Journal Mobile Options
Table of Contents
Vol. 196, No. 2, 1998
Issue release date: 1998

Interaction between Terbinafine and Warfarin

Gupta A.K. · Ross G.S.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

A 71-year-old woman presented with gastrointestinal bleeding. She had been stabilized on warfarin for the previous few months. Terbinafine had been started 32 days prior to this episode for the treatment of onychomycosis. The patient had been on cimetidine for the previous 2 years and on other medications for the last 10 years. At the time of admission for the gastrointestinal bleeding, the coagulation indices were all above the therapeutic range. Endoscopy of the gastrointestinal tract exhibited diffuse intestinal ‘oozing’ consistent with coagulopathy as the cause of bleeding. Terbinafine may have had an effect on the metabolism of warfarin since both are metabolized through the liver and cimetidine can reduce terbinafine clearance by 33% resulting in higher concentrations of the antifungal agent. Our experience suggests that caution should be exercised when prescribing terbinafine to a patient receiving warfarin.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Terbinafine hydrochloride (Lamisil®) product monograph. Sandoz Pharmaceuticals Corporation, East Hanover, New Jersey, USA, April 1996.
  2. O’Sullivan DP, Needham CA, Bangs A, Atkin K, Kendall FD: Post-marketing surveillance of oral terbinafine in the UK: Report of a large cohort study. Br J Clin Pharmacol 1976;42: 559–565.
  3. Kaminsky LS, Dunbar DA, Wang PP, Beaune P, Lawey D, Guengerich FP, Schnellmann RG, Sipes IG: Human heptic cytochrome P-450 composition as probed by in vitro microsomal metabolism of warfarin. Drug Metab Dispos 1984;12: 470–477.

    External Resources

  4. Toon S, Low LK, Gibaldi M, Trager WF, O’Reilly RA, Motley CH, Goulart DA: The warfarin/sulfinpyrazone interaction: Stereochemical considerations. Clin Pharmacol Ther 1986; 39:15–24.

    External Resources

  5. Slaughter RL, Edwards DJ: Recent advances: The cytochrome P-450 enzymes. Ann Pharmacother 1995;29:619–624.
  6. Brøsen K: Drug interactions and the cytochrome P-450 system: The role of cytochrome P-450 1A2. Clin Pharmacokinet 1995;29 (suppl 1):20–25.
  7. Choonara IA, Cholerton S, Haynes BP, Breckenridge AM, Park BK: Stereoselective interaction between R enantiomer of warfarin and cimetidine. Br J Clin Pharmacol 1986;21: 271–277.

    External Resources

  8. Weintraub M, Breckenridge RT, Griner PF: The effects of dextrothyroxine on the kinetics of prothrombin activity: Proposed mechanism of the potentiation of warfarin by D-thyroxine. J Lab Clin Med 1973;81:273–279.

    External Resources



Pay-per-View Options
Direct payment This item at the regular price: USD 33.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 23.00