Interaction of terbinafine (anti-fungal agent) with perhexiline: a case report
Date
2014
Authors
Sheikh, A.R.
Westley, I.
Sallustio, B.
Horowitz, J.D.
Beltrame, J.F.
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Journal article
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Heart Lung and Circulation, 2014; 23(6):e149-e151
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Abdul Rauf Sheikh, Ian Westley, Benedetta Sallustio, John D Horowitz, John F Beltrame
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Abstract
Perhexiline is a unique anti-anginal agent that is frequently used in the treatment of chronic refractory angina. Its utility has been limited because of its complex pharmacokinetics that were only appreciated following the development of a therapeutic perhexiline assay. Perhexiline is cleared primarily via formation of mono-hydroxy metabolites (OH-perhexiline) by cytochrome P450 2D6 (CYP2D6). Drugs that are inhibitors of CYP2D6 may therefore inhibit perhexiline metabolism, increase plasma perhexiline concentration and may consequently increase the risk of toxicity. We report a case of a rise in perhexiline plasma concentration to a toxic level following the introduction of terbinafine hydrochloride; a moderate CYP2D6 inhibiting drug.
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Crown Copyright © 2013