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Author Topic: Lamisil vs. Itraconazole for THrush  (Read 6480 times)

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Offline Beowulf52

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  • Posts: 4
Lamisil vs. Itraconazole for THrush
« on: June 08, 2008, 11:06:38 PM »
Hey all, my Medicare part D is refusing to pay for Itraconazole which I have been on for several years now, for thrush, as well as toxo and cryptococcal prohylaxis. I am resisitant to Nizoral, Diflucan, Nystatin, and allergic to Griseofulvin. My Medicare co. wants me to take Lamisil, but I can;t seem to find anything about it in the treatment of THrush and the above prophylaxes. Has anyone got experience taking this drug (Lamisil)  and can anyone tell me if it's more toxic to the liver than Itraconazole?

I have appealed it, and my doc has appealed it, but they still insist on Lamisil. Any advice, thoughts, etc, would be much appreciated.

Hard to believe I have survived nearly 23 years only to come up against this  Insurance "wall" .

Thank you in advance,

Beowulf (Bill)

Offline Tim Horn

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  • Posts: 799
Re: Lamisil vs. Itraconazole for THrush
« Reply #1 on: June 09, 2008, 02:30:16 PM »
Beowulf --

What a bunch of bastards. The Medicare officers have got some cheek overriding what you -- and your healthcare provider -- feel is best for you. And the fact that Lamisil is only approved for onchomycosis of the fingernail suggests that, not only is Medicare taking away your autonomy to make important decisions, its making off-label recommendations to boot!

With that said, oral Lamisil is active against various Candida varieties (including albicans, the cause of oral and esophageal thrush). Unfortunately, we don't know how effective it is, as I'm not aware of any studies evalauating Lamisil as prophylaxis (or treatment) for candidiasis. 

What's your CD4+ count? The reason I ask is because this, alone, could be your greatest defense against thrush recurrences and both toxo and cryptococcus. And how are you doing on your antiretroviral therapy?

Certainily, if you experience a thrush breakthrough while on Lamisil, Medicare's recommendations are basically moot, as they simply aren't working for you -- so there may be another fight ahead (but let's hope this doesn't become necessary).

Tim Horn



 

Offline Beowulf52

  • Member
  • Posts: 4
Re: Lamisil vs. Itraconazole for THrush
« Reply #2 on: June 09, 2008, 07:03:08 PM »
Thanks for your input Tim, sadly this happened a year ago as well- the exact same scenario, only they took my Doc's recommendation. Now they are refusing- my CD4 is up to 250, which is is the highest it's ever been since I got diagnosed in 1986. The current HAART has been the first that has ever boosted my cell count even a little, and though Medicare says I shouldn't;t have thrush at that count, the cold hard fact is that I do. I eat no sugar at all, and try very hard to use other therapies, but when I need a Rx I need it. And Itraconazole is hardly an abusable drug- LOL! When I call Medicare Rx they insist I am using it for nail  fungus, which I do NOT have , when I tell them it's oral candidiasis, and all they need to do is look at the charts to confirm it- they go back to the toenail issue again- my conclusion as a retired RN- the people doing the reviews are either idiots, or not well versed in treatment issues or both. Of course, since there is virtually no case management where I live, it makes it all the more difficult. Thank you supposed "Case Managers" at New Hope Clinic , Yakima. It's all a bunch of bunk, but I am going to try the Lamisil, and if there is no improvement- I guess maybe THEN they will see either see the light, or find some other lame excuse to refuse coverage.

In any case thank you for your feedback Tim!

Hugs

Beowulf (Bill)

 


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