Can terbinafine (Lamisil) be used to treat onychomycosis (fingernail fungus)?

From the Guidelines

Terbinafine (Lamisil) is the first-line treatment for onychomycosis (fingernail fungus) due to its higher efficacy and tolerability compared to other antifungal medications. The standard treatment regimen for fingernail onychomycosis is oral terbinafine 250 mg once daily for 6 weeks, as recommended by the British Association of Dermatologists' guidelines 1. This medication has been shown to be more effective than itraconazole in treating dermatophyte onychomycosis, with higher complete cure rates and fewer relapses 1.

Key points to consider when treating onychomycosis with terbinafine include:

• Confirmation of diagnosis to rule out other nail conditions that may mimic fungal infections
• Patient awareness that complete nail clearing takes time, as the healthy nail needs to grow out
• Potential side effects, such as headache, gastrointestinal upset, and rash
• Recommendation for liver function tests before starting treatment and potential monitoring during therapy
• Caution when using terbinafine in patients with liver disease or those taking certain medications that may interact with it

According to the British Association of Dermatologists' guidelines, terbinafine has been shown to persist in the nail for a considerable period after elimination from the plasma, allowing for intermittent or "pulse" treatment regimens 1. However, the standard continuous treatment regimen is still the most commonly recommended approach. Studies have demonstrated higher efficacy rates for terbinafine compared to itraconazole, with complete cure rates of 55% for terbinafine versus 26% for pulsed itraconazole at 72-week follow-up 1.

From the FDA Drug Label

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

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

Yes, terbinafine (Lamisil) can be used to treat onychomycosis (fingernail fungus) 2 2.

• The treatment duration is 6 weeks for fingernail onychomycosis.
• The dosage is one 250 mg tablet once daily.

From the Research

Treatment of Onychomycosis with Terbinafine

• Terbinafine, an orally and topically active antimycotic agent, has been shown to be effective in the treatment of onychomycosis, a fungal infection of the nails 3, 4, 5.
• The drug works by inhibiting the biosynthesis of ergosterol, a principal sterol in fungi, resulting in a fungistatic effect and the accumulation of toxic intracellular squalene, leading to a fungicidal effect 3.
• Studies have demonstrated that oral terbinafine is more effective than itraconazole, fluconazole, and griseofulvin in the treatment of dermatophyte onychomycosis, with higher mycologic and complete cure rates 3, 5.
• The optimal treatment duration for terbinafine in onychomycosis has been found to be 12 weeks, with cure rates of 71% at the end of a 24-week follow-up period 4.
• Terbinafine has also been shown to be effective in combination with other antifungal agents, such as amorolfine, with additive or synergistic effects observed in vitro 6.

Safety and Tolerability

• Terbinafine has been found to be generally well tolerated, with a low potential for drug interactions and a favorable safety profile compared to other antifungal agents 3, 5.
• The most common adverse events associated with terbinafine are mild-to-moderate gastrointestinal symptoms, with a low discontinuation rate due to side effects 4.
• The use of terbinafine in children has also been found to be safe and effective, with high cure rates and a low risk of adverse events 7.

Clinical Use

• Terbinafine is considered the treatment of choice for dermatophyte onychomycosis, due to its high efficacy, favorable safety profile, and low potential for drug interactions 3, 5.
• The drug is also effective in the treatment of other superficial fungal infections, including tinea pedis, tinea corporis/cruris, and tinea capitis 5, 7.
• Combination therapy with terbinafine and other antifungal agents, such as amorolfine, may be beneficial in the treatment of onychomycosis, particularly in cases involving non-dermatophyte fungi 6.