Can Lamisil Intake Cause Elevated AST And ALT Levels?

Posted on Tue, 25 Nov 2014

Question: I haven't been able to get rid of the rash on my right foot over the last year so my Phamacist recommended I get a Rx to take Lamisil. My GP had seen it back in April and prescribed the same thing my Dermatologist prescribed in July for a fungus. My GP says it is risky as my bloodwork showed AST as high and ALT(SGPT) as high also. He's going to prescribe it as long as I know the risks. I wake up every night with my foot itching. How much of a risk is it?
I there anything else i can do for this fungus that is less risky?

Answered by Dr. Vivek Chail (20 minutes later)

Brief Answer:
Risk is 1 in 300 patients with abnormal AST ALT.

Detailed Answer:
Hi
Thanks for writing in to us.

Lamisil is terbinafine. Drug induced liver injury due to terbinafine is widely known. Oral medication terbinafine is associated with elevations in serum aminotransferases in less than 1% of patients and the elevations are generally asymptomatic and resolve without stopping therapy. However, it might reach high levels in some patients requiring stopping the medication.

The estimated probability of developing elevated serum aminotransferase levels requiring stopping treatment is about 0.31% for 2 to 6 weeks' treatment and 0.44% for treatment longer than 8 weeks.

The above risk is about 1 in 300 people with raised liver function tests.

In the above situation, it will be best to continue with ointment application containing Triamcinolone Acetonide and an antifungal ointment. Also keep your foot dry and avoid sweat formation in the fungal infection area.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (40 minutes later)

Isn't Triamcinolone Acetonide an anti fungal? Would it be a good idea to coat the problem area with vaseline at night? That's when my foot seems to sweat.
Also, since I have bloodwork scheduled withing the next month I think I'd like to try the Lamisil and also keep up with the ointment. Maybe I will stop wearing sock to bed... they might not be helping at least with the problem between my toes. What do you think about the socks?

Answered by Dr. Vivek Chail (1 hour later)

Brief Answer:
Triamcinolone acetonide is a steroid.

Detailed Answer:
Hi XXXXXXX,
Thanks for writing back with an update.

Triamcinolone acetonide is a medium to strong-potency corticosteroid. This reduces itching. That is the reason I suggested you added antifungal ointments.

Coat with vaseline prevents moisture formation at the toe nails and is recommended. You can stop wearing socks to bed for sometime and notice any improvements. Socks hold back a lot of moisture and cause sweat formation which delays fungal infection healing.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Taking Lamisil can be done under close supervision and scrutiny of your liver function tests. Ointment application must be continued.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (55 minutes later)

I can't reach any doctor today as they all shut down here on Fridays, but I would like to ask why an anti-fungal ointment wasn't prescribed. In the mean time I'll ask my Pharmacist for an over-the-counter anti-fungal.
Perhaps I'll let you know his answer. I'm going there now.
Thanks, I'll get back to you.

Answered by Dr. Vivek Chail (11 hours later)

Brief Answer:
Triamcinolone to control itching

Detailed Answer:
Hi XXXXXXX,
Thanks for writing back with an update.

Initial treatment with triamcinolone was started most likely to control itching I guess.

I was wondering if you found an antifungal ointment at the pharmacy and need any more suggestions.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (12 hours later)

Oh yes, the pharmacist recommended Lotrimin (clotrimazole cream). You have any better suggestion? And, does tea tree oil serve any useful purpose? I know some people use it for nail fungus.

Answered by Dr. Vivek Chail (9 hours later)

Brief Answer:
Tree oil works in fungal infections.

Detailed Answer:
Hi XXXXXX,
Thanks for writing back with an update.

I think Lotrimin (clotrimazole cream) is a good option for you. Please apply the cream twice a day after wiping dry the affected part. Do not wear socks for some days if possible.

There has been medical research done on the antifungal actions of tree oil. Tea tree oil was found to be able to inhibit growth of all clinical fungal isolates. You can go ahead and use tree oil also for a quick recovery.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar