Terbinafine

(ter' bin a feen)

Brand Name(s): Lamisil^®; also available generically

WHY is this medicine prescribed?

Terbinafine granules are used to treat fungal infections of the scalp. Terbinafine tablets are used to treat fungal infections of the toenails and fingernails. Terbinafine is in a class of medications called antifungals. It works by stopping the growth of fungi.

Are there OTHER USES for this medicine?

Terbinafine is also sometimes used to treat ringworm (fungal infections of the skin that cause a red scaly rash on different parts of the body) and jock itch (fungal infection of the skin in the groin or buttocks). Talk to your doctor about the risks of using this medication for your condition.

HOW should this medicine be used?

Terbinafine comes as granules and as a tablet to take by mouth. Terbinafine granules are usually taken with a soft food once a day for 6 weeks. Terbinafine tablets are usually taken with or without food once a day for 6 weeks for fingernail infections and once a day for 12 weeks for toenail infections. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take terbinafine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

To prepare a dose of terbinafine granules, sprinkle the entire packet of granules onto a spoonful of soft food such as pudding or mashed potatoes. Do not sprinkle the granules onto a fruit-based soft food, such as applesauce. If your doctor has told you to take 2 packets of terbinafine granules, you may sprinkle the contents of both packets onto one spoonful, or you may sprinkle each packet onto a separate spoonful of soft food.

Swallow the spoonful of granules and soft food without chewing.

Your fungus may not be completely cured until a few months after you finish taking terbinafine. This is because it takes time for a healthy nail to grow in.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with terbinafine and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) to obtain the Medication Guide.

What SPECIAL PRECAUTIONS should I follow?

Before taking terbinafine,

• tell your doctor and pharmacist if you are allergic to terbinafine, any other medications, or any of the ingredients in terbinafine granules or tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: amiodarone (Cordarone, Nexterone, Pacerone); beta blockers such as atenolol (Tenormin), labetalol (Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Hemangeol, Inderal LA, Innopran XL); caffeine (in Excedrin, Fioricet, Fiorinal, others); cimetidine (Tagamet); cyclosporine (Gengraf, Neoral, Sandimmune); dextromethorphan (Delsym, in Mucinex DM, Promethazine DM, others); flecainide; fluconazole (Diflucan); ketoconazole (Nizoral); monoamine oxidase type B (MAO-B) inhibitors such as rasagiline (Azilect), and selegiline (Eldepryl, Emsam, Zelapar); propafenone (Rythmol); rifampin (Rifadin, Rimactane, in Rifamate, Rifater); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); tricyclic antidepressants (TCAs) such as amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor if you have or have ever had liver disease. Your doctor will probably tell you not to take terbinafine.

• tell your doctor if you have or have ever had human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), a weakened immune system, lupus (condition in which the immune system attacks many tissues and organs including the skin, joints, blood, and kidneys), or kidney disease.

• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking terbinafine, call your doctor. Do not breastfeed while taking terbinafine.

• plan to avoid unnecessary or prolonged exposure to sunlight and artificial sunlight (tanning beds or UVA/B treatment) and wear protective clothing, sunglasses, and sunscreen. Terbinafine may make your skin sensitive to sunlight.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

If you are taking terbinafine granules and you miss a dose, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

If you are taking terbinafine tablets and you miss a dose, take the missed dose as soon as you remember it. However, if your next dose is in less than 4 hours, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Terbinafine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• diarrhea
• indigestion
• itching
• headache
• feeling sad, worthless, restless, or other changes in mood
• loss of energy or interest in daily activities
• changes in how you sleep

Some side effects can be serious. The following symptoms are uncommon; however, if you experience any of them, call your doctor immediately or get emergency medical treatment:

• nausea
• loss of appetite
• extreme tiredness
• vomiting
• pain in the right upper part of the stomach
• dark urine
• pale stools
• yellowing of the skin or eyes
• severe skin rash that keeps getting worse
• fever, sore throat, and other signs of infection
• swelling of the face, throat, tongue, lips, and eyes
• difficulty swallowing or breathing
• hoarseness
• swollen lymph glands
• peeling, blistering, or shedding skin
• hives
• itching
• red or scaly rash that may be sensitive to sunlight
• loss of skin color
• mouth sores
• sore throat, fever, chills, and other signs of infection
• chest pain
• unexplained bleeding or bruising
• blood in urine
• fast or irregular heartbeat

You should know that terbinafine may cause a loss or a change in the way you taste or smell. Loss of taste can cause decreased appetite, weight loss, and anxious or depressed feelings. These changes may improve shortly after you stop treatment with terbinafine it may last a long time, or it may be permanent. If you notice a loss or a difference in the way you taste or smell, call your doctor.

Terbinafine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Store terbinafine tablets away from light.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• nausea
• vomiting
• stomach pain
• dizziness
• rash
• frequent urination
• headache

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests before you begin treatment and during your treatment.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: January 15, 2018.