KEY TAKEAWAYS
Terbinafine combined with alcohol may cause nausea, vomiting, loss of appetite and jaundice [1].
Alcohol and terbinafine can also prolong a fungal infection or exacerbate it [2].
NHS guidelines specify that you can drink alcohol whilst taking terbinafine, but side effects may include dehydration and headaches [3].
Drinking alcohol with terbinafine has the potential to reduce the effectiveness of the drug, by prolonging and exacerbating fungal infections [4].
How Does Alcohol Use Alter Terbinafine's Effectiveness?
The National Institute for Alcohol Abuse and Alcoholism in 2017 completed experiments by giving alcohol to mice, finding that the mice had liver damage and an increase of intestinal fungal growth, demonstrating that alcohol and terbinafine prolongs fungal infections or causes fungal infections to flare up [5].
In a study of patients being treated with terbinafine, changes in liver function tests indicating liver damage appeared in 0.5% to 10% of patients [6].
Another study carried out in 1999 by the CEIFE shows that terbinafine and other antifungal medications cause liver damage, which is worsened by alcohol use, meaning that mixing terbinafine and alcohol may lead to liver damage or complete liver failure in extreme cases [7].
In some cases, liver damage is resolved in around 3-6 months after immediately stopping treatment, but in other cases mixing terbinafine and alcohol leads to liver failure, resulting in either the need for a transplant or death [8].
Drinking Alcohol After Taking Terbinafine
Terbinafine has a 36 hour half life which means that it can take around 5 days to clear through the body.
Terbinafine has to be fully metabolised by the liver and then excreted through the kidneys in order to minimise any damage caused by combining alcohol and terbinafine [9].
Side Effects Of Terbinafine And Alcohol
Side effects of Terbinafine and alcohol include:
Precautions When Taking Terbinafine
Limiting Alcohol Use
Limit the potential dangers of mixing Terbinafine and alcohol by:
Liver Function Tests
Before prescribing terbinafine, a doctor will perform liver function tests to ensure that there is no pre-existing damage to the liver.
They will then continue to perform the tests to assess the liver throughout treatment.
A liver function test will:
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Liver function tests identify levels of certain enzymes or proteins that indicate damage to the liver [17].
It is recommended that a liver function test should be performed after 4-6 weeks of combining terbinafine and alcohol.
Combining terbinafine and alcohol together should be discontinued if there are any irregularities in the liver function test [18].
Vulnerable Groups For Terbinafine And Alcohol Use
Groups more likely to experience medical issues when combining alcohol use with terbinafine include:
Terbinafine is typically not prescribed for those who have an active liver disease [22].
Although it is possible to be unaffected by combining terbinafine and alcohol, there are still risks of developing dehydration, nausea and vomiting, seizures and cardiac arrest [23].
Side effects of combining terbinafine and alcohol affect around 1 in every 1,000 users [24].
Best practice for patients taking terbinafine is:
