terbinafine
Terbinafine is a first-choice treatment option for fingernail and toenail fungus. It's available as once-daily tablets, but treatment can take many weeks. Common side effects of terbinafine include headache, rash, diarrhea, and upset stomach. Terbinafine can have interactions with other medications, including certain antidepressants, beta-blockers, and some medications that treat an irregular heart rhythm.
What is Terbinafine?
What is Terbinafine used for?
Fungal infection of toenail or fingernail
How Terbinafine works
Terbinafine is an antifungal. It kills the fungus causing the infection by preventing it from forming its protective outer layer.
Drug Facts
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What are the side effects of Terbinafine?
Common Side Effects
- Headache (13%)
- Rash (6%)
- Diarrhea (6%)
- Upset stomach (4%)
Other Side Effects
- Changes in your sense of taste
- Nausea
- Stomach pain
- Excessive gas
- Itching
- Hives
- Changes in vision
- Changes to liver blood test results
Serious Side Effects
- Liver damage: nausea, vomiting, right upper stomach pain, dark urine, pale stools, yellowing of the skin or whites of the eyes
- Serious allergic reaction: rash, blisters, fever, flu-like symptoms
Source: DailyMed
More on Terbinafine side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Less common
Body aches or pain
chills
difficulty with breathing
ear congestion
general feeling of discomfort or illness
headache
joint pain
loss of appetite
loss of voice
shivering
skin rash or itching
sweating
trouble with sleeping
unusual tiredness or weakness
upper abdominal or stomach pain
vomiting
Rare
Dark urine
difficulty with swallowing
pale skin
pale stools
redness, blistering, peeling, or loosening of the skin
stomach pain
unusual bleeding or bruising
yellow skin or eyes
Incidence not known
Black, tarry stools
bleeding gums
blood in the urine or stools
cough or hoarseness
dizziness
fast heartbeat
feeling of discomfort
flu-like symptoms
general feeling of tiredness or weakness
high fever
indigestion
inflammation of the joints
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
light-colored stools
lower back or side pain
muscle aches
painful or difficult urination
pains in the stomach, side, or abdomen, possibly radiating to the back
persistent loss of appetite
pinpoint red spots on the skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red skin lesions, often with a purple center
red, irritated eyes
red, scaling, or crusted skin
sores, ulcers, or white spots on the lips or in the mouth
sores, welting, or blisters
stomach pain, continuing
swollen glands
swollen lymph glands
tightness in the chest
troubled breathing with exertion
ulcers, sores, or white spots in the mouth
unexplained bleeding or bruising
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Stomach pain (mild)
Less common
Acid or sour stomach
bad, unusual, or unpleasant (after) taste
belching
change of taste or loss of taste
toothache
Incidence not known
Decreased vision
difficulty with moving
discouragement
feeling sad or empty
irritability
lack of appetite
loss of interest or pleasure
loss of sense of smell
muscle cramps or spasms
muscle stiffness
tiredness
trouble concentrating
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Terbinafine
Pros
Works better to treat nail fungus than other treatment options
First-choice over other antifungal medications that are taken by mouth (e.g., versus itraconazole (Sporanox))
Only taken once a day, with or without food
Lower-cost generic available
Cons
Can take several weeks to work
Can cause loss of taste or smell (sometimes permanently)
Not recommended if you have long-term or current liver problems
Not studied in children
Pharmacist tips for Terbinafine
You can take terbinafine with or without food. If you experience upset stomach or nausea from terbinafine, taking it with food can help lessen these side effects.
If you forget to take your dose of terbinafine, take it as soon as you remember. But if it's fewer than 4 hours before your next dose is due, skip the missed dose and continue with your usual dosing schedule.
Terbinafine tablets can affect your sense of taste or smell. If you notice any changes to these senses at any time while taking terbinafine tablets, contact your healthcare provider. You might need to take a different medication.
Before going out into the sun, wear protective clothing and sunscreen. Terbinafine can make your skin more sensitive to sunlight, which might make it easier to get sunburns or a rash.
Your nail(s) can take several months to look normal again after using terbinafine. Sometimes, your nail(s) might not look completely better even after you finish your last dose of terbinafine. This doesn't mean that the medication didn't work.
If you have any concerns that your infection isn't better after finishing your course of terbinafine, contact your healthcare provider.
Before starting any new medications, check with your pharmacist or provider first. They can make sure your medications are safe to take. Terbinafine can interact with some medications that you might be taking at the same time. Terbinafine can also stay in your system for months after you stop taking it and interact with other medications even after you've finished your antifungal treatment.
Frequently asked questions about Terbinafine
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What are the risks and warnings for Terbinafine?
Terbinafine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Liver damage
Risk factors: History of liver problems | Current liver problems
Very rarely, terbinafine can cause severe liver damage or even liver failure, which can be life-threatening. Your risk of liver injury is higher if you have or have had liver problems. You'll have to get blood tests done before you start terbinafine and during treatment. These test results help your provider make sure your liver stays healthy. If you experience unexplained stomach pain, nausea, vomiting, dark urine, pale stools, or yellowing of your skin or white part of your eyes, contact your healthcare provider right away.
Changes to taste and smell
Sometimes, people taking terbinafine can experience changes in their senses of taste and smell. Most times, your sense of taste can come back as you continue to take the medication. But although rare, it's possible that these side effects might go away a few weeks after the medication is stopped, linger on for much longer, or become permanent loss of smell or taste. Talk to your healthcare provider if this happens to you because you might need to stop taking terbinafine.
Depression
Some people noticed that their mood went down while they were taking terbinafine. Talk to your healthcare provider if you notice any unusual changes in sleep, mood, or develop symptoms of depression.
Low white blood cell levels
Risk factors: Currently have a weak immune system | Taking terbinafine longer than 6 weeks
Terbinafine can lower the number of white blood cells in your body. White blood cells help fight off infections. Without a healthy amount of white blood cells, you can get sick easier and have a harder time getting better once you're sick. This side effect is rare, but it can be life-threatening. You're at risk of having low white blood cells if you already have a weak immune system and are taking terbinafine for longer than 6 weeks. You might have to get blood tests done regularly while you're taking terbinafine to make sure your white blood cells are at a normal level. If your levels drop too low, you'll probably have to stop taking terbinafine.
Serious skin reactions
Very rarely, people have developed severe, potentially life-threatening skin reactions after starting terbinafine. These types of allergic rashes are painful and create blisters all over the body. Get medical attention right away if you notice a new or severe rash, a rash that happens with a fever, unexplained blisters, flu-like symptoms, or new sores inside your mouth.
Lupus flare up
Risk factors: History of lupus
Terbinafine might cause a flare-up of lupus. This is rare. But if it happens, you might have to stop taking terbinafine tablets and use a different medication. Let your healthcare provider know if you have or have had lupus before starting terbinafine so they can keep an eye out for signs of a flare up.
Clotting and bleeding problems
In some rare cases, terbinafine tablets might affect your body's ability to form blood clots. This can be life-threatening. If you experience unusual fever, weakness, bruises, purple dots on the skin, or unusual bleeding (bleeding of the gums, nose bleed, or heavy bleeding from a minor cut), get medical help right away.
Terbinafine dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 250mg | 30 tablets | $9.92 | $0.33 |
Typical dosing for Terbinafine
The typical dose is 250 mg by mouth once a day for 6 weeks (for fingernail infection) or 12 weeks (for toenail infection).
More on Terbinafine dosage forms
Interactions between Terbinafine and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Eliglustat
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amphetamine
- Aripiprazole
- Benzphetamine
- Brexpiprazole
- Clozapine
- Codeine
- Deutetrabenazine
- Dextroamphetamine
- Dihydrocodeine
- Donepezil
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Fluoxetine
- Lisdexamfetamine
- Methamphetamine
- Metoclopramide
- Metoprolol
- Nebivolol
- Pitolisant
- Risperidone
- Tramadol
- Valbenazine
- Vortioxetine
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Terbinafine cost?
Terbinafine contraindications
Long-term or active liver problems
What are alternatives to Terbinafine?
Jock itch
Athlete's foot
Ringworm
Tinea versicolor (fungal infection that causes discolored spots on the skin)
Yeast infections of the skin
Seborrheic dermatitis of the scalp - shampoo and gel only
Fungal nail infection - nail lacquer only
Aspergillosis in people in which amphotericin b (Ambisome) hasn't worked or isn't tolerated
What is the latest news about Terbinafine?
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References
Best studies we foundAmerican Osteopathic College of Dermatology. (n.d.). Terbinafine.
Aurobindo Pharma Limited. (2022). TERBINAFINE- terbinafine hydrochloride tablet [package insert]. DailyMed.
Bacle, A., et al. (2019). A case report of photodermatoses induced by the antifungal drug terbinafine. European Journal of Hospital Pharmacy: Science and Practice.
Centers for Disease Control and Prevention. (2020). Histoplasmosis.
Centers for Disease Control and Prevention. (2022). Aspergillosis.
Centers for Disease Control and Prevention. (2022). Blastomycosis.
Centers for Disease Control and Prevention. (2022). Fungal nail infections.
Duxbury, A.J., et al. (2000). Persistent impairment of taste associated with terbinafine. British Dental Journal.
Gupta, A. K., et al. (2021). The growing problem of antifungal resistance in onychomycosis and other superficial mycoses. American Journal of Clinical Dermatology.
Leyden, J. (1998). Pharmacokinetics and pharmacology of terbinafine and itraconazole. Journal of the American Academy of Dermatology.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. (2018). Terbinafine. National Institute of Diabetes and Digestive and Kidney Diseases.
Mirshekari, M., et al. (2021). Smart terbinafine recent nano-advances in delivery of terbinafine. Nanomedicine Journal.
O'Sullivan, D.P., et al. (1996). Postmarketing surveillance of oral terbinafine in the UK: Report of a large cohort study. British Journal of Clinical Pharmacology.
van der Schroeff, J. G., et al. (1992). A randomized treatment duration-finding study of terbinafine in onychomycosis. The British Journal of Dermatology.
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