What patient teaching is recommended for terbinafine (antifungal medication)?

From the Guidelines

Patient teaching for terbinafine should prioritize informing patients to take the medication for the full prescribed duration and to be aware of potential side effects, including rare but serious liver and skin reactions. When prescribing terbinafine, it is essential to educate patients on the proper use and potential risks associated with this antifungal medication, as outlined in the British Association of Dermatologists' guidelines for the management of onychomycosis 2014 1. Key points to cover in patient teaching include:

• Taking oral terbinafine with food to minimize gastrointestinal upset, which is reported in 49% of patients 1.
• Avoiding alcohol during treatment, as it may increase the risk of liver problems, particularly in patients with pre-existing liver disease 1.
• Being aware of potential side effects, including headache, rash, taste disturbances, and gastrointestinal symptoms like nausea or diarrhea, with the understanding that taste disturbance, although rare, can be permanent 1.
• Recognizing more serious but rare side effects that require immediate medical attention, such as signs of liver problems (yellowing of skin/eyes, dark urine, persistent nausea), severe skin reactions (like Stevens–Johnson syndrome and toxic epidermal necrolysis), or unusual fatigue 1.
• Informing their healthcare provider about all medications they're taking, as terbinafine can interact with certain drugs, particularly those metabolized by the cytochrome P450 2D6 isoenzyme 1.
• Understanding that improvement may take time, as the medication works by preventing fungal cell wall formation, gradually eliminating the infection as new healthy tissue grows, and that complete eradication of fungal nail infections may take months due to the slow growth of nails. It is also crucial to monitor patients for any adverse effects, especially those with a history of heavy alcohol consumption, hepatitis, haematological abnormalities, or in children, where baseline liver function tests and a complete full blood count are recommended 1.

From the FDA Drug Label

Patients taking terbinafine tablets should receive the following information and instructions: Patients should take one 250 mg tablet once daily for 6 weeks for treatment of fingernail onychomycosis or once daily for 12 weeks for treatment of toenail onychomycosis The optimal clinical effect is seen some months after mycological cure and cessation of treatment due to the time period required for outgrowth of healthy nail. Patients should be advised to immediately report to their physician any symptoms of persistent nausea, anorexia, fatigue, vomiting, right upper abdominal pain, jaundice, dark urine or pale stools Terbinafine tablets treatment should be discontinued. Patients should be advised to report to their physician any signs of taste disturbance, smell disturbance and/or depressive symptoms. Terbinafine tablets treatment should be discontinued Patients should be advised to immediately report to their physician or get emergency help if they experience any of the following symptoms: hives, mouth sores, blistering and peeling of skin, swelling of face, lips, tongue, or throat, difficulty swallowing or breathing. Terbinafine tablets treatment should be discontinued Patients should be advised to report to their physician any symptoms of new onset or worsening lupus erythematosus. Symptoms can include erythema, scaling, loss of pigment, and unusual photosensitivity that can result in a rash. Terbinafine treatment should be discontinued. Photosensitivity reactions have been reported with the use of terbinafine tablets Patients should be advised to minimize exposure to natural and artificial sunlight (tanning beds or UVA/B treatment) while using terbinafine tablets. Measurement of serum transaminases (ALT and AST) is advised for all patients before taking terbinafine tablets Patients should be advised that if they forget to take terbinafine tablets, to take their tablets as soon as they remember, unless it is less than four hours before the next dose is due. Patients should also be advised that if they take too many terbinafine tablets they should call their physician

The recommended patient teaching for terbinafine includes:

• Taking the medication as directed (one 250 mg tablet once daily for 6 weeks for fingernail onychomycosis or once daily for 12 weeks for toenail onychomycosis)
• Reporting any symptoms of persistent nausea, anorexia, fatigue, vomiting, right upper abdominal pain, jaundice, dark urine or pale stools to their physician
• Reporting any signs of taste disturbance, smell disturbance and/or depressive symptoms to their physician
• Reporting any symptoms of new onset or worsening lupus erythematosus to their physician
• Minimizing exposure to natural and artificial sunlight while using terbinafine tablets
• Taking missed doses as soon as remembered, unless it is less than four hours before the next dose is due
• Calling their physician if they take too many terbinafine tablets 2

From the Research

Patient Teaching on Terbinafine

Patient teaching on terbinafine, an antifungal medication, is crucial for effective treatment and management of fungal infections, particularly onychomycosis (nail fungus). The following points are recommended for patient teaching:

• Duration of Treatment: The recommended duration of treatment with terbinafine varies depending on the type of fungal infection and the severity of the condition. For toenail onychomycosis, treatment typically lasts for 12 weeks 3, 4, while fingernail onychomycosis may require a shorter treatment duration of 6 weeks 3.
• Dosage and Administration: Patients should be instructed to take terbinafine 250 mg daily, with or without food, for the recommended duration of treatment 3, 4, 5.
• Monitoring and Follow-up: Regular follow-up appointments are necessary to monitor the patient's response to treatment and to assess for any potential side effects. Patients should be advised to report any changes in their condition or any adverse effects to their healthcare provider 4, 5.
• Potential Side Effects: Common side effects of terbinafine include gastrointestinal symptoms, such as nausea, diarrhea, and abdominal pain. Patients should be informed about these potential side effects and advised to seek medical attention if they experience any severe or persistent symptoms 4, 5.
• Liver Function Monitoring: Patients should be aware of the potential risk of liver enzyme elevation associated with terbinafine treatment. Liver function tests should be performed at baseline and during treatment, especially during the first month of therapy 6.
• Importance of Completing Treatment: Patients should be emphasized the importance of completing the full treatment course, even if symptoms improve before the end of treatment. Stopping treatment prematurely may lead to recurrence of the infection 3, 4.

Special Considerations

• Candida Nail Infection: For patients with Candida nail infection, terbinafine treatment may be effective, but the efficacy and safety of treatment should be closely monitored 6.
• Pregnancy and Breastfeeding: Patients should be advised to inform their healthcare provider if they are pregnant or breastfeeding, as terbinafine may not be recommended in these situations.

By providing patients with comprehensive teaching on terbinafine treatment, healthcare providers can ensure that patients are well-informed and empowered to manage their fungal infections effectively.