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Myasthenia Gravis

Toenail fungus and myasthenia

11/26/2007

Question:

Is toenail fungus more of a threat to a person with MG than to a healthy person for any reason? If so, could someone with well-controlled MG who is taking prednisone, imuran and mestinon also take LAMISIL to combat the toe fungus?

If taking Lamisil is not safe, could you suggest a safe way for an elderly person with severe (though well-controlled) MG to get rid of toenail fungus?

Thanks very much for your help.

Answer:

Imuran and prednisone are medications that turn down your immune system. Toenail fungus just might be one of the consequences because your body can't fight off the infections like a normal person. People without immunosuppression also develop the toenail fungus—you just might be more predisposed.

Lamisil (terbinafine) should have little interaction with imuran (azathioprine), prednisone, or mestinon (pyridostigmine). They are metabolized by different enzymes (terbinafine uses the CYP2D6 system vs CYP 3A for prednisone, and mestinon is excreted unchanged by the kidney). The only caution would be the risk of liver disease with both Imuran and terbinafine, as well as effects on immune cells that are already suppressed by the imuran.

I am unfortunately not an infectious disease doctor and could not guide you toward a better medication for the fungus. I would recommend consulting with an infectious disease or dermatology doctor to discuss your case.

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Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati