Terbinafine Loss of taste

To those who have lost sense of taste due to Terbinafine, know that taste buds do regenerate after 8-10 weeks. This was the amount of time it took me to start tasting again. It was a gradual process. The flavors had to be stronger than the salty, metallic taste in my mouth. I first tasted sushi and then Mexican food. Subtle flavors came later.  The horrible salty, metallic taste took a month longer.  I was recommended zinc for aiding in taste but the side effect can be a metallic taste so I stopped taking it. I never learned if the Terbinafine effects the taste buds or the brain. No doctors could provide answers. I just know if kills toe fungus then it must kill gut flora as well. I wish it were taken off the market.

 

I can really appreciate now the distress. Even though I had quit the drug soon after my realization of taste loss, I think that the residual drug in the body finished off the job of taking all the taste buds. There is now that combination of salty, bitter, metallic along with certain irritated feeling on the tongue and lips. Perhaps this because of the constant licking, movement of the tongue looking to get rid of the taste. It is quite a nasty back ground taste sensation. Is this really how the world actually tastes without sense filters of sweet, sour, bitter, savory?   It does seem that food that you would expect to be bland taste "better" because of the low expectation. Happiness is about expectation management, Oatmeal with milk, rice, beans, potatoes, carrots, clam chowder,  popcorn, unsalted nuts,  heavy chocolate milk shakes or protein shakes that coat the mouth and provide some relief. I think chocolate may be its own flavor category because I know its chocolate in my mouth even though I cannot taste the complete complexity. Oh, what is interesting is Stevia....that sweet substitute that 100-200 times sweeter than sugar, will momentarily mask the SBM....but just for a moment. I have been long duration sipping peppermint tea heavily laced with Stevia. I really want to try the really bitter IPA beers once I know the liver is no longer processing the Terrabine. Maybe, it will taste like Budweiser or Coors.  :-)  I also I think we should consider creating internet dating site specifically for people that have gone through this experience, especially in countries that have nationalized health insurance.  :-)

As the salty, bitter, metallic taste builds during the day, the evening becomes intolerable. So, chewing popcorn, but NOT swallowing the pulverized mulch in your mouth keeps that bitter, metallic taste at bay. Think of it like chewing tobacco. 

I wondered the same thing. I got no answers. Try "bitters" like Angostura but there are healthier ones out there. There are supposed to wake up taste buds.

Hang in there I know how intolerable it is.

It has  been 15 days since being off Terbinafine and I am feeling a bit of the malaise and depression many speak of here. The half-life of the drug in body tissues is 400 hours or 16 days. That means depending on the level of saturation at the end of 30 day dosing only 1/2 of it has been eliminated from the body tissues. Another 16 days shall have to pass to be down to 1/4. And another 16 days to be down to 1/8. So, I can see how there can be longer term side-effects and even drug interactions with anything else you may be taking. Be especially careful if you are taking antidepressants. Because it turns out  that Terabine is very potent CYP2D6 inhibitor. CYP2D6 is one of the most important detox enzymes. It is responsible for the clearance of 20% of clinical drugs, including opioids (codeine, tramadol), antitumor drugs (tamoxifen), antidepressants (fluoxetine), and antipsychotics (haloperidol). In addition, this enzyme also metabolizes dopamine and serotonin in the brain. Therefore, it doesn’t come as a surprise that the activity of this enzyme can be associated with human personality, behavior traits, and psychiatric disease susceptibility.   G. biloba may exert opposite and biphasic effects on CYP1A2 and CYP2D6 metabolism. Induction of CYP1A2 and inhibition of CYP2D6 were found at low concentrations; the opposite was observed at high concentrations. CYP2D6 activity, regarded generally as non-inducible, was increased by exposure to common valerian (linear to dose) and G. biloba (highest concentration). An allosteric activation is suggested.allosteric regulation is the regulation of an enzyme by binding an effector molecule at a site other than the enzyme's active site. The site to which the effector binds is termed the allosteric site or regulatory site.  From the data obtained, G. biloba, common valerian and St. John's wort (decreases CYP2D6) are suggested as candidates for clinically significant CYP interactions.

To clarify G. biloba, common valerian increase CYP2D6 activity and St John;s Wort decreases CYP2D6

It is an amazingly consistent side-effect. Almost all the people here had the taste loss at six weeks. I am on day 28 in the recovery. 

I went hot, like real hot, just so I could feel the burn. E.g. Thai curries fit the bill, and chicken dishes (the mouth feel of chicken) tasted better. While I enjoy Mexican food, the mouth feel of beans, sour cream, guacamole, things like that were gross but I did keep eating chips and salsa. If you like pico type salsa, throw in some heat to feel it, plus salsa is healthy. Just to mess around with my un-tasting mouth, I would take a spoonful of apple cider vinegar in the morning; you can feel that in the back of the throat and it's healthy. I also tried some different oils which, which since they are concentrated, are really strong; consider trying peppermint, lemon, or grapefruit oils just to jump-start your taste buds - look up which other ones are safe before ingesting. Also, consider high-nutrient, high-protein during this time so that you can more quickly get full, stay full, and get the nutrition you need. Maybe even buy a tub of protein and down some protein shakes during the day. I lost 10 lbs but have healthily gained it back in the last 2 weeks or so (it was probably a lot of water loss since I was constantly dehydrated). On that note, do your best to stay hydrated. Dehydration will only worsen the depression that comes with this medicine. The protein shakes will help keep you hydrated, full, and provide nutrition. 

Oh, dang, I almost forgot. Coconut water. I lived on coconut water. For some reason, it really helped combat the crap taste of normal water. I like it normally, but it was really good when regular water tasted like soapy, salt water. Plus, it's like getting an IV. Coconut water is really healthy and really good at keeping you hydrated. Get some exercise, something that will really make you sweat. Then down some coconut water with protein and keep drinking coconut water throughout the day.  

Sorry your're going through this. Try to stay positive and see this as a temporary thing. I have most of my taste back now, although still a little muted (except for sweet/sugary... still can't taste that). You'll get your taste back too. 

Thanks so much for your message Willybman, I find with hot food that it is just burning my mouth without the enjoyment ha.

I am definitely going to get the coconut water today to try. I started taking the peppermint oil yesterday, is one glass with 4 drops enough ???

I'm also on a probiotic and zinc to try and kick start the taste buds..... if it was just the taste buds I think I'd be ok eating more.... but it's just when it mixes with the taste that's in my mouth it makes food unbareable !!!

O I will also get some protein and just live off shakes for the next while as hungry and angry aren't a good mix ha !!!

thanks again for taking the time to reply to my message.

I was told by my dr. to take zinc but my dentist told me to stop. Google side effects of zinc, can have metallic taste. She recommended B12. Take care! 

No problem. I understand how frustrating this is and this thread was helpful for me when I was really struggling. I don't know about dosages on those oils. Some can be more concentrated than others and some are not for internal ingestion. They're strong, which helps with the mouth taste issue, but be careful, do some research, and talk with a doctor. 

I'd like to hear what you think about the coconut water. That was huge for me but I have to emphasize exercising too. It makes you feel better in many ways and it causes your body to heal quicker. Everything that goes along with exercising (muscle cell regrowth, increased blood flow, good for your brain, etc. etc) will speed up your recovery. http://time.com/4474874/exercise-fitness-workouts/ 

Also, since you're already not eating much, you may even consider intermittent fasting to really kickstart your body's recovery (boost human growth hormones, or HGH, and other beneficial things). But, when you're not fasting, during that shorter eating window, make sure you ingest what you need (same caloric intake of healthy food).

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Hi Sherrill

Thanks a million for taking the time to post, I have vitamin B12 as well. I will stop the zinc immediately and keep with the B12 and peppermint oil. I do think no matter what I will have to wait the 8-10 weeks.

I think my stomach is shrinking now so the hunger doesn't seem as bad.

thanks again

Hi Willy....So you can now taste sour, salty and bitter? Can you taste cheese? What day are you on in your recovery? I really miss IPA beer. I can almost sense the "ghost" of some foods like blueberries, melon. Popcorn still removes the metallic taste in my mouth. Kombucha seems to okay too. But watch out for all caffeine in it if you drink it later in the afternoon.

As your taste returns but the salt and metallic flavor remain, I enjoyed sushi. The salty soy sauce masked the bad salt flavor and I could taste the ginger and umami (or the taste of meat/seafood.)

Hi Willyban 

Thanks again for your reply, I tried the coconut water on Fri and it was really good refreshing and just better than water. 

I did consult a aromatherapist regarding the oil and he told me under no circumstances are any essential oils to be ingested, he did however make up a nasal sniffer of essential oils, including peppermint and rosemary (he said rosemary is great for taste buds) for me to try. I’ve managed protein shakes and Ramon noodles as well which are helping... I do walk for 2 hrs a day so the exercise/outdoors is ok but to try do rigorous exercise is a bit hard as I’ve no energy. I’m on day 9 off the tablets so it’s just a waiting game now. Thanks again 

At five weeks, I think I got my first very small hint of being able to taste salt but the background default salt and metallic taste is either subdued somewhat or I am getting use to it. 

Hi Lou.....my research seems to indicate it is not your taste buds, it is your brain neurons that are being affected. The cholesterol that is synthesized by the enzyme to create the messenger molecules between the synapses is missing. That is because terrabine is an inhibitor of this enzyme. That is why many people get depressed too. Lots and lots of oxygen and exercise may be the best cure to speed up the much longer half-time presence of the drug in the brain. 

Yep. At about 5 weeks, I started getting my taste back. I’m at about 8 weeks off the pills and I can taste everything now except for some sweet/sugary flavors. I’m sure hard exercise helped. Increased bloodflow helps speed up healing. 

Hey, that is great Willy. Yes, I think intense exercise is the ticket too. There is a difference in the number of hairs in the taste-buds for each taste sense. These micro-fibers sends the signals to the brain synapses to make the connection between the perception and the sense. Sweet taste buds have fewer micro-fibers to send signals to the brain. That would explain the gradual way in which we get our taste back with limited number of enzymes making the signaling transmitters. But when the enzyme production is finally up to speed even the sweet taste comes back.

During the holidays we often find ourselves surrounded by a wide variety of taste sensations. Have you ever wondered how well we sense different tastes? People are generally able to discern five basic tastes: sweet, umami (also known as savory), salty, sour and bitter. Is it easier to detect some of these flavors compared with others? In this science activity, you (and maybe some friends or family) will find out by exploring your taste thresholds for sweetness, saltiness and sourness. Get ready to find out how low you can go!

Background

Our sensory system for taste is remarkably sensitive. Not only can we detect substances at extremely low concentrations, we can also differentiate between molecular compounds that are closely related. For example, we can distinguish between different stereoisomers, which are molecules that are made of exactly the same components, but are mirror images of one another in their structure. The artificial sweetener aspartame is an example of this—it tastes sweet to us, but its stereoisomer (its opposite) does not. This amazing sensitivity is made possible by our taste buds. Taste buds, located on small bumps on the tongue called fungiform papillae, are each made up of about 50 to 150 taste receptor cells. On the surface of these cells are receptors that bind to small molecules related to flavor. Through sensory nerves, the receptors relay the taste sensation information to the brain. Terrabine probably messed up the production neurotransmitters needed for this information to be perceived in the brain This process allows us to discern five basic tastes. Here is how to measure your recovery. You will have increase the concentration of the solutions greatly because you are obviously impaired.

Materials

• Measuring spoons

• Water, preferably distilled

• 12 paper or plastic cups

• Permanent marker

• Kitchen scale or measuring spoons

• Granulated sugar or sucrose

• Table salt

• Vinegar

• Spoons

• Cotton swabs

• Paper towels

• Piece of paper and pen or pencil (optional)

• Taste-test volunteers (optional)

Preparation

• Pour 6 tablespoons (tbsp.) of distilled water into a paper or plastic cup. Add 10 grams of sugar (or about 2 1/2teaspoons (tsp.)) and stir until the sugar is dissolved. This gives you a 10 percent sugar solution, approximately. Label the cup.

• Pour 2 tsp. of the 10 percent sugar solution into a new cup. Add 6 tbsp. of water to it and stir. This gives you a 1 percent sugar solution. Label the cup. 

• Repeat this dilution process (diluting 2 tsp. of the previous solution in a new cup with 6 tbsp. of water) to make 0.1 percent and 0.01 percent sugar solutions. These are called serial dilutions. Be sure to label the two new cups. What do you think is the lowest concentration you'll be able to taste the sugar in?

• Repeat these steps (using clean utensils) to create salt solutions that have concentrations of 10 percent, 1 percent, 0.1 percent and 0.01 percent. Label the cups. For 10 grams of salt, you can use 1 3/4 tsp. of salt. What do you think is the lowest concentration you'll taste the salt in?

• Again repeat the steps (using clean utensils) to create vinegar solutions that have concentrations of 10 percent, 1 percent, 0.1 percent and 0.01 percent. Label the cups. Use 2 tsp. of vinegar initially. What is the lowest concentration you think you'll taste the sour vinegar in?

Procedure

• Rinse your mouth with plain water and wipe your tongue dry with a clean paper towel. Dip a clean cotton swab into the 10 percent sugar solution and smear it all around the surface of your tongue. Can you taste the sweetness?

• Repeat the previous step to test the 1 percent, 0.1 percent and 0.01 percent sugar solutions, rinsing your mouth and wiping your tongue before testing each solution. Which solution is the lowest concentration at which you can still taste the sweetness? This is your approximate taste threshold for sugar. You can write this down to remember later.

• Rinse your mouth with plain water and wipe your tongue dry with a clean paper towel. Dip a clean cotton swab into the 10 percent salt solution and smear it all around your tongue. Can you taste the saltiness?

• Repeat the previous step to test the 1 percent, 0.1 percent, and 0.01 percent salt solutions. Which solution is the lowest concentration at which you can still taste the saltiness? This is your approximate taste threshold for salt. You can write this down.

• Rinse your mouth with plain water and wipe your tongue dry with a clean paper towel. Dip a clean cotton swab into the 10 percent vinegar solution and smear it all around your tongue. Can you taste the sourness? Repeat this process to test the 1 percent, 0.1 percent and 0.01 percent vinegar solutions. Which solution is the lowest concentration at which you can still taste the sourness? This is your approximate taste threshold for vinegar. You can write this down.

• Were your taste thresholds (the lowest concentration at which you could still taste the flavor) the same for all three tastes, or did you have lower thresholds for some of them? Did the solutions that were 10-fold more concentrated taste 10 times stronger?  

• Extra: Try repeating this activity using several volunteers. Compare your results. Do some people generally have lower thresholds than other people? Is there a variation in which taste has the lowest threshold for individuals in the group? 

• Extra: Recruit several volunteers in different age groups to take this threshold-of-taste test. Does taste threshold change predictably with age?

• Extra: In this activity you used 10-fold serial dilutions to roughly establish your threshold of taste. Design a test to determine your threshold with higher precision. What exactly is your taste threshold for sugar, salt and vinegar?

Observations and results

Could you taste all of the 10 percent solutions, but none of the 0.01 percent solutions? Did the sugar solutions have the highest threshold, meaning you could only taste it in the more concentrated solutions, compared with the salt and vinegar solutions, which had lower thresholds?

For the sugar, salt and vinegar solutions, the 10 percent solutions should be detectable by nearly everyone who tries the test, whereas almost nobody should be able to detect the 0.01 percent solutions because the concentrations are too low. The basic tastes of sweet, salty and sour have different thresholds, or concentration levels, at which they can be detected. In other words, it is easier to detect some flavors at low concentrations compared with other flavors. Taste thresholds can vary from person to person. You may have seen that the sugar solutions were harder to taste at lower concentrations compared with the salt and vinegar solutions. In other words, the sugar solutions may have had a relatively high taste threshold compared with the salt and vinegar solutions. You may have also seen that the vinegar solutions had a lower threshold compared with the salt solutions (meaning the vinegar was easier to taste at lower concentrations), but this difference can be minor and may require testing by many individuals to see a clear trend.

Day 36. 1/2 Sour taste, 1/2 Savory taste, 1/4 Salt, No sweet. I know something is sweet, like a blackberry or blueberry when it is "not sour". 

Okay, I have no idea whether this treatment will generalize but I will explain. I really do believe it is working for me. When the terrabine did it's terrible side effects, I immediately stopped taking it orally. However, what I have been doing over that last month is using the pills in a toe soak twice a day. That is, I bought a $7 plastic painters scroll pan from hardware store. Also a bag of epsom salts and ounce of tea tree oil. I take a cup of hot water  from the tap, pour in half cup of epson salts, four/five drops of tea tree oil, and one pill of the remaining prescription of terrabine and let it dissolve in the water. Make sure you file down the nail thin and smooth, cut back as much infected part as much as possible (do not mangle yourself though!) place back your manicure tools in a antifungal disinfectant container. Sit comfortably reading, studying, facebooking, etc for an hour in the morning and evening. When done put on topical lamisil to let in soaking further. Save the solution for the evening, heat up again by boiling a 1/2 cup of water and pouring it in. Repeat in the evening. My nails are really looking promising right now. I will not know for sure until some time has passed. You know, an infected nail does not have to look "late stage" to be infected. Cloudy, not bad looking nails eventually turn to white and seperate from the bed. But, my nails have not looked this good in years. Maybe this is the only way to use terrabine without all the risks we know of.