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Terbinafine-induced hepatic dysfunction
W M Chambers1, A Millar, S Jain
1Liver Transplantation and Hepato-biliary Medicine Unit, Royal Free Hospital, Pond St., Hampstead, London UK.
European Journal of Gastroenterology & Hepatology
|September 21, 2001
Summary
Terbinafine, an antifungal medication, can cause severe liver injury. This case highlights a severe cholestatic reaction, emphasizing the need for monitoring patients on this drug.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Toxicology
Background:
- Terbinafine is a widely used antifungal agent.
- Drug-induced liver injury (DILI) is a significant clinical concern.
- Cholestatic liver injury can result from various medications.
Observation:
- A 41-year-old male presented with severe hepatic dysfunction after a 3.5-week course of terbinafine.
- Symptoms included jaundice, pruritus, malaise, anorexia, and loin pain.
- Laboratory tests revealed markedly elevated bilirubin and alkaline phosphatase, with a prolonged prothrombin time.
Findings:
- Transjugular liver biopsy confirmed canalicular cholestasis, indicative of a drug reaction.
- The patient's condition represents the most severe cholestatic reaction reported to date associated with terbinafine.
- Liver function normalized 15 months after discontinuing the medication.
Implications:
- This case underscores the potential for severe hepatotoxicity from terbinafine.
- Close monitoring of liver function is crucial in patients receiving terbinafine.
- Recovery is possible even in severe cases without the need for liver transplantation.