Infectious Disease Book

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Terbinafine

Aka: Terbinafine, Lamisil, Allylamine Antifungal
  1. Mechanism
    1. Allylamine Antifungal
  2. Indications
    1. Topical Management (Lamisil, Terbinafine HCl 1%)
      1. Resistant dermatophyte infection (e.g. Tinea Pedis)
    2. Systemic Management (Terbinafine)
      1. Onychomycosis
  3. 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
  4. 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
  5. 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
  6. Drug Interactions
    1. Cimetidine increases Terbinafine levels
    2. Rifampin decreases Terbinafine levels
    3. Increased bleeding risk with Warfarin
  7. References
    1. Ely (2014) Am Fam Physician 90(10): 702-10 [PubMed]
    2. Gupta (1999) J Am Acad Dermatol 41:237-49 [PubMed]
    3. Friedlander (1999) Pediatr Infect Dis J 18(2):205-10 [PubMed]
    4. McClellan (1999) Drugs 58(1):179-202 [PubMed]
    5. Perez (1999) Mycoses 43:79-83 [PubMed]
Medication Costs
Terbinafine (on 6/18/2017 at Walmart.com)
Terbinafine 250mg #30 tablets for $4.00 $0.13 each
Terbinafine 250mg #90 tablets for $10.00 $0.11 each
terbinafine (on 5/17/2017 at Medicaid.Gov Pharmacy Drug pricing)
TERBINAFINE 1% CREAM Generic OTC $0.26 per gram
TERBINAFINE HCL 250 MG TABLET Generic $0.16 each
lamisil (on 4/19/2017 at Medicaid.Gov 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 $0.62 per gram
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Lamisil (C0721298)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C041359
English Lamisil, lamisil, LamISIL
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Allylamine Antifungals (C1579364)

Concepts Pharmacologic Substance (T121)
English Allylamine Antifungals
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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