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Is this combo of meds safe?

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Posted 11/8/2021 12:51 PM (GMT 0)
I'm taking right now rifampin and azithromycin, along with green tea and milk thistle for liver support. I developed Candida that isn't getting better with just probiotics and nystatin, so I have my doctor prescribe me terbinafine (lamisil) for it. However, I'm concerned about the side effects of terbinafine and the interaction with rifampin. I have Candida in the gut, so I need something which can kill it there. Rifampin seems to decrease the blood concentration of terbinafine, but that shouldn't bother me if my problem is Candida in the gut, not systemic Candida. However, what concerns me is that both rifampin and terbinafine can cause liver damage. I'll have to check my liver each month, to make sure everything is ok. Regardless of that, terbinafine has a long half life it seems. And it can cause hair loss and permanent taste loss, which is freaking scary.


Should I take terbinafine for Candida or not?
Posted 11/8/2021 5:14 PM (GMT 0)
Have you tried flucanazole for the Candida?

I take it prophylactically two days a month -
Posted 11/9/2021 1:12 PM (GMT 0)
I always use this drug interaction checker, you can put your list of drugs in it and it will tell you if there are interactions:

https://www.drugs.com/drug_interactions.html

That said, it's not a complete solution. For example, Rifampin interacted with some of my other medication through a liver enzyme. This was not mentioned on the interaction tracker. I'm guessing because it's more of an indirect side effect.
Posted 11/9/2021 6:42 PM (GMT 0)
not sure if the link will work - but this is what the interaction checker says

https://www.drugs.com/interactions-check.php?drug_list=2161-0,2012-0&types%5b%5d=major&types%5b%5d=minor&types%5b%5d=moderate&types%5b%5d=food&types%5b%5d=therapeutic_duplication&professional=1

basically Rifampin increases the excretion of most drugs - as it upregulates the activity of the CYP 450 enzyme - which is the pathway in the liver that detoxifies most pharma drugs.

the hepatotoxicity of lamasil seems to be genetically determined and limited to certain immunological histo types ( HLA - types) that occur in less than 1% of the population - and only a subset of these seem to have severe reactions leading to dramatic liver damage - usually those with pre-existing complications the others seem to have merely raised liver enzymes and recover just fine after stopping the drug.

decent paper here https://www.ncbi.nlm.nih.gov/books/nbk548617/

safe is a relative term - all antibiotics have a list of possible side effects a long as your arm on the leaflet that they come with. some of them v serious

the way the legal systems work in the west is the drug companies can only be prosecuted if you suffer something that can be proven to be a direct cause of the drug taken and the side effect WAS NOT warned of in the leaflet - hence such long lists of stuff they may cause.

i don't see any obvious reason to suppose an increased risk from taking with rifampin - as the mechanisms are v different

i think if it were me, and i needed to take the drug, i would just get LFT done 2 weeks in and 4 weeks - and be alert for any sign of liver damage
Posted 11/9/2021 11:41 PM (GMT 0)
Sachromyces boullardii is helpful for Candida. It’s a beneficial yeast. It doesn’t colonize the gut, so it needs to be taken regularly. Orthomolecular has a high dose that is more affordable. I get it through my doctor’s Fullscript account. You can get Florastor if you don’t have other options. You just get less pills and a way lower dose with Florastor.
Posted 11/10/2021 1:24 AM (GMT 0)
Some good suggestions on here already. I’d personally stay away from anything fluoride based. Most of us have high DNA damage already.

I did a light dive into the floxie community out of curiosity some months back. Scary stuff.

WBF - have you found flucanazole to be more helpful than other anti fungals? I know you’ve spoke about it helping before.
Posted 11/10/2021 1:40 AM (GMT 0)
Oh wow Garzie they must have updated the interaction checker.
When I did it years ago they didn't mention that about rifampin.
That's really great.
Posted 11/10/2021 3:12 AM (GMT 0)
loski,

Yes. I found both Fluconazole and Nystatin beneficial. I took Fluconazole daily for 2 months, I think and then added Nystatin. At that point, Fluconazole was switched to 3 days a week - Fri, Sat, Sun.

Recently, my doc wanted me to swap out the Fluconazole for Voriconazole. I took it for 3 weekends. The third weekend, I developed a phototoxic reaction the first day but continued for the rest of that weekend. Then I stopped and switched back to Fluconazole. I found Voriconazole to be a harsh drug.
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