Liver toxicity is a rare complication of terbinafine therapy. It’s estimated that one in 70,000 exposures will cause liver toxicity. It’s thought to be idiosyncratic and as such unpredictable. The onset of toxicity is not immediate but may take days or weeks to develop. Patients frequently report the onset of fever, nausea and jaundice similar to any other drug hepatotoxicity.

Underlying liver disease doesn’t increase the risk of liver toxicity due to terbinafine. While it may be useful to screen patients for underlying liver disease, its presence does not preclude using terbinafine.

In your clinical situation, I wouldn’t recommend baseline liver function tests for a pediatric patient. The parents should be instructed to watch for fevers, jaundice or symptoms that may mimic influenza. If these occur, then the patient should stop the medication and contact your office. That would be an appropriate time to do the liver function tests.

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