treatment for fungal nail infections caused by dermatophytes,
which cause most fungal nail infections. Other oral medication choices, such as
itraconazole and fluconazole, may be preferred for nail fungal infections caused
by other types of fungi, such as candidal infections.
In helping you choose the right medication, your doctor will consider your symptoms
and the overall risks and benefits of each medication option based on your unique
health profile. Each medication has different risks and different potential side
effects.
Safety Record of Lamisil Tablets
Lamisil Tablets are an oral form of terbinafine, and 10 year’s worth of study data
show a good safety record for this product. Most side effects are fairly rare and
mild, ranging from stomach upset to a rash or a headache. In post-marketing surveillance
of Lamisil Tablets involving over 25,000 patients, about 10% of the people experienced
side effects, the most common of which was stomach upset, which occurred in less
than 5% of patients, and skin rashes, which occurred in only 2.3% of patients. Side
effects such as these cleared up after treatment. Only very rarely did serious adverse
events -- such as allergic reactions or low white blood cell counts -- occur. Events
of this magnitude occurred in only .04% of patients.
Although side effects with Lamisil Tablets tend to be mild, people who consider
this medication will be informed of the potential for liver enzyme abnormalities,
one of the more serious but still rare potential side effects of the medication.
The liver metabolizes oral terbinafine, so liver health should be monitored before,
and possibly during, treatment. The goal is to screen for liver enzyme abnormalities
that might signal damage or injury to the liver.
Evaluating Liver Health
Evaluating liver health before terbinafine treatment and screening liver function
during treatment can help make rare liver function problems even less likely. The
risks from Lamisil Tablets to liver health are low to begin with, in part because
the treatment duration is relatively short -- 12 weeks for toenails and 6 weeks
for fingernails. Also, any effects are transient and reverse after treatment. But
screening could help avert the occurrence of liver side effects altogether because
only people not at risk of liver function problems would be screened in to use terbinafine.
The liver is a detoxifying organ, and liver enzymes help inactivate harmful substances
in the body. Too many foreign agents in the liver could inhibit liver function,
causing liver enzymes to leak into the blood stream. Measuring liver enzyme levels
in the bloodstream can help determine whether the liver is functioning optimally.
Potential Causes of Elevated Liver Enzymes
- hepatitis B or C
- drug use
- excessive alcohol intake
- exposure to toxins
- fatty liver disease
- tumors
- congestive heart failure
- nutritional deficiencies
- muscle injury
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People whose livers are in poor health, such as people with chronic or active liver
disease, should be screened out of treatment with oral terbinafine. Also, because
terbinafine has not been studied in people with renal failure, this group also should
be excluded from treatment until more research is available.
People whose livers are in good health, however, and who do not have other contraindications
for using terbinafine, are at low risk for liver-related side effects. And a liver
function test before and during treatment can help ensure safety.
People whose prescreening blood tests show elevated liver enzymes in the blood may
not be right for treatment with Lamisil Tablets, but it depends on the cause of
those elevated enzyme levels. The elevation could be temporary, or it could be a
marker of a chronic underlying health problem. Heavy drinking may raise levels,
especially when combined with the use of acetaminophen. Liver enzyme levels also
might rise temporarily after muscle injury, such as from severe muscular exertion
or from trauma. Possible reasons for chronic elevations in liver enzyme levels include
liver damage, liver inflammation, or other chronic medical conditions, such as hypothyroidism
or congestive heart failure.
Depending on the cause or nature of the elevated enzyme levels, a healthcare provider
might recommend against treatment with Lamisil Tablets or recommend rescreening
liver function later.
Medication Interactions
Another important consideration when deciding on terbinafine treatment is whether
it might interact with other drugs you take. There is a short list of medications
with which terbinafine might interfere, or vice versa. For the most part, however,
Lamisil Tablets have a relatively clean drug-drug interaction profile. Medications
that are metabolized using the same enzyme system through which oral terbinafine
is metabolized carry the potential for drug-drug interactions, but there were no
reports of any interactions in post-marketing surveillance of Lamisil Tablets in
over 25,000 patients, 40% of whom used at least one other medication concomitantly
with Lamisil Tablets.
Medications That Do Not Interact with Oral Terbinafine
- tolbutamide (Orinase®)
- ethinylestradiol (Premarin®, Estrace®, Ogen®)
- ethoxycoumarin
- cyclosporine (Neoral®, Sandimmune®)
Medications with Which Oral Terbinafine Might Interact
- tricyclic antidepressants (Anafranil®, Vivactil®)
- beta blockers (Inderol®, Levatol®)
- SSRIs (Paxil®, Zoloft®)
- MAO inhibitors (Nardil®, Marplan®)
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No drug-drug interaction study data exist for Lamisil Tablets and some medications,
but the nature of terbinafine and its mechanism of action suggest there should be
little if any interaction.
Consider Your Own Health Profile
Your doctor is your best source of information when deciding on a treatment course
for a fungal nail infection. If after evaluating your health history, symptoms,
medications, and liver function blood tests your doctor recommends oral Lamisil
Tablets, you can maximize safety by using the medication exactly as your healthcare
provider prescribes and by monitoring your health throughout treatment with follow-up
visits.
All medications come with risks, benefits, and the potential for side effects --
from simple aspirin to antibiotics. The safety record of oral Lamisil Tablets and
the low risk for drug interactions make this product a good choice for many people
whose personal health profiles fit with the risk and benefit profile of this medication.
Work with your doctor to find the safest and most effective solution for you.
Copyright© 2008, RealAge, Inc. All rights reserved. RealAge shall not be liable
for any errors or delays in the content, or for any actions taken in reliance thereon.
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