Update on antifungal therapy with terbinafine

Area of Science:

• Pharmacology
• Mycology
• Dermatology

Background:

• Terbinafine is a synthetic allylamine antifungal with broad-spectrum activity.
• It exhibits fungicidal action against dermatophytes and moulds, and fungistatic action against Candida albicans.
• Terbinafine is known for its lipophilic and keratophilic nature, leading to prolonged presence in skin, nails, and hair.

Purpose of the Study:

• To review the pharmacologic and pharmacokinetic properties of terbinafine.
• To explore the potential of pulse therapy for onychomycosis treatment.
• To discuss the efficacy of topical terbinafine formulations.

Main Methods:

• Review of existing literature on terbinafine's properties and clinical applications.
• Analysis of pharmacokinetic data, including absorption, distribution, and elimination.
• Evaluation of different therapeutic regimens, including oral pulse therapy and topical applications.

Main Results:

• Terbinafine demonstrates rapid absorption (>70%) with peak plasma concentrations within 2 hours.
• High plasma protein binding (>90%) and bioavailability (70-80%) are characteristic.
• The drug persists in the stratum corneum, sebum, nails, and hair for extended periods post-administration.
• Terbinafine is a well-tolerated, effective treatment for onychomycosis with low drug interaction potential.
• Proposed pulse therapy regimens (e.g., weekly intermittent or single monthly dose) may be effective.
• Topical terbinafine 1% and a novel film-forming solution (FFS) are effective for tinea infections.

Conclusions:

• Terbinafine's pharmacokinetic profile supports the efficacy of pulse therapy for onychomycosis, potentially reducing costs and drug exposure.
• Both oral and topical terbinafine formulations offer effective treatment options for superficial fungal infections.
• Further investigation into pulse therapy regimens is warranted for optimizing onychomycosis treatment.