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Terbinafine hydrochloride

Lamisil   in Argentina, Australia, Belgium, Brazil, Canada, Chile, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Mexico, New Zealand, Romania, Russia, Slovenia, South Africa, Sweden, United Kingdom, United States and Venezuela, also sold under the name Corbinal and Terbisil in Turkey) is a synthetic allylamine antifungal.

It is highly lipophilic in nature and tends to accumulate in skin, nails, and fatty tissues. As a generic it is sold under the name Zabel in Australia. It is also available as a generic medication in the United States, United Kingdom, Belgium, Switzerland and Brazil.

In India, Terbinafine hydrochloride is available in topical form under the brand name Sebifin (Ranbaxy Labs), Zimig (GSK Pharma) and mycoCeaze (Progreś Laboratories).

The theory of Terbinafine hydrochloride is as follows “Like other allylamines, terbinafine inhibits ergosterol synthesis by inhibiting squalene epoxidase, an enzyme that is part of the fungal cell membrane synthesis pathway. Because terbinafine prevents conversion of squalene to lanosterol, ergosterol cannot be synthesized. This is thought to [sic] change cell membrane permeability, causing fungal cell lysis".

Terbinafine is used for the dermatophytes group of fungi. As a 1% cream or powder it is used for superficial skin infections such as jock itch (Tinea cruris), athlete's foot (Tinea pedis) and other types of ringworm (Tinea corporis).

Oral 250mg tablets are often prescribed for the treatment of onychomycosis of the toenail or fingernail due to the dermatophyte Tinea unguium. Fungal nail infections are located deep under the nail in the cuticle to which topically applied treatments are unable to penetrate in sufficient amounts.

Side effects

Many side effects and adverse drug reactions have been reported with terbinafine possibly due to its extensive biodistribution and the often extended durations involved in anti-fungal treatment ( > 2 months ). The following is a comprehensive list of adverse events that are associated with terbinafine use:

• Gastrointestinal Problems -  Diarrhea, constipation, nausea, sickness, fullness, abdominal pain, indigestion, dyspepsia, gastritis, cholestasis, flatulence, altered stool colour, abdominal muscular pain.

• Central Nervous System / Neurological Problems Headaches, dizziness, vertigo, light-headedness, decreased concentration levels, paraesthesia (pins and needles)

• Liver problems - Hepatic Problems Raised liver enzymes, liver inflammation (hepatitis), liver damage, liver failure

• Immune System Problems  - Decreased white blood cell counts including pancytopenia, leukopenia, lymphopenia, thrombocytopenia, agranulocytosis, and neutropenia. Auto-immune reactions such as lupus erythematosus

•  Psychological Problems Depression, anxiety, insomnia, increased / unusual dream activity, malaise.

•  Sensory Problems Complete loss of taste (ageusia), decreased taste (hypogeusia) and distorted taste (dysgeusia) often involving a metallic taste sensation and dry mouth.

•  Visual disturbances including hallucinations,  blurred vision, green vision and double vision.

•  Skin Problems -  Rash, hives. (urticaria), skin irritation, itching (pruritis), jaundice, Stevens-Johnson syndrome.

• Other  - Fatigue, increased heart rate (tachycardia), hair loss, decreased red blood cell count (anemia), muscle pain (myalgia), joint pain (arthralagia).

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