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Lamisil Once - question

Discussion in 'General Issues and Discussion Forum' started by MrBen, Nov 3, 2009.

  1. MrBen

    MrBen Active Member


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    I had a patient that i recommended Lamisil once. He purchased and after reading the instructions he called asking about the appropriateness of the product due to the sentence:
    "If you have fungal nail infection (fungus inside and under the nail), with discoloration of the nails and change in nail texture (thick, flaky), do not use Lamisil Once but consult a doctor. You may require prescription medication for your nail infection."

    He interperated the above sentence as the product being contraindicated when onychmycosis is present. My thought was that it was only ineffective against onychomycosis.

    The patient currently has onycomycosis that I'm treating separately. The Lamisil Once is for treatment of plantar & interdigital Tinea.

    Also how are other recommending this product? good or bad experiences?
     
  2. blinda

    blinda MVP

    I have experienced similar concern expressed by two patients; they also interpreted the same sentence as a contraindication. It IS worded badly, it should state that the lotion is ineffective for OM. However, it is no coincidence that Novartis are pushing their tablets more!

    I will continue to recommend Lamisil Once. Ok, they usually have to apply the lotion more than `once` but pt concordance is better than the cream, which needs to be applied daily for at least 4 weeks for any positive result. It has worked particularly well as a kick start for those taking a combination oral anti-fungal and Amorolfine (for OM) where there is chronic TP.


    Cheers,
    Bel
     
  3. charlie70

    charlie70 Active Member

    This is purely anecdotal:
    1) Don't use for Dhobi itch. Although it is amusing watching your beloved fill a sink with ice cold water and plunge his nethers in, he does not recommend Lamisil Once at all!

    2) It takes more than one application, but it was effective for ID tinea.

    Personally, I don't think it lives up to the hype.
     
  4. Ian Drakard

    Ian Drakard Active Member

    I'd broadly agree with belinda

    I find it a useful product- patient compliance is better and i can also apply it in clinic for those people who can't get down to their feet.

    I do warn people with heavy widespread infection it can take more than one application, or follow up in areas with the cream. I also warn about reinfection especially where it is longstanding or there is o/m, and try to get them to think of it as a process they have to manage.

    Ian
     
  5. MrBen

    MrBen Active Member

    After contacting Novartis I recieved this reply:

    And thankyou for the replies. Once again shows how valuable a tool a forum like this can be.

    Ben
     
  6. blinda

    blinda MVP

    Aha! Thanks for that Mr Ben. :drinks Do you think it would be acceptable to quote Novartis on this, or do you think they may take the same approach as Prof Rhubarb?...


    Cheers,
    Bel
     
  7. MrBen

    MrBen Active Member

    permission granted

     
  8. SoulShine

    SoulShine Member

    Hmmm, very interesting. I have worked in Pharmacy in Aus for 15 years. I understand it is illegal to recommend prescription medication to anyone unless you are a Dr- hence why we don't have ads on TV etc and Pharmacists are not allowed to say anything either. This is to stop people pressuring their GP by going in to see them having already decided what they want. The loophole might be not using the name but considering Novartis do make to the prescription tablet they mention- I'd call it advertising! :) They should probably just say 'seek medical advice'.

    Furthermore I think the original once a day 7 day treatment is preferable and compliance should be ok as long as they can reach their feet. If you put it in terms of other anti fungal creams (you can use this one 3 times a day for 3 weeks or ...) then it helps improve pt attitude to what you're prescribing- imo.

    There is a product called 'solve easy' by Ego which is half the price of lamisil 7 day and exactly the same inside so you may also save the pt some $$- making it even more appealing tx and avoiding the concerns re warnings (though I haven't explicitly checked their packet/leaflet) and we can stop putting money in the pocket of Novartis!
     
  9. Julian Head

    Julian Head Active Member

    Hi

    Interesting thread......

    Terbinafine hyd 1% is the same ingredient in both lamisil once and the cream/gel, so the difference is just the base it is in. No-one I have met has found lamisil once to be particularly effective.

    I attended a dermatology update and the recommendation for chronic dermatomycoses is terbinafine hyd 1% cream twice a day for 2 weeks then miconazole nitrate 2% (daktarin activ) twice a day for 4 weeks. Review after 6 weeks to see if the cycle needs repeating, and also use a powder in the shoes weekly to ensure reinfection from the shoes is avoided. I treat a lot of orthodox Jews in North London who have chronic and severe dermatomycoses with associated callosities, quite often fissures with bleeding, and this works a treat. Why do they have worse infections? because of attending Mikva.

    Waymade healthcare sell generic terbinafine at a fraction of the price of lamisil (30 gram tube is something like £2 wholsesale). You can pass some of the savings onto patients and increase your margin.....win-win.

    Hope this helps

    http://en.wikipedia.org/wiki/Terbinafine
     
  10. AndyBru

    AndyBru Member

    Re: Lamisil Once - Zetaclear

    Hi
    Has anyone used Zetaclear, and whats been the results????
    Andy b
     
  11. blinda

    blinda MVP

    Nope

    :welcome: BTW Andy, good to see you here!


    Bel x
     
  12. cpowell

    cpowell Welcome New Poster

    I recently visited a pt with o/m nls. After consultation the pt was only suitable for topical tx. I forwarded a letter to his Gp confiming consent, giving presentation of the condition and requesting a prescription of loceryl topical nail application.
    When visiting the pt for the next appointment he confirmed the GP had prescribed Clotrimazole 1% cream and requested this be put onto the nails and covered with a plaster.

    Firslty I thought Clotrimazole 1% was basically for the tissue/feet and not the nails? Further has anyone heard of the use of the plaster to occlude?

    CP
     
  13. Ian Drakard

    Ian Drakard Active Member

    I use this method frequently- normally with lamisil, and a water resistant cover (hypafix transparent is quite efficient). However I would only ever expect it do work in minor involvement or alongside debridement of the effected area.

    I have had this work in cases of matrix involvement with significant debridement and successive treatments but this is definitely the exception.

    Interesting to hear of a GP recommending it. How extensive is the O/M involvement?
     
  14. cpowell

    cpowell Welcome New Poster

    Thank you for the feed back. I was surprised that the GP prescribed Clotrimazole 1% and not the loceryl as requested and unable to understand a reason for this?

    The O/M B/F on the hallux is extensive. Presume your debridement of the nail is following the tx of the lamisil and the breakdown of the keratin?
    CP
     
  15. Katiebruce

    Katiebruce Member

    Have a young boy of 10yrs with significant mycosis to one 1st toe nail. Obviously we are limited in choice of treatments. Would the lamisil cream and occlusion be a good choice and could you advise re application. He has been using curanail paint for last 4 months with no obvious sign of improvement. Thanks for your suggestions Katie
     
  16. blinda

    blinda MVP

    If you mean matrix involvement by significant mycosis, then any topical treatment will probably be ineffective. Griseofulvin is the only approved oral anti-fungal therapy for kids. But, you`ll have to ask the doc nicely. And it has a nasty side effect of loss of friends due to flatulents.

    Hope that helps!
     
  17. Katiebruce

    Katiebruce Member

    Have a young boy of 10yrs with significant mycosis to one 1st toe nail. Obviously we are limited in choice of treatments. Would the lamisil cream and occlusion be a good choice and could you advise re application. He has been using curanail paint for last 4 months with no obvious sign of improvement. Thanks for your suggestions Katie
     
  18. Katiebruce

    Katiebruce Member

    Thanks blinda, not sure mum would be happy with oral medication. Have just been reading thread about laser treatment but sounds like not quite there yet. Have been doing debridement prior to paint so will try lamisil and occlusion if no progress soon. Have had a few kids in with mycotic nails. They are a problem. Katie
     
  19. Greg Fyfe

    Greg Fyfe Active Member

    My limited experience with this was with my number one son, who had one of his smaller nails affected at the age of 7. It's a while ago now so I don't recall if it extended to the nail matrix.

    We used loceryl for a while with no joy.

    Then I got impatient and with local anaesthetic , avulsed the nail and it grew back without any infection fungal or otherwise.

    Putting the l.a. in was a bit of an ouch moment :)

    I didn't apply any antifungal lotions after, and suspect, on reflection, that the infection hadn't got to the nail matrix.

    All the best
    Greg
     
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