Names and pronunciation
(ter-bin′a-feen) Lamisil, Terbinex
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Drug reference
(ter-bin′a-feen) Lamisil, Terbinex
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Func. class.: Antifungal
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Chem. class.: Synthetic allylamine derivative
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Do not confuse: terbinafine/terbutaline LamISIL/LaMICtal
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ACTION: Interferes with cell- membrane permeability of fungi such as Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton tonsu rans, Epidermophyton floccosum, Microsporum canis, Microsporum audouinii, Microsporum gypseum, Candida; broad-spectrum antifungal
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USES: (Oral) onychomycosis of toe- nail or fingernail due to dermatophytes, tinea capitis/corporis/cruris/pedis/versi- color Unlabeled uses: Sporotrichnosis, aspergillosis
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CONTRAINDICATIONS: Hyper- sensitivity, chronic/active hepatic disease Precautions: Pregnancy, breastfeeding, children, renal disease GFR ≤50 mL/min, immunosuppression depression, HIV, insomnia, hemolytic-uremic syndrome, suicidal ideation, TTP
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SIDE EFFECTS CNS: Depression EENT: Tinnitus, hearing impairment GI: Diarrhea, dyspepsia, vertigo, abdomi- nal pain, nausea, hepatitis HEMA: Neutropenia INTEG: Rash, pruritus, urticaria, Ste vens-Johnson syndrome, photosensitivity MISC: Headache, hepatic enzyme changes, taste, visual/olfactory disturbance
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INTERACTIONS Increase: levels of dextromethorphan Increase: terbinafine clearance— rifAMPin Increase: clearance of cycloSPORINE Decrease: terbinafine clearance— cimetidine Decrease: metabolism of—CYP2D6 (antidysrhythmics IC, III, amoxapine, atomoxetine, cloZAPine) Drug/Herb • Side effects: cola nut, guarana, yerba maté, tea (black, green), coffee Drug/Lab Test Increase: LFTs
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DOSAGE AND ROUTES • Adult: PO 250 mg/day × 6 wk (finger- nail); × 12 wk (toenail)
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Available forms: Tabs 250 mg; oral granules 125, 187.5 mg
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Administer: • PO: without regard to food • Store at <25°C (77°F); protect from light • Granules: take with food; sprinkle packet contents on pudding or nonacidic soft food; swallow without chewing; do not use fruit-based foods
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Assess: • Hepatic studies (ALT, AST) before be- ginning treatment; do not use in presence of hepatic disease • CBC in treatment >6 wk • Continuing infection: increased size, number of lesions • Pregnancy/breastfeeding: avoid dur ing pregnancy and breastfeeding
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Evaluate: • Therapeutic response: decrease in size, number of lesions
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That treatment may take 12 wk (toe- nail), 6 wk (fingernail) • To notify prescriber of nausea, vomit ing, fatigue, jaundice, dark urine, clay- colored stool, RUQ pain; may indicate he patic dysfunction • To take without regard to meals; gran- ules may be sprinkled on soft food but not chewed; do not mix with fruit-based products See Appendix B
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PHARMACOKINETICS Peak 1-2 hr, >99% protein binding, half- life 36 hr
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• Adult: PO 250 mg/day × 6 wk (finger- nail); × 12 wk (toenail)
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