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 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