Terbinafine
Terbinafine
Lamisil; OTC topical Lamisil AT
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Summary
Classes
Common uses
Onychomycosis (nail fungal infection)0, Tinea pedis (athlete's foot)0, Tinea corporis / cruris0
Pharmacy
Starting dose
Oral: 250 mg PO once daily × 6 weeks (fingernails) or 12 weeks (toenails); topical: cream BID × 1-2 weeks
Preparations
250 mg tablets; 1% topical cream, gel, spray; granules (pediatric)
US FDA Max
250 mg/d
Pharmacology
Routes
Oral, topical
Onset
Clinical and mycologic cure follows the full course; nail clearance over months of regrowth
Duration
24 hours
Half-life
~36 hours (terminal much longer due to tissue accumulation in skin/nails)[1]
Bioavailability
~40% (oral; food does not significantly affect)[1]
Pregnancy
Limited data; generally avoided in pregnancy for the cosmetic indication of onychomycosis.[citation needed]
Legal status
OTC (topical) and Rx-only (oral) in US
Purported mechanism
Terbinafine inhibits fungal squalene epoxidase, blocking the early step of ergosterol biosynthesis; the resulting squalene accumulation is itself toxic, producing fungicidal (not just fungistatic) activity against dermatophytes — the basis of relatively short treatment courses for skin infections compared with azoles.0 CYP2D6 inhibitor — clinically relevant interaction with metoprolol, antidepressants, and other CYP2D6 substrates. Hepatotoxicity (idiosyncratic, sometimes severe) is the main systemic concern; baseline and on-treatment LFT monitoring is standard for the 12-week oral course[1].
References
- ↑ 1.0 1.1 1.2 FDA Prescribing Information, Lamisil (terbinafine HCl), Novartis, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020539s021lbl.pdf