Home' Australian Pharmacist : Australian Pharmacist September 2014 Contents Australian Pharmacist September 2014 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
1. Which type of tinea pedis generally
affects the lateral aspects of the foot?
2. Which topical antifungal agent DOES
NOT require treatment continuation
after symptoms resolve?
3. Oral antifungal agents can cause
serious adverse effects, such as
elevated liver enzymes. Which of the
following medications DOES NOT
affect liver enzymes?
4. Jonathan is a 32-year-old patient
who has recently been prescribed
terbinafine for his fungal toenail
infection. You advise Jonathan that:
a) Terbinafine is well tolerated and rarely
causes stomach upset.
b) He can expect to take a 3 week
treatment course – this is usually
recommended with terbinafine for
c) Terbinafine can cause photosensitivity,
so his skin will become more sensitive
to the sun during the treatment course.
d) He should consult his GP, as he is
currently taking Efexor (venlafaxine) and
this may interact with terbinafine.
5. When treating toenail
a) Griseofulvin is an effective treatment
option, at a dose of 500 mg once daily
for three months.
b) Terbinafine is an effective treatment
choice, with a 70–80% cure rate.
c) Ciclopirox is available as a nail lacquer,
that should be applied twice daily for
two weeks for eradiation of infection.
d) Amorolfine can cause hair colour
You inform Thomas that if he does not
see any improvement in symptoms
within a few weeks, or if he notices
any pus or yellow crust on the lesions,
he should visit his GP for further advice.
You recommend that Thomas keeps
his feet dry, ensuring he dries them
well before putting on socks or shoes.
He should use a separate towel for his
feet to prevent spread of the infection.
Ideally, Thomas should wear cotton
(natural fibre) socks and breathable
runners and shoes. He should try to
change his running shoes every two
to three days, so they dry out properly.
Thomas should also try to wear sandals
or thongs in communal showers or
• A variety of pathogens cause of fungal
• Tinea pedis is a common condition,
and symptoms include macerated,
itchy and irritated skin.
• Onychomycosis (brittle, discoloured
toenails) is more likely to occur on the
toenails, and is usually associated with
a tinea pedis infection.
• Pharmacists should be aware of the
various treatment options for fungal
foot infections, including directions for
use, side effects and drug interactions.
• It is also prudent that pharmacists
provide patients with preventative
advice, to prevent recurrence of fungal
foot infections, and know when to refer
patients to their GP.
1. Flint W, Cain J. Nail and skin disorders of the foot. Med Clin N
2. Moriarty B, Hay R, Morris-Jones R. The diagnosis and
management of tinea. BMJ. 2012;345:37–42.
3. Dermatology expert group. Therapeutic guidelines:
Dermatology. Version 3. Melbourne: Therapeutic Guidelines;
4. Field L, Adams B. Tinea pedis in athletes. The International
Journal of Dermatology. 2008;47:285–92.
5. Hasan M, Fitzgerald S, Saoudian M, Krishnasawamy G.
Dermatology for the practicing allergist: tinea pedis and
its complications. Clinical and molecular allergy. 2004;2(5):
Clin Mol Allergy. 2004 [cited 2014 Jun 8]. doi: 10.1186/1476-
6. Shirwaikar A, Thomas T, Shirwaikar A, Lobo R, Prabhu K.
Treatment of onychomycosis: an update. Indian Journal of
Pharmaceutical Sciences. 2008;70(6):710–4 .
7. Tinea pedis [revised Dec 2013]. In: dermnet.org.nz. New
Zealand: New Zealand Dermatological Society Incorporated;
2013. At: www.dermnetnz.org/fungal/tinea-pedis.html
8. Elewski B, Rich P, Tosti A, Pariser D, Scher R, Daniel R, et al.
Onychomycosis: an overview. J Drugs Dermatol. 2013;12(7
9. Rossi S, ed. Australian medicines handbook. Adelaide:
Australian medicines handbook, 2014: at www.amh.net.au/
10. Ellis D, Watson A. Systemic antifungal agents for cutaneous
fungal infections. Aust Prescr. 1996;19:72–5 .
11. Pharmaceutical Society of Australia. Non-prescription
medicines in the pharmacy – a guide to advice and
treatment. Canberra: The Pharmaceutical Society of
Table 3. Common drug interactions with oral
Drug interactions and mechanism
• Inhibits CYP2D6 enzyme
• Can increase concentrations of
medications metabolized by CYP2D6
leading to increased potential for
• Affected drugs include: amitriptyline,
codeine, haloperidol, metoprolol,
olanzapine, oxycodone, tramadol,
Fluconazole and itraconazole:
• Inhibits CYP3A4 enzyme leading to
increased potential for adverse effects
• Affected drugs include: amiodarone,
haloperidol, quetiapine, felodipine,
diazepam, codeine, oxycodone, warfarin
• Fluconazole – may prolong QT interval
if given with medications that can
prolong QT interval, such as: celecoxib,
diazepam, ibuprofen and phenytoin
• Itraconazole – has a negative inotropic
effect; combination with a calcium
channel blocker (also have negative
inotropic effects) can lead to heart
• Phenobarbitone – may reduce efficacy
• Griseofulvin – may reduce efficacy of
combined oral contraceptive.
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