BMA Concise Guide to Medicine & Drugs

Terbinafine

Brand names Lamisil AT 1% Cream/Gel/Spray, Lamisil Cream, Lamisil Once, Lamisil Tablets

Used in the following combined preparations None

QUICK REFERENCE

Drug group Antifungal drug

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes (except for some skin preparations)

Available as generic Yes

GENERAL INFORMATION

Terbinafine is an antifungal drug used to treat fungal infections of the skin and nails, particularly tinea (ringworm). It is also used as a cream for candida (yeast) infections.

Terbinafine has largely replaced older drugs such as griseofulvin because it is more easily absorbed and is therefore more effective.

Tinea infections are treated in two to six weeks, but treatment of nail infections may take up to 6 months.

Rare adverse effects of terbinafine include a sore mouth and/or throat, jaundice, a severe skin rash, and bruising and/or bleeding in the mouth. All of these should be reported to your doctor without delay.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, spray, cream, gel, skin solution.

Frequency and timing of doses Once daily (tablets); 1–2 x daily (cream or gel); once only (solution).

Adult dosage range Tinea infections 250mg (tablets or gel). Candida infections As directed (cream).

Onset of effect Depends on the type and severity of infection.

Duration of action 24 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 4 hours, take a single dose now and skip the next.

Stopping the drug Take the full course. Even if you feel better, the original infection may still be present and may recur if treatment is stopped too soon.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Terbinafine can cause a wide range of adverse effects but most are mild and transient. Nausea, indigestion, bloating, abdominal pain, diarrhoea, and headache are common. Less commonly, it may cause loss or disturbance of taste, dizziness, tiredness, pins and needles, and muscle or joint pain. Discuss with your doctor if you experience muscle or joint pain or if any of these other symptoms are severe. If you develop a severe skin rash, sore mouth or throat, bruising or bleeding in the mouth, or jaundice, or if the drug causes your urine to become abnormally dark or your faeces pale, stop taking the drug and contact your doctor immediately.

INTERACTIONS

Rifampicin This drug may reduce the blood level and effect of terbinafine.

Cimetidine This drug may increase blood level of terbinafine.

Oral contraceptives Breakthrough bleeding may occur when these are taken with terbinafine.

Ciclosporin Terbinafine may reduce the blood level of ciclosporin.

SPECIAL PRECAUTIONS

Be sure to consult your doctor or pharmacist before taking this drug if:

· You have liver or kidney problems.

· You have psoriasis.

· You have an autoimmune disorder (e.g. systemic lupus erythematosus)

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Safety not established. Discuss with your doctor.

Over 60 No special problems.

Driving and hazardous work No known problems.

Alcohol No known problems.

PROLONGED USE

Long-term use of oral terbinafine may rarely cause severe liver damage.

Monitoring Periodic blood tests are usually performed to check the effect of the drug on the liver.