Advice??

[psalmist]

I just got my Lamisil and will be taking it 2 pills a day for one week and then the next three off. It is a new approach called pulse dosing. It is suppose to eliminate the need for liver testing as it is easier on your liver. I self test and I am wondering if I need to seek the help of a coumadin nurse to help monitor my meds as I take this medication as it will have an effect on my coumadin. It will supposedly increase the effect of my meds. I have a coumadin nurse but rarely work with here since my numbers are very consistant. I am afraid that this will change that.... at least for the week I am taking it. Any suggestions??

 

[Ross]

I'm sorry to say, but your going to have to test INR more frequently until you find just how much it's affecting you. It can be adjusted for, but I'm not sure how it would work with the alternate dosing of the Lamisil. It may not be a big problem since warfarin takes so long to metabolize in the system.

TERBINAFINE (in Lamisil Tablets) may interact with WARFARIN SODIUM (in Coumadin Tablets)

Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. This drug is broken down and removed from the body by the liver. If this happens too quickly, then potentially less warfarin would be available for the body to use and blood levels could become too low. Terbinafine may cause warfarin to be broken down at a faster rate than normal. When terbinafine and warfarin are used at the same time, warfarin may be less effective and this could cause the blood to clot more. If these drugs are taken together, your doctor may want to monitor you closely when warfarin. If you are experiencing problems, it may be necessary to adjust the dose of warfarin.Ask your healthcare provider about these drugs and this potential interaction as soon as possible.

This interaction is poorly documented and is considered major in severity.

Last Updated: December 2003

 

[catwoman]

I just got my Lamisil and will be taking it 2 pills a day for one week and then the next three off. It is a new approach called pulse dosing. It is suppose to eliminate the need for liver testing as it is easier on your liver. I self test and I am wondering if I need to seek the help of a coumadin nurse to help monitor my meds as I take this medication as it will have an effect on my coumadin. It will supposedly increase the effect of my meds. I have a coumadin nurse but rarely work with here since my numbers are very consistant. I am afraid that this will change that.... at least for the week I am taking it. Any suggestions??

Seth:

So you'll be on for 1 week, off for 3 weeks. Then I assume you'll be back on for 1 week and off for another 3 weeks? If that's the case, you might want to check a professional anticoagulation manager you have a track record with. If you know of someone with CACP (certified anticoagulation care provider) designation, he/she might have some resources or training in this. I've seen some of the questions posed for the CACP exam and they're pretty involved. That's not to say that someone who has not gotten CACP
designation might not be equal.

If you were going on for a week or two and then not taking it any more, the answer would be a no-brainer: Test before starting, then about 3 days afterward and adjust. But if you'll be on an on-off dosing scheduling, that might not work.

Two caveats: Among the side effects in the prescribing information are diarrhea and loss of appetite. You can deal with the diarrhea by taking some acidophilus and the loss of appetite by taking it at night on a full stomach.

 

[Ross]

Seth I know it will take a long time, but let me know how the Lamisil works out. I've put up with this infection of mine for years and I'm wondering if they removed the nail and nail bed, if the infection would return?

 

[Lynlw]

Seth I know it will take a long time, but let me know how the Lamisil works out. I've put up with this infection of mine for years and I'm wondering if they removed the nail and nail bed, if the infection would return?

Justin took it about 2 years ago for his big toe, it workd well. He did the daily for a couple week/month I can't remeber dose (we also called both his cardiologists before his ped would write for it) the sad/funny thing is JUST when all the old nail grew out and he had a nice normal toe nail, some guy dropped a road case on that toe and the nail turned black and he had to wait for a nice nail again.

his blood work all remained good on it

 

[psalmist]

Thanks

Thanks

I will start today/tomorrow. I was told that it may increase the affect of my meds. I guess I will see. I think the good thing is that I will be taking it for one week then off for three. I will do this for six months. I need to establish the affect for this week and then that will be my standard. Its just not knowing how it will affect it. I wonder if I should half dose the stuff until I see which way it is going to go and then ease into it?? I am a little nervous...

 

[Ross]

Don't monkey with your Coumadin. Test before jumping to conclusions because the way your being dosed on Lamisil, may or may not have much of an effect on your INR. If anything, you should have to increase your Coumadin, not decrease.

 

[catwoman]

Seth:

Your first time on Lamisil will provide you information on how to deal with it the next time you take it.
My suggestion is to test 3-4 days after starting it. Adjust for the duration. Then return to normal for the off period. But run that past your Coumadin nurse. Perhaps another warfarin patient will have been there, done that with Lamisil and you can benefit from that patient's experience and how it was handled.

Your experience may help others here.

 

[Lynlw]

Don't monkey with your Coumadin. Test before jumping to conclusions because the way your being dosed on Lamisil, may or may not have much of an effect on your INR. If anything, you should have to increase your Coumadin, not decrease.

I was wonderring if he meant 1/2 the coum or 1/2 the losimil. Either way I would just take everything in the proper amounts and go from there.
IF there is a big difference, maybe you could ask about taking the smaller amount every week instead of jumping around every couple weeks.
also I'm not sure how long the meds stay with you, so maybe the first week with no med might give you a different INR than the next two.

 

[psalmist]

rolling right along

rolling right along

I am on my second night tomorrow is the third and I will test to see what the affect is. I specifically asked the nurse how it would affect my INR and she said, again, that it would raise it. It makes me wonder.... No probs at this point! I am excited about having clear nails agian.

Oh, I was talking about halfing the lamisil. I would never play with my coumadin...It was a very hard decision to make to even take this stuff!

 

[Bina]

It sounds like it is worth a shot....let us all know how it goes.

 

[Ross]

Oh, I was talking about halfing the lamisil. I would never play with my coumadin...It was a very hard decision to make to even take this stuff!

I can beleive it. My doctor WON'T let me take it.

 

[Lynlw]

I can beleive it. My doctor WON'T let me take it.

I'm sorry tohear that since it worked os well for Justin. Which doc said NO? Justin's ped would not write the script unil we got the Ok from his cardiologist, just to make sure we asked both of them and they gave the ok.
Maybe if it is your GP, you can ask if you get clearence from your other docs would she allow it.

 

[Ross]

I'm sorry tohear that since it worked os well for Justin. Which doc said NO? Justin's ped would not write the script unil we got the Ok from his cardiologist, just to make sure we asked both of them and they gave the ok.
Maybe if it is your GP, you can ask if you get clearence from your other docs would she allow it.

My PCP. They have me on 14 different things now and he, now she, (retirement, not sex change) simply doesn't want to stress out my liver anymore then it's already being stressed.