Terbinafine Hydrochloride and Neutropenia

• Generic Name: terbinafine
• Dosage Forms: n.a.
• Other Brand Names: Lamisil, Terbinex

Treatment of dermatophyte infections of the toenail or fingernail (onychomycosis, tinea unguium) caused by susceptible fungi.

Has been effective in treatment of nail infections caused by most strains of Trichophyton rubrum and T. mentagrophytes. Although usually active in vitro against Epidermophyton floccosum, Candida albicans, and Scopulariopsis brevicaulis, efficacy in treatment of onychomycosis caused by these organisms has not been established in adequate and controlled studies.

Terbinafine may be particularly useful in patients who cannot tolerate azole antifungals (e.g., itraconazole) or when there are concerns regarding possible drug interactions between azoles and other drugs the patient is receiving. However, liver failure (sometimes leading to death or liver transplant) has occurred rarely in patients with or without preexisting liver disease who were receiving oral terbinafine for treatment of onychomycosis. (See Hepatotoxicity under Cautions.)

Treatment of tinea capitis (scalp ringworm) caused by susceptible dermatophytes (e.g., Trichophyton, Microsporum).

Tinea capitis requires treatment with an oral antifungal. Topical therapies (e.g., shampoos containing selenium sulfide, povidone iodine, or ketoconazole; topical antifungals) sometimes used as adjuncts to an oral antifungal and may reduce fungal shedding and the risk of transmission or reinfection.

Oral griseofulvin is usual drug of choice; alternatives include oral fluconazole, itraconazole, or terbinafine.

Oral terbinafine appears to be as effective as oral griseofulvin for treatment of tinea capitis caused by Trichophyton, and requires a shorter duration of treatment which may increase compliance. However, there is some evidence that griseofulvin may be more effective than terbinafine when M. canis is the causative agent.

Treatment of tinea corporis (body ringworm) or tinea cruris (jock itch).

Topical antifungals usually are effective for treatment of uncomplicated tinea corporis. An oral antifungal (griseofulvin, fluconazole, itraconazole, terbinafine) may be necessary if tinea corporis is extensive, dermatophyte folliculitis is present, the infection does not respond to topical therapy, or the patient is immunocompromised because of coexisting disease or concomitant therapy.