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Area of Science:

  • Pharmacogenomics
  • Neuroscience
  • Biochemistry

Background:

  • Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism affects folate metabolism.
  • The methylation cycle is crucial for cellular function and neurotransmitter synthesis.
  • Terbinafine (Lamisil) is an antifungal medication with a known mechanism impacting cellular processes.

Observation:

  • A patient experienced headache, fatigue, and dizziness after terbinafine administration.
  • Genetic testing revealed the patient was heterozygous for the MTHFR C677T mutation.
  • L-methylfolate (Deplin) supplementation led to significant symptom reduction.

Findings:

  • Terbinafine's mechanism of action interferes with the cellular methylation cycle.
  • This interference may compromise cellular function in individuals with the MTHFR C677T mutation.
  • MTHFR C677T heterozygosity appears to be a risk factor for terbinafine-induced adverse effects.

Implications:

  • Consider MTHFR genotype in patients prescribed terbinafine, especially those with neurological symptoms.
  • L-methylfolate supplementation may be a viable therapeutic strategy for managing terbinafine-induced side effects in susceptible individuals.
  • Highlights the importance of personalized medicine and understanding drug-gene interactions in clinical practice.