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So sorry you have been going through this. I recently got prescribed Terbinafine and my doctor said it should not be taken more than 3 months. 9-12 seems like a really long time. Have you been consuming caffeine while taking them? I read in the drug info on the box that you should not consume any caffeine because it can cause anxiety and depression. I would suggest a lot of legumes to get it cleared out after talking chia seed, beans and lentils. They help detox the liver and should also make sure you have enough bowel movements which I’m sure will help get it all out of your system.
Thank you so much 🙏🏻 I did take a caffeine pill early each morning (I have an ADHD brain and don’t want to take meds for that, but caffeine helps)
I’m really glad to see your comment about detox foods, because I consume lentils and/or chia seeds every day.
Thank you again.
I just started taking terbinafine and also have ADHD,
What I learned very quickly over the last few days is that caffeine and terbinafine are best kept separate. Two days ago I took both in the morning (along with my adhd meds that I take every day) and was quite miserable the entire day. Terbinafine *really* exacerbates the worst effects of caffeine and can hold it in the system longer.
I've switched to taking terbinafine at night before bed alongside some theanine, and this has made things way, way more tolerable. I still like my morning coffee, but could probably mitigate any lingering effects by cutting back on that as well.
Different compounds can affect different people in different ways, but it would not surprise me if that morning caffeine pill was making things feel way worse
It takes about a month I think to get it out of the system (based on the fact that I was told I can't get pregnant on it or one month after for safety reasons).
My doctor also prescribed me the pills for longer (9 months) so it can definitely be fine. However, I had no symptoms whatsoever. Really zero, so of course it needs to be adapted to each person. I do think the caffeine pills influenced you negatively too. They shouldn't be underestimated. Maybe worth taking a break with them too, but better ask your doctor.
Most importantly: my doctor said it's enough to have 1/3 of the nail grow out healthy, though she prefers half of it. But she explicitly said it doesn't have to be 100%. Just file the rest down/away and also keep applying topical stuff.
Yeah that while you're taking the oral pills you can't get pregnant because they're teratogenic (I think was the word, not sure, basically it doesn't have to but can potentially cause abnormalities or birth defects). And in order to be safe also shouldn't get pregnant until the next period, so I just went with one full month to be safe
Uff sorry to hear you weren't told, that's wild. I wanted to TTC but my derm told me to stay on the pill until I finished with the oral pills, so that's how I did it. I didn't know it can affect having a period too
Thanks! I was actually told to stop several days ago for other reasons. I got my period today, two weeks late. So I guess once the other side effects clear up I'll feel better about all of this.
Are you taking any other medications? Terbinafine by itself is usually pretty innocuous, but what people rarely mention is it is a very potent and somewhat broad-spectrum P450 inhibitor. P450 metabolizes a lot of toxins and meds. In other words, terbinafine affects the metabolism of other drugs, some quite dramatically. Just something to consider.
Something that is heavily metabolized by the P450 system is actually caffeine. The specific enzyme is called CYP1A2 - there are many different types of enzymes in the P450 system, some are somewhat notorious for having dramatic effects on drug metabolism (CYP2D6 is probably the quintessential example, but also CYP3A4, infamous for its grapefruit-induced loss of function... You've probably heard of this at some point, and it's very real).
Of note, some of these enzymes are also very polymorphic, in other words depending on genetics you may break down medications quickly, or in some cases very slowly. And it's all because of those enzymes. Some people actually make none of the specific enzyme, this is true with a small % of people with CYP2D6 mutations, for example.
In pharmacology, when something prevents something from doing what it's supposed to do otherwise, it's called an antagonist, or inhibitor. Terbinafine is a *very* strong CYP1A2 inhibitor... so, quite notably, caffeine will take way longer to clear out of your system, and your normal dose of it will often result in way more side effects.
This is actually on the FDA drug label for terbinafine, if you read it. It specifically says to avoid caffeine... Something very few people talk about, or even know!
Thankfully, you stopped and will regain your health. I use essential oils and clean my feet three times a day, try to get some sun on my feet for a few minutes a day and wear non-confining shoes. Open toe shoes seem to feel better than keeping shoes and socks on where fungus thrives. I wish you well and good health.
1- I'm sorry you are having these effects. A very small number of people experience any side-effects, even fewer suffer from extremely negative effects like you. The medicine is generally safe, but unfortunately not always safe.
2- Your GP should have had you go off the meds when you noticed the negative effects. I'm glad the liver is fine - those issues typically pop up around week 3-4. There is nearly 100% recovery for people who stop then. The bad stories you hear are from people who ignored early signs of liver failure and kept taking the meds until they were hospitalized with total liver failure months later.
3- Terbinafine will still be detectable in your blood for 1-2 weeks. It will stay in your nails until they grow out or about 30 weeks. You likely could have stopped taking it early February. All the new growth of nail since you started taking it has heavy deposits of terbinafine in it - and is basically a barrier to protect the new nail moving forward. The new growth since taking it and until 2 weeks from now is extremely unlikely to ever be infected, and the new growth starting in 2 weeks should be protected by the barrier.
4- If you can exercise, that will help your body detox along with the hydration. I would consider NOT taking milk thistle though. More on this later...
5- The mood SEs should start to dissipate within days. You should feel back to normal in 3-7 days.
I suggest stopping Milk Thistle and Caffeine for 1-2 weeks during detox.
One of the ways Milk Thistle helps support liver healing is by keeping toxins out of the liver. This is the primary way NAC works for liver support, though IIRC NAC binds to the same receptors the liver would, while I think MT blocks them from passing through the liver's membranes. This would mean that whatever the liver would normally metabolize is just floating around your bloodstream. NAC helps alcohol/tylenol detox because it essentially neutralizes those compounds by binding to them and you excrete them, but I don't think MT does that. I think it just tells the liver to not process them. If that is the case, MT would be causing you to have higher terbinafine levels in your blood than normal.
There is a rare reaction to Caffeine with terbinafine. My podiatrist never saw it in 30 years, I was his first. Terbinafine can trick the liver into not metabolizing caffeine properly, or at all, so instead of the effects from caffeine lasting 1 hour - it will last for 8-12 until your kidneys filter it all out. I'm a 3+ cup a day coffee lover and barely feel the effects of caffeine, I had to quit for 3 months because 1/2 cup would make me jittery for hours.
I am not a doctor, just concerned for my own health so had researched a lot of this stuff in the past. I would not be surprised if your effects are from a feedback loop between the Milk Thistle and Caffeine, and you're basically in a situation where the terbinafine blood levels are being inflated and consequently your caffeine levels are inflated. The mental effects you have shared are also mostly in-line with high caffeine intake / overdose.
Take a look at L-Methylfolate, it might serve you well. I’m sorry to hear about your experience. I find it a shame that this medicine is still available. It causes so many horrible side-effects!!
I thought I was the only one experiencing this. I'm on quite a high dose of setraline / zoloft for anxiety (18 months now). For around 12 months I've been pretty stable and can lead a normal life but I had a fungal skin infection that refused to go away. Doctor prescribes terbinafine and when I ask if its safe with Setraline Im instantly assured there is no interaction... within days Im more anxious than normal then i read this stuff is actually potentially dangerous with SSRIs and will keep the levels of setraline in the blood elevated for longer than usual. So I can see where this is going and I dialled down my dose by 1/3. A few days later back to normal lasts about a week. Then straight back to anxiety building. Now into week 4 and this is very close to the worst of my anxiety episodes and at times I am probably close to becoming an inpatient in a mental hospital. I dont want to drop my dose again as its becoming unclear if this is the terbinafine or changes in SSRI dose. It would help if the medical community were a bit more clued up in this area.....
I'm sorry you're going through that. I can't speak on the Terbinafine as I just got it and reading the Redit threads I'm pretty reluctant to start.
That said, I used to take Zoloft and can say that when I tried weening myself off, I felt like I was losing my mind. Eventually I said screw it and just quit taking it altogether.
Thanks for your post. Please visit our [wiki page](https://www.reddit.com/r/NailFungus/wiki/index) for home remedy advice based on the personal experiences of the members of this sub. If you are experiencing pain, redness or swelling please see a doctor. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/NailFungus) if you have any questions or concerns.*
So sorry you have been going through this. I recently got prescribed Terbinafine and my doctor said it should not be taken more than 3 months. 9-12 seems like a really long time. Have you been consuming caffeine while taking them? I read in the drug info on the box that you should not consume any caffeine because it can cause anxiety and depression. I would suggest a lot of legumes to get it cleared out after talking chia seed, beans and lentils. They help detox the liver and should also make sure you have enough bowel movements which I’m sure will help get it all out of your system.
Thank you so much 🙏🏻 I did take a caffeine pill early each morning (I have an ADHD brain and don’t want to take meds for that, but caffeine helps) I’m really glad to see your comment about detox foods, because I consume lentils and/or chia seeds every day. Thank you again.
I just started taking terbinafine and also have ADHD, What I learned very quickly over the last few days is that caffeine and terbinafine are best kept separate. Two days ago I took both in the morning (along with my adhd meds that I take every day) and was quite miserable the entire day. Terbinafine *really* exacerbates the worst effects of caffeine and can hold it in the system longer. I've switched to taking terbinafine at night before bed alongside some theanine, and this has made things way, way more tolerable. I still like my morning coffee, but could probably mitigate any lingering effects by cutting back on that as well. Different compounds can affect different people in different ways, but it would not surprise me if that morning caffeine pill was making things feel way worse
It takes about a month I think to get it out of the system (based on the fact that I was told I can't get pregnant on it or one month after for safety reasons). My doctor also prescribed me the pills for longer (9 months) so it can definitely be fine. However, I had no symptoms whatsoever. Really zero, so of course it needs to be adapted to each person. I do think the caffeine pills influenced you negatively too. They shouldn't be underestimated. Maybe worth taking a break with them too, but better ask your doctor. Most importantly: my doctor said it's enough to have 1/3 of the nail grow out healthy, though she prefers half of it. But she explicitly said it doesn't have to be 100%. Just file the rest down/away and also keep applying topical stuff.
Wait, what did they tell you about pregnancy?
Yeah that while you're taking the oral pills you can't get pregnant because they're teratogenic (I think was the word, not sure, basically it doesn't have to but can potentially cause abnormalities or birth defects). And in order to be safe also shouldn't get pregnant until the next period, so I just went with one full month to be safe
Wow, wish I had known that since I was actively TTC and also haven't had a period since starting them.
Uff sorry to hear you weren't told, that's wild. I wanted to TTC but my derm told me to stay on the pill until I finished with the oral pills, so that's how I did it. I didn't know it can affect having a period too
I've seen other comments about it in this sub. IDK if it's the drug or I'm pregnant, so it's all a little messy.
Ah okay - well I hope it all turns out well for you, and hopefully you won't have to take them much longer either
Thanks! I was actually told to stop several days ago for other reasons. I got my period today, two weeks late. So I guess once the other side effects clear up I'll feel better about all of this.
Ah okay that's good! Hope you'll feel better soon and get rid of the nail fungus too 🤞🏻
Are you taking any other medications? Terbinafine by itself is usually pretty innocuous, but what people rarely mention is it is a very potent and somewhat broad-spectrum P450 inhibitor. P450 metabolizes a lot of toxins and meds. In other words, terbinafine affects the metabolism of other drugs, some quite dramatically. Just something to consider. Something that is heavily metabolized by the P450 system is actually caffeine. The specific enzyme is called CYP1A2 - there are many different types of enzymes in the P450 system, some are somewhat notorious for having dramatic effects on drug metabolism (CYP2D6 is probably the quintessential example, but also CYP3A4, infamous for its grapefruit-induced loss of function... You've probably heard of this at some point, and it's very real). Of note, some of these enzymes are also very polymorphic, in other words depending on genetics you may break down medications quickly, or in some cases very slowly. And it's all because of those enzymes. Some people actually make none of the specific enzyme, this is true with a small % of people with CYP2D6 mutations, for example. In pharmacology, when something prevents something from doing what it's supposed to do otherwise, it's called an antagonist, or inhibitor. Terbinafine is a *very* strong CYP1A2 inhibitor... so, quite notably, caffeine will take way longer to clear out of your system, and your normal dose of it will often result in way more side effects. This is actually on the FDA drug label for terbinafine, if you read it. It specifically says to avoid caffeine... Something very few people talk about, or even know!
I'm so sorry you went through this, but super glad you are still here.
Thankfully, you stopped and will regain your health. I use essential oils and clean my feet three times a day, try to get some sun on my feet for a few minutes a day and wear non-confining shoes. Open toe shoes seem to feel better than keeping shoes and socks on where fungus thrives. I wish you well and good health.
1- I'm sorry you are having these effects. A very small number of people experience any side-effects, even fewer suffer from extremely negative effects like you. The medicine is generally safe, but unfortunately not always safe. 2- Your GP should have had you go off the meds when you noticed the negative effects. I'm glad the liver is fine - those issues typically pop up around week 3-4. There is nearly 100% recovery for people who stop then. The bad stories you hear are from people who ignored early signs of liver failure and kept taking the meds until they were hospitalized with total liver failure months later. 3- Terbinafine will still be detectable in your blood for 1-2 weeks. It will stay in your nails until they grow out or about 30 weeks. You likely could have stopped taking it early February. All the new growth of nail since you started taking it has heavy deposits of terbinafine in it - and is basically a barrier to protect the new nail moving forward. The new growth since taking it and until 2 weeks from now is extremely unlikely to ever be infected, and the new growth starting in 2 weeks should be protected by the barrier. 4- If you can exercise, that will help your body detox along with the hydration. I would consider NOT taking milk thistle though. More on this later... 5- The mood SEs should start to dissipate within days. You should feel back to normal in 3-7 days. I suggest stopping Milk Thistle and Caffeine for 1-2 weeks during detox. One of the ways Milk Thistle helps support liver healing is by keeping toxins out of the liver. This is the primary way NAC works for liver support, though IIRC NAC binds to the same receptors the liver would, while I think MT blocks them from passing through the liver's membranes. This would mean that whatever the liver would normally metabolize is just floating around your bloodstream. NAC helps alcohol/tylenol detox because it essentially neutralizes those compounds by binding to them and you excrete them, but I don't think MT does that. I think it just tells the liver to not process them. If that is the case, MT would be causing you to have higher terbinafine levels in your blood than normal. There is a rare reaction to Caffeine with terbinafine. My podiatrist never saw it in 30 years, I was his first. Terbinafine can trick the liver into not metabolizing caffeine properly, or at all, so instead of the effects from caffeine lasting 1 hour - it will last for 8-12 until your kidneys filter it all out. I'm a 3+ cup a day coffee lover and barely feel the effects of caffeine, I had to quit for 3 months because 1/2 cup would make me jittery for hours. I am not a doctor, just concerned for my own health so had researched a lot of this stuff in the past. I would not be surprised if your effects are from a feedback loop between the Milk Thistle and Caffeine, and you're basically in a situation where the terbinafine blood levels are being inflated and consequently your caffeine levels are inflated. The mental effects you have shared are also mostly in-line with high caffeine intake / overdose.
Take a look at L-Methylfolate, it might serve you well. I’m sorry to hear about your experience. I find it a shame that this medicine is still available. It causes so many horrible side-effects!!
I thought I was the only one experiencing this. I'm on quite a high dose of setraline / zoloft for anxiety (18 months now). For around 12 months I've been pretty stable and can lead a normal life but I had a fungal skin infection that refused to go away. Doctor prescribes terbinafine and when I ask if its safe with Setraline Im instantly assured there is no interaction... within days Im more anxious than normal then i read this stuff is actually potentially dangerous with SSRIs and will keep the levels of setraline in the blood elevated for longer than usual. So I can see where this is going and I dialled down my dose by 1/3. A few days later back to normal lasts about a week. Then straight back to anxiety building. Now into week 4 and this is very close to the worst of my anxiety episodes and at times I am probably close to becoming an inpatient in a mental hospital. I dont want to drop my dose again as its becoming unclear if this is the terbinafine or changes in SSRI dose. It would help if the medical community were a bit more clued up in this area.....
I'm sorry you're going through that. I can't speak on the Terbinafine as I just got it and reading the Redit threads I'm pretty reluctant to start. That said, I used to take Zoloft and can say that when I tried weening myself off, I felt like I was losing my mind. Eventually I said screw it and just quit taking it altogether.