Sunday, April 18, 2010

Question: "My husband was given a prescription for fungal nails… and has been prescribed Lamisil… could this be dangerous to take with other meds?"

Answer: Good question. The answer is yes it could be a problem to take Lamisil with other drugs, but it depends (see below).

Background:
  • Fungal infection of the toenails or fingernails is known as onychomycosis. This is a common but hard to treat infection.
  • The following text is not intended to be a complete review of the onychomycosis or medications. You should see your doctor and discuss your condition and how it relates to you specifically.
What it looks like?
  • Onychomycosis can have different appearances.
  • Early on, the infection can be subtle and hard to detect.
  • The infection can cause the nail to look yellow, green, or cloudy.
  • The nails can become thick, rough and crumbly.  The nail can also separate from the nail bed. 
  • Other diseases can look similar to onychomycosis, so you will need a doctor to evaluate and diagnose.
Photo credit: http://wikipedia.org/

Why does the fungus grow in the toenail?

  • Since onychomycosis is a fungal infection, it will thrive in conditions where fungus do well; dark/moist places. Under the nail is one of those spaces. Tight fitting old sweaty shoes are also optimal living conditions for toe fungus.
How do you get it?

  • Onychomycosis is a common infection and can be spread from person to person via floors or other surfaces.
  • Therefore, some things that can help reduce your chance of getting the infection are: Don’t go barefoot in public bathrooms. You should ware flip flops in public showers. Don’t share nail files or emery boards.
Onychomycosis and diabetes:

  • Onychomycosis can be a big problem for people with diabetes. 
  • People with diabetes can get the infection easier than other people, the infection can be harder to treat and it can lead to more serious infections.
  • Treating onychomycosis will decrease the risk of getting other/secondary infections that can lead to toe or foot amputation.
Treatment:

  • There are several medications available.
  • Topical medications have few side effects but are not very effective.
  • Lamisil is the oral medication that your husband has been prescribed. The generic name for Lamisil is terbinafine (ter BIN na feen).
  • Studies have shown that oral medications are more effective than topical medications. Some physicians advocate both oral and topical medications to increase effectiveness.
  • There are even some promising drug-free treatments that use laser light. http://abcnews.go.com/Health/OnCall/story?id=7113863&page=1
Preexisting conditions:
  • Lamisil is a medication that has a predisposition to adversely affect the liver. Therefore, people with liver problems should take this medication with caution.
  • Kidney disease and autoimmune disease such as lupus may also be a particular problem with Lamisil. 
  • As with any medication, there are potential side effects that can have a negative effect on some people regardless of preexisting health conditions.  It can be difficult to tell who will experience those adverse reactions.
Lamisil with other drugs:

  • Lamisil can alter the livers ability to process/metabolize other medications.  Therefore, Lamisil can alter the concentrations of other drugs in the body. This can result in too much or too little of a particular medication. Not all medications are affected in this way and some are more vulnerable to body concentration alteration than others.
  • This does not mean you should not take Lamisil.  However, you should have your liver evaluated before taking the medication.  You should also be sure that your doctor knows about all the other medications you are taking (prescription/nonprescription/herbal or otherwise).
Take as prescribed:

  • Treatment for onychomycosis is long; It may take several months for your nails to return to normal.
  • If you stop taking this (or any) antimicrobial medication before the prescription is complete then the infection may become resistant to that medication.
When you are taking Lamisil:

  • Call your doctor at once if you have symptoms of liver damage. Signs of liver damage may include:
    • Nausea, abdominal pain, loss of appetite, fatigue.
    • Itching, dark urine, clay-colored stools.
    • Jaundice (yellowing of the skin or eyes).
There is more in-depth information about Terbinafine (Lamisil) at: http://www.drugs.com/pro/terbinafine.html

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