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Terbinafine-associated hepatic injury
J W van 't Wout1, W A Herrmann, R A de Vries
1Department of Internal Medicine and Dermatology, Bronovo Hospital, The Hague, The Netherlands.
Journal of Hepatology
|July 1, 1994
Summary
Terbinafine can cause liver injury, presenting as cholestatic-hepatocellular hepatitis. This reaction is likely idiosyncratic, not directly toxic, and may require prolonged monitoring.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Toxicology
Background:
- Terbinafine is an antifungal medication commonly prescribed for dermatophyte infections.
- Drug-induced liver injury (DILI) is a significant concern with various medications, including antifungals.
- Understanding the mechanisms and clinical presentation of DILI is crucial for patient safety.
Observation:
- Two cases of terbinafine-associated hepatic injury are presented.
- Both patients exhibited a mixed cholestatic-hepatocellular pattern of hepatitis.
- Extrahepatic cholestasis and viral hepatitis were ruled out, and other drug involvements were unlikely.
Findings:
- The first patient's liver enzyme abnormalities resolved after discontinuing terbinafine.
- The second patient showed persistent elevation of alkaline phosphatase, aminotransferase, and gamma-glutamyl transferase levels three months post-treatment.
- The hepatic injury was deemed most likely an idiosyncratic reaction to terbinafine.
Implications:
- This study highlights the potential for idiosyncratic liver injury from terbinafine.
- Clinicians should be vigilant for hepatic abnormalities in patients taking terbinafine.
- Prolonged monitoring may be necessary for some patients experiencing terbinafine-associated liver injury.