From the Guidelines
The recommended dose of terbinafine for chronic fungal infections in adults is typically 250 mg once daily, with a treatment duration of 6 weeks for fingernail infections and 12-16 weeks for toenail infections, as supported by the British Association of Dermatologists' guidelines 1. The treatment duration may vary depending on the type of infection and the patient's response to therapy.
- For fingernail infections, 6 weeks of treatment is generally recommended 1.
- For toenail infections, 12-16 weeks of treatment is usually necessary 1. It is essential to note that terbinafine is generally preferred over itraconazole due to its higher efficacy and tolerability, as demonstrated in several large studies 1. Patients should be re-evaluated 3-6 months after treatment initiation, and further treatment should be given if the disease persists 1. Additionally, patients should be monitored for potential side effects, including liver function abnormalities, especially during extended treatment courses, and terbinafine may interact with certain medications like cimetidine and rifampin, so a medication review is important before starting therapy 1.
From the FDA Drug Label
Terbinafine tablets are an allylamine antifungal indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium) (1) Fingernail onychomycosis: One 250 mg tablet, once daily for 6 weeks. Toenail onychomycosis: One 250 mg tablet, once daily for 12 weeks
The recommended dose and duration of terbinafine for a patient with chronic fungal infection are as follows:
- Fingernail onychomycosis: 250 mg once daily for 6 weeks.
- Toenail onychomycosis: 250 mg once daily for 12 weeks. 2
From the Research
Recommended Dose and Duration of Terbinafine
The recommended dose and duration of terbinafine for a patient with chronic fungal infection vary depending on the specific condition being treated.
- For onychomycosis, a dose of 250 mg daily for 12 weeks is recommended, with a 70% chance of cure 3.
- For superficial dermatophytosis, a dose of 500 mg once daily for 2-6 weeks is effective, with 87-92% of patients showing a very good response 4.
- For tinea pedis and tinea manuum, a 2-week treatment with 250 mg daily is successful, with 86% of patients becoming mycologically negative 5.
Treatment Duration
The duration of treatment with terbinafine also depends on the specific condition being treated.
- For onychomycosis, a 4-month continuous course of terbinafine is more effective than a 3-month course, with a complete clinical and mycological cure rate of 78% 6.
- For superficial dermatophytosis, treatment durations of 2-6 weeks are effective, with longer treatment durations resulting in higher cure rates 4.
- For tinea pedis and tinea manuum, a 2-week treatment duration is sufficient, with 71% of patients judged to have received effective therapy 5.
Efficacy and Safety
Terbinafine is generally well-tolerated, with mild to moderate adverse effects reported in 5.3-12.9% of patients 7, 4.