II. Mechanism
- Allylamine Antifungal
III. Indications
- Topical Management (Lamisil, Terbinafine HCl 1%)
- Resistant dermatophyte infection (e.g. Tinea Pedis)
- Systemic Management (Terbinafine)
IV. Adverse Effects: Oral Terbinafine
- Uncommon effects
- Headache
- Rash
- Gastrointestinal upset
- Rare effects
- Cholestatic hepatitis
- Blood dyscrasia
- Stevens-Johnson Syndrome
V. 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
VI. 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
VII. Drug Interactions
- Cimetidine increases Terbinafine levels
- Rifampin decreases Terbinafine levels
- Increased bleeding risk with Warfarin
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Related Studies
terbinafine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
TERBINAFINE 1% CREAM | Generic OTC | $0.27 per gram |
TERBINAFINE HCL 250 MG TABLET | Generic | $0.16 each |