How to protect your liver while taking Lamisil (Terbinafine)?
By
Dr Natalia Marceli Stephanes (PhD)
Author bio
Dr Natália Marcéli Stephanes PhD is a Pharmacist with expertise in Drugs Administration and Toxicity; Discovery of New Drugs; Cancer Treatment; Biochemical Analyzes and Hematological Analyzes. She writes and reviews content on these topics.
Dr Natália Marcéli Stephanes’ Highlights:
- Pharmacist at the Department of Health of Santa Catarina State, Brazil
- PhD with a focus on oncology treatment
- Years of experience in commercial pharmacy
- Bachelor, Master and PhD degrees in Pharmacy at the Federal University of Santa Catarina
Professional Experience:
From her undergraduate studies to her Master’s and Doctorate degrees in Pharmacy, Dr Natália Marcéli Stephanes has participated in numerous scientific studies in the field of oncology and onco-hematology at the University Hospital of the Federal University of Santa Catarina, Brazil. Her research has focused on understanding the molecular and biochemical bases of malignant neoplasms and investigating safer and more effective therapeutic alternatives.
Dr Natália Marcéli Stephanes has also served as an assistant professor of haematology for undergraduate students at the Federal University of Santa Catarina. Additionally, she held the position of professor of Hospital Pharmacy at the Qualificar Technical School in Brazil, where she developed instructional materials for use in the Pharmacy Postgraduate Program at the Leonardo Da Vinci University Center.
In addition to her academic experiences, Dr Natália Marcéli Stephanes possesses a strong expertise in commercial pharmacy, with in-depth knowledge of medications, their routes of administration, desired effects, adverse effects, and toxicity.
Currently, Dr Natália Marcéli Stephanes works as a Pharmacist at the Health Department of Santa Catarina State, where her role entails providing pharmaceutical scientific consulting services to judges.
Education:
- 2016 Bachelor in Pharmacy at the Federal University of Santa Catarina, Brazil
- 2018 Master in Pharmacy at the Federal University of Santa Catarina, Brazil
- 2023 PhD in Pharmacy at the Federal University of Santa Catarina, Brazil
The main publications of Dr Natália Marcéli Stephanes are:
Falchetti M ; Delgobo M, Zancanaro H, Almeida K, Das Neves RN, Dos Santos B, Stefanes NM, et al. Bishop Omics-based identification of an NRF2-related auranofin resistance signature in cancer: Insights into drug repurposing. Comput. Biol. Med [Internet]. 2023; 152:106347.
Feuser PM, Matos dos Santos PC, Cordeiro AP, Stefanes NM, Walter LO, Maioral MF, Santos-Silva MC, et al. Antineoplastic activity of free 4-nitrochalcone and encapsulated in poly(thioether-ester) nanoparticles obtained by thiol-ene polymerization in two human leukemia cell lines (Jurkat and K562). J Drug Deliv Sci Technol [Internet]. 2022; 67:102924.
Jacques AV, Stefanes NM, Walter LO, Perondi DM, Efe FL, Souza LFS, Sens L, et al. Synthesis of chalcones derived from 1-naphthylacetophenone and evaluation of their cytotoxic and apoptotic effects in acute leukemia cell lines. Bioorg. Chem [Internet]. 2021; 116:105315.
Duarte BF, Vieira DSC, Lisboa ML, Stefanes NM, Grando LJ, Santos-Silva MC. Características clínico-epidemiológicas de pacientes portadores de carcinoma de células escamosas de boca. Arquivos Catarinenses de Medicina. 2021; 50(2): 232–245.
Machado V, Jacques AV, Stefanes NM, Santos-Silva MC, Biavatti MW. Anti-leukemic activity of semisynthetic derivatives of Lupeol. Nat. Prod. Res. 2021; 35(22):4494-4501.
Bigolin A, Maioral MF, Stefanes NM, Mascarello A, Chiaradia-Delatorre LD, Nunes RJ, Yunes RA, et al. A novel sulfonamide derivative as a strong and selective apoptotic agent against hematological malignancies. Chem. Pap. 2020; 74:2965–2976.
Bigolin A, Maioral MF, Stefanes NM, Zatelli GA, Philippus AC, Falkenberg MB, Santos-Silva MC. Cytotoxic mechanisms of primin, a natural quinone isolated from Eugenia hiemalis, on hematological cancer cell lines. Anticancer Drugs. 2020; 31(7):709-717.
Maioral MF, Stefanes NM, Neufeldt PD, Chiaradia-Delatorre LD, Nunes RJ, Santos-Silva MC. Aldehyde biphenyl chalcones induce immunogenic apoptotic-like cell death and are promising new safe compounds against a wide range of hematologic cancers. Future Med. Chem. 2020; 12(8):673–688.
Perondi DM, Jacques AV, Stefanes NM, Maioral MF, Sens L, Pacheco LA, Cury NM, et al. A novel thiosemicarbazone as a promising effective and selective compound for acute leukemia. Anticancer Drugs. 2019; 30(8):p 828-837.
Rengifo AFC, Stefanes NM, Toigo J, Mendes C, Argenta DF, Dotto MER, Santos-Silva MC, et al. PEO-chitosan nanofibers containing carboxymethyl-hexanoyl chitosan/dodecyl sulfate nanoparticles loaded with pyrazoline for skin cancer treatment. Eur. Polym. J. 2019; 119:335-343.
Rengifo AFC, Stefanes NM, Toigo J, Mendes C, Santos-Silva MC, Nunes RJ, Parize AL, et al. A new and efficient carboxymethyl-hexanoyl chitosan/dodecyl sulfate nanocarrier for a pyrazoline with antileukemic activity. Mater. Sci. Eng. C [Internet]. 2019; 105:110051.
Maioral MF, Stefanes NM, Bigolin A, Zatelli GA, Philippus AC, Falkenberg MB, Santos-Silva MC. Miconidine acetate, a new selective and cytotoxic compound with synergic potential, induces cell cycle arrest and apoptosis in leukemia cells. Invest. New Drugs. 2019; 37:912–922.
Srefanes NM, Toigo J, Maioral MF, Jacques AV, Chiaradia-Delatorre LD, Perondi DM, Ribeiro AAB, et al. Synthesis of novel pyrazoline derivatives and the evaluation of death mechanisms involved in their antileukemic activity. Bioorg. Med. Chem. 2019; 27(2):375-382.
Maioral MF, Bodack CN, Stefanes NM, Bigolin A, Mascarello A, Chiaradia-Delatorre LD, Yunes RA, et al. Cytotoxic effect of a novel naphthylchalcone against multiple cancer cells focusing on hematologic malignancies. Biochim. 2017; 140:48-57.
You can view some of Dr Natália’s work below and links to her professional profile below.
Research Gate: https://www.researchgate.net/profile/Natalia-Stephanes
Linkedin: https://www.linkedin.com/in/nataliamarceli/
In this article, we will discuss the best ways to protect your liver or minimise liver injury while taking Lamisil (Terbinafine), an antifungal medication. We will also discuss the mechanism of liver injury with Lamisil and how it is managed in clinical settings.
How to protect your liver while taking Lamisil (Terbinafine)?
To ensure the safety of your liver while taking Lamisil (Terbinafine), the following steps are essential:
Talk to your healthcare provider
The first step is to discuss the use of Lamisil with your healthcare provider. Make sure to inform your doctor about any history of liver injury or related conditions before taking Lamisil, especially if you’re at higher risk due to alcohol consumption or pre-existing liver disease (1).
Your doctor can closely monitor you and adjust the dosage or suggest alternative treatments if necessary, ensuring your safety throughout the course of treatment.
Follow dosage instructions properly
Follow your healthcare provider’s dosage instructions diligently. Avoid self-adjusting the dosage or extending the treatment duration without medical approval, as this can increase the risk of liver-related side effects.
Sticking to the recommended dose and duration is essential to minimize any potential harm to your liver.
Avoid the use of alcohol
During Lamisil treatment, it’s recommended to avoid alcohol consumption. Alcohol can place extra strain on your liver, making it more susceptible to the medication’s adverse effects. By abstaining from alcohol, you’ll be taking a proactive step to safeguard your liver’s well-being (1).
Closely monitor your side effects
Keep an eye out for any symptoms that might indicate liver problems. If you notice persistent nausea, abdominal pain, jaundice (yellowing of the skin or eyes), or unusual fatigue, contact your doctor immediately (1).
To monitor your liver’s health during Lamisil treatment, your doctor may recommend regular liver function tests. These tests can detect any potential liver injury at an early stage, allowing for timely intervention if needed.
Research studies on Lamisil-induced liver injury
Several research studies have indicated that although it is uncommon, the use of Lamisil (Terbinafine) can cause acute liver injury. The risk of liver damage with this antifungal can vary among individuals, as people can have different factors affecting their liver functions (1,2).
Research indicates that during Terbinafine oral therapy, serum aminotransferase levels may elevate in less than 1% of patients. However, it usually resolves without stopping the treatment.
Clinically apparent liver injury from Terbinafine is rare (1 in 50,000 to 120,000 prescriptions) and may present within the first 6 weeks of therapy. Severe hepatocellular injury with acute liver failure has also been reported (1,3).
Mechanism of liver injury with Lamisil
According to clinical studies, Terbinafine can cause acute liver injury due to a hypersensitivity reaction. Certain genetic factors have been linked to liver injury caused by the drug (1).
While the exact mechanism is not fully understood, studies have shown these genetic associations in people who experienced liver injury from terbinafine, indicating that the reaction is likely immune-related (1).
How is Lamisil-induced liver injury managed?
If someone experiences liver injury due to Lamisil, it’s important to seek immediate medical attention. Doctors usually advise stopping the use of Lamisil to prevent any further harm to the liver.
The person will be carefully monitored by their healthcare provider, who may conduct liver function tests to assess the severity of the injury and keep track of their recovery progress (4).
Depending on how severe the liver injury is, doctors might suggest additional treatments or interventions to support the liver’s function and help it heal. In more serious cases, hospitalization may be required for close monitoring and specialized care.
During the recovery period, the patient may receive guidance on following a specific diet and lifestyle changes to reduce any extra strain on the liver. This could involve avoiding alcohol and certain medications that could worsen liver function.
In some situations, healthcare providers may prescribe medications or therapies to manage specific symptoms associated with liver injury caused by Lamisil. For instance, if the person experiences nausea, they might be given medications to help alleviate this discomfort.
It’s crucial for individuals to inform their healthcare provider about any pre-existing liver conditions or risk factors before starting Lamisil treatment.
This information allows the doctor to make informed decisions about whether Lamisil is appropriate for them and to closely monitor those who may be at higher risk for liver injury.
Remember, open communication with your doctor is vital for your safety and well-being.
Conclusion
In this brief article, we have covered everything about Lamisil-induced liver injury – including its mechanism, symptomatic management, and potential prevention strategies.
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References
1.-
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012–. Terbinafine. 2018 Jan 1. PMID: 31643929. https://www.ncbi.nlm.nih.gov/books/NBK548617
2.-
Yan J, Wang X, Chen S. Systematic review of severe acute liver injury caused by terbinafine. Int J Clin Pharm. 2014 Aug;36(4):679-83. doi: 10.1007/s11096-014-9969-y. Epub 2014 Jul 2. PMID: 24986266. https://pubmed.ncbi.nlm.nih.gov/24986266/
3.-
Choudhary NS, Kotecha H, Saraf N, Gautam D, Saigal S. Terbinafine induced liver injury: a case report. J Clin Exp Hepatol. 2014 Sep;4(3):264-5. doi: 10.1016/j.jceh.2014.03.040. Epub 2014 Apr 3. PMID: 25755569; PMCID: PMC4284205. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284205/
4.-
Lala V, Zubair M, Minter DA. Liver Function Tests. 2023 Apr 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29494096. https://www.ncbi.nlm.nih.gov/books/NBK482489
