title: Interaction of terbinafine (anti-fungal agent) with perhexiline: a case report.
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.
authors.affiliation: The Discipline of Medicine, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia; Cardiology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network.
authors.forename: Abdul Rauf
authors.initials: AR
authors.lastname: Sheikh
authors.affiliation: Department of Clinical Pharmacology, The Queen Elizabeth Hospital, Central Adelaide Local Health Network; School of Pharmacy and Medical Sciences, University of South Australia, South Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Westley
authors.affiliation: Department of Clinical Pharmacology, The Queen Elizabeth Hospital, Central Adelaide Local Health Network; The Discipline of Pharmacology, The University of Adelaide, Adelaide, South Australia.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Sallustio
authors.affiliation: The Discipline of Medicine, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia; Cardiology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network.
authors.forename: John D
authors.initials: JD
authors.lastname: Horowitz
authors.affiliation: The Discipline of Medicine, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia; Cardiology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network. Electronic address: john.beltrame@adelaide.edu.au.
authors.forename: John F
authors.initials: JF
authors.lastname: Beltrame
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D004347:Drug Interactions; D006801:Humans; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D010480:Perhexiline / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D000077291:Terbinafine
chemical_list: D000935:Antifungal Agents; D002121:Calcium Channel Blockers; D009281:Naphthalenes; D000077291:Terbinafine; D010480:Perhexiline
keywords: Cytochrome P450 2D6 (CYP2D6); Perhexiline; Selective serotonin re-uptake inhibitors (SSRIs); Terbinafine