Terbinafine: Brands, Price & Uses in Bangladesh

Terbinafine is an allylamine antifungal used to treat infections caused by dermatophyte fungi. Its indications can be classified by strength of evidence as follows:

Established / Approved Uses

• Onychomycosis (fungal nail infection): Oral Terbinafine is indicated for the treatment of onychomycosis of the toenail or fingernail caused by dermatophytes (tinea unguium), confirmed by laboratory testing (KOH preparation or culture) where appropriate.
• Tinea pedis, tinea cruris, tinea corporis: Topical Terbinafine (cream, gel, or spray) is indicated for superficial dermatophyte skin infections including athlete's foot, jock itch, and ringworm of the body. Oral Terbinafine may also be used for more extensive or refractory cases.
• Tinea capitis (scalp ringworm): Oral Terbinafine granules are indicated in pediatric patients for tinea capitis caused by susceptible dermatophytes.

Uses Requiring Clinical Judgment / Extent-Dependent

Choice between topical and oral Terbinafine for tinea pedis, cruris, and corporis depends on the extent, severity, and site of infection, and response to prior topical therapy.

Off-Label Use

Terbinafine is sometimes used off-label for other dermatophyte or selected non-dermatophyte fungal skin infections at a physician's discretion; such use should be guided by clinical assessment and, where possible, mycological confirmation.

Dosing of Terbinafine depends on the indication, formulation, and patient's age/weight. Always follow the prescribing physician's instructions.

Oral Terbinafine tablets may be taken with or without food. Oral granules should be sprinkled on a spoonful of non-acidic, soft food (e.g., mashed potato) and swallowed without chewing. Topical Terbinafine should be applied to clean, dry skin, extending slightly beyond the visible edge of the rash; hands should be washed after application unless the hands themselves are being treated.

For hepatic and renal considerations, see Use in Special Populations.

Common side effects of Terbinafine (mostly with oral use) include headache, gastrointestinal upset (diarrhea, dyspepsia, nausea, abdominal pain), and mild skin rash. Topical Terbinafine may cause local irritation, burning, redness, or itching at the application site.

Less common but serious side effects include:

• Hepatotoxicity, including rare cases of liver failure requiring transplant or resulting in death (oral use) — see Precautions and Warnings.
• Taste and smell disturbance or loss, which may be prolonged or, rarely, permanent (oral use).
• Rare serious skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis.
• Rare blood dyscrasias (e.g., neutropenia, agranulocytosis) with prolonged oral use.
• Rare mood changes or depressive symptoms have been reported with oral use.

Patients should seek prompt medical attention for any severe rash, jaundice, dark urine, persistent nausea, or unusual bleeding/bruising.