associated with terbinafine A. J. Duxbury,1 R. J. Oliver,2 and M. N. Pemberton,3
minor sinus operation as a child. She did
A second case of persistent taste disturbance associated with not smoke and drank alcohol only occa- terbinafine is described. Taste disturbance associated with this sionally. On examination the oral soft tis- drug is reviewed and a table is provided listing the more sues and dental hard tissues were all clinically healthy and no abnormalities common drugs associated with taste disturbance. were detected. The ulceration noted by her general dental practitioner had resolved and did not recur during the follow-up
Anticoagulants Phenindione (dysgeusia) Antihistamines Chlorpheniramine Antimicrobials Amphotericin (dysgeusia), ampicillin, cephamandole, griseofulvin (dysgeusia), lincomycin, levamisole, metronidazole (metallic taste), sulphasalazine, stopped immediately. Recovery was par- streptomycin, tetracyclines, terbinafine, tyrothrycin tial with continued difficulty tasting sugar Antineoplastics and Bleomycin (sour and metallic taste and taste loss), or salt in food some 3 years later. In com- immunosuppressants doxorubicin, methotrexate (sweet taste), azothiaprine, parison our patient described partial loss carmustine, vincristine.fluorouracil (altered bitter and of sweetness with a persistent bitter taste, sour taste) followed by a partial recovery over an 18- Anti-inflammatories Salicylates (taste disturbance) phenylbutazone month period. (hypogeusia, ageusia) The taste disturbance associated with Antirheumatics Allopurinol (metallic taste), colchicines, gold (metallic terbinafine is thought to be associated taste), penicillamine (reversible loss of taste) with taste receptor dysfunction through Antiseptics Chlorhexidine (aftertaste), hexetidine, sodium lauryl the inhibition of cytochrome P-450 sulphate (loss of sweet and salt taste) dependent enzymes, although the exact mechanism is unclear.2,6 Predisposing Antithyroid Carbimazole factors have been reported as being a low Antihypertensives and Captopril (and other ACE inhibitors), diazoxide, body mass index and advanced age,7 while diuretics ethacrynic acid some patients have been found to have a Anti-arrhythmics Propafenone, amiodarone reduced intake of protein and zinc. A Antipsychotics and Carbamazepine (hypogeusia, ageusia), lithium higher tissue concentration of terbinafine anticonvulsants (dysgeusia), phenytoin, trifluoperazine, zopiclone may occur in slim people and a reduction (bitter or metallic taste) in taste buds with increasing age may Local anaesthetics Benzocaine etc. exacerbate the problem. Zinc has been Muscle relaxants, Baclofen (ageusia, hypogeusia), levodopa (taste reported to have a role in the normal antiparkinson agents disturbance) appreciation of taste and smell and zinc Lipid modulating agents Clofibrate salts have been used in the treatment of disordered function of these modalities, Opiates Codeine, morphine but other reports claim this has not been Sympathomimetics Amphetamines convincingly shown.3 The ability to taste bitter and salty food is considered to be lost more often than that of sweet and salivary flow claimed by the patient may be 1 O’Sullivan D P, Needham C A, Bangs A, Atkin K, sour tastes because of the lower number of postulated as arising in response to the Kendall F D. Post marketing surveillance of oral receptors related to the former two taste sour/bitter taste.8 Terbinafine in the UK: report of a large cohort study. Br J Clin Pharmacol 1996; 42: 559-565. modalities.2 In this case, the temporal relationship 2 Bong J L, Lucke T W, Evans C D. Persistent Links between these factors and our between the onset of symptoms and the impairment of taste resulting from terbinafine. own patient exist. Our patient was middle- prescribing of terbinafine, and the known Br J Dermatol 1998; 139:747-748. 3 Lamey P J. Salivary Gland and Chemosensory aged and prior to exposure to terbinafine side effects of terbinafine make it likely Disorders. In Millard H D and Mason D K, she was under weight. At the time she took that the two events are causally related. (eds) Perspectives on 2nd World Workshop on terbinafine her weight was 7.5 stones (47.7 The role of a viral infection at the time the Oral Medicine. Section 4. pp 273-360. Chicago: kgs) while currently her weight at 9.0 loss of taste arose, or an interactive effect University of Michigan, 1993. 4 Duxbury A J. Systemic Pharmacotherapy. In stones (57.3 kgs) is normal for her height. with tetracycline, however, cannot be Jones J H and Mason D K, (eds) Oral However she ate a varied diet, there were totally discounted. We report this case to Manifestations of Systemic Disease. Chapter 11. no chronic nasal or sinus problems, and draw attention to the rare occurrence of pp 411-479. London: Balliere Tindall 1990. she was taking no over-the-counter drugs. persistent taste loss associated with 5 British National Formulary. No.38 p280. London: British Medical Association and the Royal Her medication then and now, was of pro- terbinafine and the overall problem of Pharmaceutical Society of Great Britain, 1999. pranolol and tetracycline. Propranolol is taste disturbance associated with a variety 6 Henkin R I. Drug induced taste and smell not, as far as we are aware, implicated in of drugs that may be taken by patients disorders incidence, mechanisms and taste disturbance. Tetracycline may cause attending the dental surgery (Table 1). management related primarily to treatment of sensory receptor dysfunction. Drug Safety stomatitis and has been reported previ- Loss or disturbance of taste is socially dis- 1994; 11: 318-377. ously, as have other antibiotics, as a cause abling, can make patients depressed, and 7 Stricker B H, Van Riemsdijk M M, of taste disturbance (Table 1). Our patient leads them to seek medical and dental Sturkenboom M C, Ottervanger J P. Taste loss took tetracycline prior to the development advice. Once simple medical and dental to Terbinafine: a case — control study of potential risk factors. Br J Clin Pharmacol 1996; of her taste disturbance without any effect causes have been excluded further inves- 42: 313-318. on taste; the involvement of this drug tigation by specialist departments is 8 Spielman A I. Interaction of saliva and taste. J therefore seems unlikely. The increased appropriate. Dent Res 1990; 69: 838-843.
296 BRITISH DENTAL JOURNAL, VOLUME 188, NO. 6, MARCH 25 2000