Pharm
Terbinafine
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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 Medication
s, 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]
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