Terbinafine with Cyclosporine Interaction Details
Brand Names Associated with Terbinafine
- Lamisil®
- Terbinafine
Brand Names Associated with Cyclosporine
- Cyclosporine
- Gengraf®
- Neoral®
- Sandimmune® Capsules
- Sandimmune® Oral Solution
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 04, 2024
Interaction Effect
A decreased therapeutic response to cycloSPORINE
Interaction Summary
Terbinafine has been found to increase the clearance of cycloSPORINE by 15%. The clinical impact of this effect is not clear; however, decreased cycloSPORINE serum levels and an increased risk of organ rejection are possible. Terbinafine was used successfully with cycloSPORINE in four renal transplant patients . Out of the four cases, an increase in cycloSPORINE dose was necessary in only one patient.
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Monitor patient response and adjust the dosage of cycloSPORINE during combined treatment with terbinafine. Usual therapeutic trough levels are 150 mcg/L initially post-transplant, and 50-100 mcg/L thereafter. Observe patient for signs of organ rejection.
Mechanism Of Interaction
Increased metabolic degradation of cycloSPORINE
Literature Reports
A) Eleven stabilized transplant patients immunosuppressed with cycloSPORINE and with culture-proven dermatophyte toe nail infection were followed. Patients were given terbinafine 250 mg daily for twelve weeks. No changes were made or had been made in the cycloSPORINE doses in the three months preceding terbinafine therapy. Blood samples were drawn before terbinafine treatment and at 4, 8, and 12 weeks. Results showed a statistically significant decrease in the mean cycloSPORINE blood trough level at four weeks, but stable levels thereafter. No significant increase in maximum concentration (Cmax), time of maximum concentration (Tmax), area under the concentration time curve from 0 to 8 hours (AUC0-8), or elimination half-time (T1/2) was found. These results suggest that terbinafine possibly induces metabolic degradation of cycloSPORINE but the enzyme induction is almost negligible and of little clinical significance. The authors concluded that terbinafine therapy is safe in cycloSPORINE-treated patients with dermatophyte nail infections but recommended that cycloSPORINE levels be controlled during treatment .
B) Four cases in which terbinafine was used concurrently with cycloSPORINE in renal transplant patients were reported. In all four cases, terbinafine 250 mg daily lowered trough cycloSPORINE levels. However, in three of the four patients, the decrease in cycloSPORINE level was small and no cycloSPORINE dosage increase was necessary. In the fourth patient, stepwise increases in cycloSPORINE dosage from 3.6 mg per kg per day to 6.5 mg per kg per day were necessary. The authors concluded that terbinafine was a safe and effective drug for patients receiving cycloSPORINE, but stressed that monitoring of cycloSPORINE levels was necessary for patients with drug levels at the lower end of the therapeutic range .
Terbinafine Overview
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Terbinafine granules are used to treat fungal infections of the scalp. Terbinafine tablets are used to treat fungal infections of the toenails and fingernails. Terbinafine is in a class of medications called antifungals. It works by stopping the growth of fungi.
Cyclosporine Overview
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Cyclosporine and cyclosporine (modified) are used with other medications to prevent transplant rejection (attack of the transplanted organ by the immune system of the person who received the organ) in people who have received kidney, liver, and heart transplants. Cyclosporine (modified) is also used alone or with methotrexate (Rheumatrex) to treat the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints) in patients whose symptoms were not relieved by methotrexate alone. Cyclosporine (modified) is also used to treat psoriasis (a skin disease in which red, scaly patches form on some areas of the body) in certain patients who have not been helped by other treatments. Cyclosporine and cyclosporine (modified) are in a class of medications called immunosuppressants. They work by decreasing the activity of the immune system.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.