Terbinafine is an
allylamine with fungicidal activity, first approved for the treatment of
onychomycosis in the United Kingdom in the early 1990s, and in the US in 1996.
Terbinafine is the most frequently prescribed oral
antifungal agent in the US and Canada for
onychomycosis. Its efficacy and safety in dermatophyte toenail
onychomycosis in adults has been established in many studies. In fact, 18 randomized controlled trials have shown
terbinafine to be highly effective, with a meta-average for mycological cure of 76% +/- 3% (mean +/- standard error). In large surveillance studies,
terbinafine exhibited excellent safety profiles consistent with results obtained in pivotal studies. Additionally,
terbinafine has been reported to be superior to both
itraconazole and
fluconazole in comparative studies in the treatment of dermatophyte toenail
onychomycosis. Recent studies have reported
terbinafine to be more cost effective than
griseofulvin,
fluconazole, or
itraconazole.
Terbinafine has also been used to treat
onychomycosis effectively and safely in special patient populations, such as children, the elderly, immunocompromised patients, diabetics, and those with
Down syndrome.
Terbinafine should therefore be considered for the management of
onychomycosis in adults based on its effectiveness, broad spectrum, fungicidal nature, established safety profile, and very low occurrence of drug interactions. Furthermore, the data support the use of
terbinafine to treat dermatophyte
onychomycosis in children and the elderly.