Terbinafine hydrochloride, sold as Lamisil tablets in the U.S., is often prescribed for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (Tinea unguium).
It is also sold as a 1% cream or powder for use on suface infections such as jock itch (Tinea cruris) or athlete's foot (Tinea pedis).
Nail fungus infections live deep under the nail in the nail bed. Surface treatments may not be able to reach it in sufficient amounts, so terbinafine hydrochloride is given orally in tablet form, which is absorbed through the bloodstream to reach the infection; this method can cause hepatotoxicity, or liver damage, as well as other serious side effects, so those taking Lamisil tablets often have blood screenings every month. Many health insurance companies consider these infections to be a cosmetic problem, and either do not cover the cost of the months-long course of Lamisil, which can run into the thousands of dollars, or recommend use of less expensive alternatives like fluconazole.
The tablets contain the synthetic allylamine antifungal compound terbinafine hydrochloride, which is a white fine crystalline powder that is freely soluble in methanol and methylene chloride, soluble in ethanol, and slightly soluble in water. Chemically, it is (E)-N-(6,6-dimethyl-2-hepten-4-ynyl)-N-methyl-1- naphthalenemethanamine hydrochloride. The empirical formula C21H26CIN with a molecular weight of 327.90
Active Ingredients: Terbinafine hydrochloride (equivalent to 250 mg base)
Inactive Ingredients: Colloidal silicon dioxide, Hydroxypropyl methylcellulose USP, Sodium starch glycolate, Magnesium stearate, Microcrystalline cellulose.
Description: Terbinafine (Terbinafine Hydrochloride) is an allylamine similar in structure to naftifine. It is a synthetic antifungal agent, that is highly lipophilic in nature and tends to accumulate in skin, nails, and fatty tissues.
Mode of action: Like other allylamines, terbinafine inhibits ergosterol synthesis by inhibiting squalene epoxidase -- an enzyme that is part of the fungal sterol synthesis pathway that creates the sterols needed for the fungal cell membrane. In layman's terms, it inhibits fungal and bacterial cell wall growth, causing the contents of the cell to be unprotected and eventually die.
Susceptibility Patterns: Terbinafine is mainly effective on a specific group of fungi, dermatophytes.
Side Effects: Adverse reactions to terbinafine are usually temporary and mild.
Indications: Fungal skin infections; Dermatophyte infections of the nails; Ringworm infections.
Contraindications: Terbinafine is not indicated for persons who have developed an allergy to the drug.
Routes: Oral and topical. Topically, 1% cream and solution formulations are generally used.
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