Statin Therapy and Terbinafine Interaction

Introduction to Statin and Terbinafine Co-administration

• The American Heart Association recommends that statin therapy can be continued when taking terbinafine as terbinafine has minimal drug-drug interactions with statins and does not significantly inhibit the cytochrome P450 3A4 enzyme that metabolizes most statins 1
• Terbinafine is an oral antifungal agent commonly used for treating onychomycosis (fungal nail infections) 1
• Terbinafine primarily affects the cytochrome P450 2D6 isoenzyme, not the CYP3A4 enzyme that metabolizes most statins 1

Monitoring and Special Considerations

• The American College of Cardiology recommends general monitoring for statin therapy, including evaluating muscle symptoms and CK levels at baseline and during follow-up visits, monitoring for headache, dyspepsia, and other common statin side effects, and checking liver function tests (ALT/AST) initially, after 12 weeks, and then annually 2, 3
• Patients with risk factors for statin-associated myopathy, such as advanced age, small body frame and frailty, multisystem disease, multiple medications, and perioperative periods, should be monitored more carefully regardless of concurrent medications 2, 4, 5