What Patients Need To Know About Lamisil
What is Lamisil?
Lamisil is indicated for the treatment of nail fungus (onychomycosis). It is commonly used to treat fingernails and toenails. The normal prescription for toenails is one pill taken by mouth each day for 12 weeks. For fingernails, it is typically only taken for half that time.
Before Lamisil is taken, the health of your liver needs to be assessed. The medication goes through the liver and can cause liver problems. Even though liver-related issues are relatively rare, a blood test measuring liver enzymes (ALT/AST) should be done before the medication is started. Many people choose not take Lamisil for this reason.
There are several other medications which are also broken down by the liver. When Lamisil is taken with those medications, the risk of side effects involving the liver are increased.
What Are The Side Effects?
Symptoms of liver-related side effects could include: persistent nausea, anorexia, fatigue, vomiting, right upper abdominal pain or jaundice, dark urine or pale stools. Patients with these symptoms should discontinue taking oral terbinafine, and the patient’s liver function should be immediately evaluated.
There can be other side effects with Lamisil as well. One side effect is the loss of taste and/or smell. These are very uncommon but can certainly occur. If either of these side effects do occur, the medication should be stopped and the doctor notified. The sense of smell and taste will typically return to normal soon after stopping the medication, but there are cases of it being permanent.
Does Lamisil Work?
So, the important question everyone really wants to know is does Lamisil work? The answer is maybe. According the manufacturer "prior to initiating treatment, appropriate nail specimens for laboratory testing (KOH preparation, fungal culture, or nail biopsy) should be obtained to confirm the diagnosis of onychomycosis." This is because there are many other causes of nail irregularity that make the nail appear thick and discolored. Nail fungus can also be caused by several different types of organisms and Lamisil is known to be effective against a select few. Those are Trichophyton mentagrophytes, Trichophyton Rubrum, Candida albicans, Epidermophyton floccosum, and Scopulariopsis brevicaulis.
According to the research included on the website of the manufacturer of Lamisil: "Results of the first toenail study, as assessed at week 48 (12 weeks of treatment with 36 weeks follow-up after completion of therapy), demonstrated mycological cure, defined as simultaneous occurrence of negative KOH plus negative culture, in 70% of patients. Fifty-nine percent (59%) of patients experienced effective treatment (mycological cure plus 0% nail involvement or >5mm of new unaffected nail growth); 38% of patients demonstrated mycological cure plus clinical cure (0% nail involvement)."
To put it in simpler terms after about 7 months of treatment 70% of people had their nail cultures show no evidence of fungal infection, but only 59% of those people had a negative nail culture and a significant amount of clear nail growing out (5mm or more). But the important number is 38% of people had both a nail culture showing no fungus in the nail and 100% growth of the nail being normal in appearance. Another way to look at these numbers is 70 out of 100 people had the infection clear up. 59 out of 100 had the infection clear up and had a noticeable improvement in how the nails looked, and only 38 out of 100 people had the infection clear up and also had all of their nails look completely normal. Toenail fungus is a difficult problem to treat!
What Are The Recurrence Rates for Lamisil?
Another point which needs to be brought up is that of recurrence. In the same study mentioned above there was follow up performed to look at recurrence of infection. They found that "for patients evaluated at least six months after achieving clinical cure and at least one year after completing Lamisil therapy, the clinical relapse rate was approximately 15%".
What we can really take away from this is a good understanding of just how difficult nail fungus really is to treat. While the gold standard is currently Lamisil, much research is being done into other options.
Other Treatment Options
Lasers are the newest treatment option and there is still much research that needs to be done to show that laser treatment is significantly more effective than Lamisil. One thing we do know is using a laser does eliminate the risks of side effects associated with Lamisil. However, will the long term studies show more than 38% of people with both a nail culture showing no fungus in the nail and 100% clear nail? That is yet to be determined.