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Interaction between terbinafine and warfarin

A K Gupta1, G S Ross

  • 1Department of Medicine, Sunnybrook Health Science Center, Ont., Canada.

Dermatology (Basel, Switzerland)
|May 6, 1998
PubMed
Summary
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A patient on warfarin experienced gastrointestinal bleeding after starting terbinafine. This suggests a potential drug interaction between terbinafine and warfarin, requiring careful monitoring.

Area of Science:

  • Pharmacology
  • Gastroenterology
  • Drug Interactions

Background:

  • A 71-year-old woman on stable warfarin therapy presented with significant gastrointestinal bleeding.
  • The patient had recently initiated terbinafine for onychomycosis and was also taking cimetidine.
  • Coagulation indices were elevated beyond the therapeutic range, indicating coagulopathy.

Observation:

  • Endoscopy revealed diffuse intestinal oozing, confirming coagulopathy as the cause of bleeding.
  • Both warfarin and terbinafine are metabolized hepatically, suggesting a potential metabolic interaction.
  • Cimetidine is known to reduce terbinafine clearance, potentially increasing its concentration.

Findings:

  • The co-administration of terbinafine and warfarin, possibly influenced by cimetidine, may have led to elevated warfarin levels.

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  • This interaction likely resulted in excessive anticoagulation and subsequent gastrointestinal hemorrhage.

    • Implications:

    • Clinicians should exercise caution when prescribing terbinafine to patients concurrently treated with warfarin.
    • Monitoring coagulation parameters is crucial in patients receiving this drug combination.
    • This case highlights the importance of considering drug metabolism pathways and interactions in clinical practice.