HWN Suggests

Could the antifungal terbinafine be working through a dual action?

Terbinafine (Lamisil) is an allylamine antifungal that can be applied to skin to treat dermatophyte infections such as jock itch (tinea cruris), athlete’s foot (tinea pedis) and ringworm (tinea corporis), or taken by mouth to treat fungal nail or scalp infections. It works by inhibiting the enzyme squalene epoxidase, which ultimately stops the fungus from producing the ergosterol it needs for its cell membrane. Ergosterol is used by fungi and some parasites (e.g. trypanosomes), but not humans, which makes this pathway a particularly good source of drug targets. Indeed, azole antifungals inhibit the next enzyme in the pathway, while amphotericin B targets ergosterol directly. A recent study…

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 Antifungal for Nail Fungus May Be Safer Than Originally Thought

The antifungal medication terbinafine has long been considered the gold standard for treating onychomycosis, a fungal infection of the nail. But many patients are hesitant to take the drug because of the potential for side effects like liver damage. Several new studies, including one from a dermatologist at Kaiser Permanente, are now challenging that concern.

 How safe is oral terbinafine?

Terbinafine, as a new antifungal, was a game changer in the treatment of onychomycosis when it entered the UK market in the 1991 (latterly 1998 in the USA). Before this time, the choices for treatment of fungal nails were limited. Topical treatments were often disappointing. Until this time, oral griseofulvin and ketoconazole were the drugs of choice indicated for dermatophyte nail infection orally but they were far from effective. They required long courses and had a narrow spectrum of activity. Many patients would give up due to the unpleasant side effects. So the idea of a new, modern antifungal drug was appealing with early studies suggesting it was much more effective than griseofulvin with double the mycological cure rate. This was latterly shown to be the case with terbinfaine showing superiority in numerous studies.

 Terbinafine Therapeutic Cheat Sheet

Oral and topical formulations of terbinafine are commonly used on- and off-label for the treatment of numerous dermatophyte infections.

Articles of Interest

Terbinafine is probably first choice oral drug for fungal toenail infection

The oral antifungal drug terbinafine appears to be slightly better than alternative ‘azole’ drugs for treating fungal toenail infection. Fifty-eight percent of people had a normal nail appearance after a treatment course compared with 47% taking ‘azoles’. Both drug classes were more effective than placebo and had similar side effects.

Exploring the Pros and Cons of Oral Terbinafine for Toenail Fungus

One of the most significant advantages of oral terbinafine is its high success rate in treating toenail fungus. Clinical studies have shown that terbinafine is effective in eliminating the fungal infection in approximately 70-90% of cases. This success rate makes it one of the most reliable treatments for onychomycosis.

Fungal toenails and terbinafine

Terbinafine is registered for the treatment of a range of dermatophyte infections but has been listed as a benefit only for the treatment of patients with severe onychomycosis, in whom other treatments have failed.

Staying one step ahead of toenail fungus

Itraconazole (Sporanox) and terbinafine (Lamisil) eliminated the fungus in 10 months for 55% to 70% of people in the studies required for FDA approval, but for 15% to 20% of users, the fungus returned within a few months. Either of these drugs can harm the liver, so your doctor will check your liver function at the beginning of treatment and again after six weeks.

Terbinafine Effect: How This Anti-Fungal Medication Can Hurt the Liver

There’s long been some concern about terbinafine’s potential for negative effects on the liver. Research looking into this goes back to before the United States approved the oral version of the drug. In fact, a studyTrusted Source dating back to 1996 evaluated use of the medication in 9,879 UK patients — and while there was a risk for adverse effects, the study found liver problems in only 0.1% of study participants. That study and other more recent researchTrusted Source indicates that preexisting liver conditions may play a role in why a very small number of individuals experience liver issues while on terbinafine.

Terbinafine for Onychomycosis

Preliminary evidence indicates that combining terbinafine with an azole appears to be superior to terbinafine alone. This is based on low-quality evidence, including one study with only 176 participants.

Terbinafine Is Deemed an Attractive Option for Treating Tinea Capitis

“Terbinafine and griseofulvin are the two drugs I use most often in my practice. Since compliance is an issue, and I think 6 weeks of treatment is a lot easier than 2.5–3 months of treatment, and I have to get proof-of-cure cultures in the kids I treat with griseofulvin, Lamisil simplifies my life. When I can use it as a first-line drug, I will. There are some situations where I'm going to use griseofulvin, though—like in a white kid with a Microsporum canis infection,” Dr. Cohen explained.

Terbinafine: A Powerful Solution for Fungal Infections

Whether it’s athlete’s foot, ringworm, or nail fungus, this medication offers fast relief and lasting protection. With proper use, Terbinafine can help individuals regain comfort and confidence in their skin. If you think Terbinafine may be the right treatment for you, consider consulting with a healthcare provider to discuss your options.

The Emerging Terbinafine-Resistant Trichophyton Epidemic: What Is the Role of Antifungal Susceptibility Testing?

Dermatophytosis is commonly encountered in the dermatological clinics. The main aetiological agents in dermatophytosis of skin and nails in humans are Trichophyton (T.) rubrum, T. mentagrophytes and T. interdigitale (former T. mentagrophytes- complex). Terbinafine therapy is usually effective in eradicating infections due to these species by inhibiting their squalene epoxidase (SQLE) enzyme, but increasing numbers of clinically resistant cases and mutations in the SQLE gene have been documented recently

Resources

Lamisil

Terbinafine tablets, USP are indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium).

Terbin

Terbinafine is an antifungal medication. It kills and stops the growth of the fungi by destroying its cell membrane, thereby treating your skin infection.

Topical Terbinafine

cures most athlete’s foot (tinea pedis), cures most jock itch (tinea cruris) and ringworm (tinea corporis), relieves itching, burning, cracking and scaling which accompany these conditions.

American Osteopathic College of Dermatology

With its unique mechanisms of action, terbinafine has been established as the most effective oral agent for onychomycosis with a cure rate of 50 – 70% and also treats tinea capitis. Topically it can treat tinea pedis.

StatPearls

Terbinafine is an antifungal medication that works through the inhibition of squalene epoxidase. It has activity against most dermatophytes, and it has approval for use as an oral therapy for the treatment of onychomycosis. Although most side effects are mild and self-limited, such as headache and gastrointestinal symptoms, taste disturbances (dysgeusia) can range from mild to severe, resulting in weight loss, and have rarely been reported permanent.