II. Mechanism

  1. Allylamine Antifungal

III. Indications

  1. Topical Management (Lamisil, Terbinafine HCl 1%)
    1. Resistant dermatophyte infection (e.g. Tinea Pedis)
  2. Systemic Management (Terbinafine)
    1. Onychomycosis

IV. Adverse Effects: Oral Terbinafine

  1. Uncommon effects
    1. Headache
    2. Rash
    3. Gastrointestinal upset
  2. Rare effects
    1. Cholestatic hepatitis
    2. Blood dyscrasia
    3. Stevens-Johnson Syndrome

V. Monitoring: Oral Terbinafine

  1. Protocol
    1. Baseline labs
    2. Repeat CBC after 6 weeks of continuous use if Immunodeficiency
    3. New guidelines do not require repeat LFT testing routinely
      1. Obtain repeat testing if higher risk of liver abnormality, concurrent use of Hepatotoxic Medications, or symptoms
      2. In past, LFTs have been monitored every 4 to 6 weeks
      3. Stop agent if AST or ALT >2x normal
  2. Labs
    1. Complete Blood Count and Platelet Count (if Immunodeficiency)
    2. Aspartate Aminotransferase (AST)
    3. Alanine Aminotransferase (ALT)
    4. Serum Creatinine

VI. Dosing: Oral

  1. Dose
    1. Adult (and child >40 kg): 250 mg orally daily
    2. Child 20-40 kg: 125 mg (up to 187.5 mg) orally daily
    3. Child <20 kg: 67.5 mg (up to 125 mg) orally daily
  2. Duration
    1. Tinea Capitis: 6 weeks (longer course if culture grows Microsporum)
    2. Fingernail Onychomycosis: 6 weeks
    3. Toenail Onychomycosis: 12 weeks

VII. Drug Interactions

  1. Cimetidine increases Terbinafine levels
  2. Rifampin decreases Terbinafine levels
  3. Increased bleeding risk with Warfarin

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Cost: Medications

TERBINAFINE (on 2/19/2015 at Target.com)
TERBINAFINE 250 MG* Tablet #90 for $10.00 $0.11 each
terbinafine (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
TERBINAFINE 1% CREAM Generic OTC $0.29 per gram
TERBINAFINE HCL 250 MG TABLET Generic $0.16 each
lamisil (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
LAMISIL AF DEFENS 1% SPRAY PWD OTC $0.04 per gram
LAMISIL ANTIFUNGAL 1% SPRAY OTC $0.06 per ml
LAMISIL AT 1% CREAM OTC $0.60 per gram

Ontology: terbinafine (C0076110)

Definition (NCI) A synthetic allylamine derivative with antifungal activity. Terbinafine exerts its effect through inhibition of squalene epoxidase, thereby blocking the biosynthesis of ergosterol, an important component of fungal cell membranes. As a result, this agent disrupts fungal cell membrane synthesis and inhibits fungal growth.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C041359
SnomedCT 108925005, 373450007
LNC LP14848-3, MTHU002062
English terbinafine, (E)-N-(6,6-Dimethyl-2-hepten-4-ynyl)-N-methyl-1-naphthalene Methanamine, TERBINAFINE, terbinafine [Chemical/Ingredient], Terbinafine, Terbinafine (product), Terbinafine (substance)
Spanish terbinafina (producto), terbinafina (sustancia), terbinafina

Ontology: Lamisil (C0721298)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C041359
English Lamisil, lamisil, LamISIL

Ontology: Allylamine Antifungals (C1579364)

Concepts Pharmacologic Substance (T121)
English Allylamine Antifungals