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Terbinafine
Aka: Terbinafine, Lamisil, Allylamine Antifungal
- Mechanism
- Allylamine Antifungal
- Indications
- Topical Management (Lamisil, Terbinafine HCl 1%)
- Resistant dermatophyte infection (e.g. Tinea Pedis)
- Systemic Management (Terbinafine)
- Onychomycosis
- Adverse Effects: Oral Terbinafine
- Uncommon effects
- Headache
- Rash
- Gastrointestinal upset
- Rare effects
- Cholestatic hepatitis
- Blood dyscrasia
- Stevens-Johnson Syndrome
- Monitoring: Oral Terbinafine
- Protocol
- Baseline labs
- Repeat CBC after 6 weeks of continuous use if Immunodeficiency
- New guidelines do not require repeat LFT testing routinely
- Obtain repeat testing if higher risk of liver abnormality, concurrent use of Hepatotoxic Medications, or symptoms
- In past, LFTs have been monitored every 4 to 6 weeks
- Stop agent if AST or ALT >2x normal
- Labs
- Complete Blood Count and Platelet Count (if Immunodeficiency)
- Aspartate Aminotransferase (AST)
- Alanine Aminotransferase (ALT)
- Serum Creatinine
- Dosing: Oral
- Dose
- Adult (and child >40 kg): 250 mg orally daily
- Child 20-40 kg: 125 mg (up to 187.5 mg) orally daily
- Child <20 kg: 67.5 mg (up to 125 mg) orally daily
- Duration
- Tinea Capitis: 6 weeks (longer course if culture grows Microsporum)
- Fingernail Onychomycosis: 6 weeks
- Toenail Onychomycosis: 12 weeks
-
Drug Interactions
- Cimetidine increases Terbinafine levels
- Rifampin decreases Terbinafine levels
- Increased bleeding risk with Warfarin
- References
- Ely (2014) Am Fam Physician 90(10): 702-10 [PubMed]
- Gupta (1999) J Am Acad Dermatol 41:237-49 [PubMed]
- Friedlander (1999) Pediatr Infect Dis J 18(2):205-10 [PubMed]
- McClellan (1999) Drugs 58(1):179-202 [PubMed]
- Perez (1999) Mycoses 43:79-83 [PubMed]