Terbinafine Tablets And Alcohol

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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].

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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].

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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:

  • Dark urine, Terbinafine is metabolised in the liver, which when mixed with alcohol leads to liver disorders [10]
  • Dehydration, both Terbinafine and alcohol cause dehydration
  • Diarrhoea
  • Loss of appetite
  • Dizziness
  • Nausea and vomiting
  • Shortness of breath
  • Itching skin
  • Heart palpitations
  • Seizures
  • Jaundice [11]
  • Discoloured skin, jaundice appearing as yellowish skin indicates liver damage [12]

Precautions When Taking Terbinafine

Limiting Alcohol Use

Limit the potential dangers of mixing Terbinafine and alcohol by:

  • Drinking alcohol in moderation, no more than 14 units a week spread evenly over a few days
  • Having several alcohol-free days a week
  • Seeking professional medical advice if alcohol use becomes excessive or concerning [14]
  • Having regular liver function tests to check for any damage to the body [15]
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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:

  • Screen for liver infections that may be caused by terbinafine and alcohol use
  • Monitor disease progression of fungal infections and the effect of terbinafine and alcohol use
  • Measure the severity of diseases such as scarring of the liver
  • Monitor Terbinafine medication side effects [16]

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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:

  • Elderly patients - A study found that 62% of over 65's suffer from more than one chronic condition such as heart, liver and kidney problems [19]
  • Patients with pre-existing hepatic or renal impairments [20]
  • Patients taking codeine, fluoxetine or tramadol at the same time as Terbinafine and alcohol [21].
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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:

  • Limiting alcohol use
  • Taking liver function tests regularly [25]
  • Avoid terbinafine altogether where possible, if consuming alcohol
  • Take a lower dose if there is a pre-existing medical condition such as hepatic or renal impairments [26]
  • Also consider a lower dose if there is a vulnerable group classification such as being elderly or taking medicines that do not agree with terbinafine and alcohol such as codeine, tramadol or fluoxetine [27].
  • Consult a doctor immediately upon experiencing any side effects.
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Last Updated: January 18, 2023

About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health issues, and is a member of the Burney Society. Content reviewed by Peter Szczepanski (Clinical Lead).