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Comment & Response
May 1, 2019

Methodology of Evaluating the Laboratory Monitoring of Terbinafine Therapy

Author Affiliations
  • 1Division of Dermatology, Department of Medicine, J.H. Stroger Hospital of Cook County, Chicago, Illinois
  • 2Department of Dermatology, Rush Medical College, Chicago, Illinois
  • 3Department of Dermatology, University of Illinois, Chicago, Illinois
JAMA Dermatol. 2019;155(6):756. doi:10.1001/jamadermatol.2019.0360

To the Editor We welcome the recent study by Stolmeier et al1 that addresses the problem of laboratory monitoring for terbinafine and griseofulvin in adults and children, and we agree with their conclusion for terbinafine. We also have recently addressed the utility of monitoring liver function tests for terbinafine.2 Our conclusion was that monitoring does not work, primarily because the terbinafine-induced liver injury has an unpredictable and rapid onset and can occur at virtually any point within the first 2 months of treatment. It is also not necessary because the patients are clearly symptomatic at the very beginning of the reaction. Thus, we concluded that warning patients of the symptoms of acute liver injury and telling them to stop taking the medication and seek medical care when these symptoms occur is the best physicians can do.

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