Terbinafine

Terbinafine is an antifungal medicine. It is used to treat skin infections caused by a fungus (yeast), including:

• athlete's foot
• fungal nail infections
• ringworm
• jock itch (sometimes called dhobie itch, an infection in the groin area)
• pityriasis versicolor (this causes small patches of scaly and discoloured skin, often on your back, chest, upper arms, neck and tummy)

Terbinafine comes as a cream, gel or spray for treating athlete's foot, ringworm, jock itch and pityriasis versicolor. There is also a liquid (solution) for athlete's foot. You can buy these from a pharmacy or supermarket.

It also comes as tablets for treating fungal nail infections and other fungal infections. Your doctor may recommend tablets if they think creams, gels, sprays or solution are not likely to work.

Terbinafine tablets are only available on prescription.

• Many fungal infections get better within 7 days of treatment with terbinafine – nail infections can take 3 months or more.
• When using terbinafine on your skin, the most common side effect is irritation in the area where you apply it.
• If you're taking the tablets, the most common side effects are having a smaller appetite than usual, pain in your joints or muscles, or upset stomach.
• The cream, gel and spray usually start to work within a week, and the tablets can take between 2 weeks and a few months to work.
• Brand names for terbinafine tablets and cream include Lamisil. Brand names for the solution for athlete's foot include Lamisil Once.

Tablets, cream and gel can be prescribed for adults and children aged 1 year and over.

The cream, gel and spray that you can buy in a pharmacy or supermarket is suitable for people aged 16 years or older. The solution is only suitable for adults (18 years or older).

To make sure terbinafine is safe for you, tell your doctor or pharmacist if you:

• have had an allergic reaction to terbinafine or any other medicines in the past

To make sure the tablets are safe for you, tell your doctor or pharmacist if you:

• have ever had liver or kidney problems
• are pregnant, trying to get pregnant or are breastfeeding

The treatment you use will depend on where the infection is on your body and how severe it is.

For large areas of skin, or if the area is hairy, it's best to use the spray.

Your pharmacist or doctor will tell you how much to use and how long you need to use it for, depending on your infection.

If you buy terbinafine in a pharmacy or supermarket, follow the instructions that come with your medicine.

How to use terbinafine cream or gel

Put the cream or gel on the infected area once or twice a day for 1 to 2 weeks.

1. Wash your hands before using the cream or gel.
2. Wash and dry the infected skin where the cream or gel will go. If you are treating your feet, it's also important to wash and dry between your toes first.
3. Unscrew the cap.
4. Squeeze out a small amount of the cream or gel onto your finger (enough to put a thin layer on your skin).
5. Gently rub it into the infected areas. Avoid putting it near your mouth, lips and eyes.
6. Replace the cap.
7. Wash your hands.

If you're using the cream or gel on the area between your toes, or on your bottom or groin, you can cover the skin with a clean strip of gauze afterwards. This type of light dressing is available to buy at pharmacies and is especially helpful to use at night.

How to use terbinafine spray

Put the spray on the infected area once or twice a day for 1 to 2 weeks.

1. Wash your hands before using the spray.
2. Wash and dry the infected skin before using the spray. If you are treating your feet, it's also important to wash and dry between your toes first.
3. Take the cap off and prepare the spray by pressing the top of the spray down once or twice.
4. Hold the bottle about 10cm away from the infected area and spray until your skin is thoroughly wet. Avoid getting it near your mouth, lips and eyes.
5. Replace the cap.
6. Wash your hands.

If you're using the spray on the area between your toes, or on your bottom or groin, you can cover the skin with a clean strip of gauze afterwards. This type of light dressing is available to buy at pharmacies and is especially helpful to use at night.

How to use terbinafine solution (Lamisil Once)

The solution comes in a tube with a nozzle. It is a single treatment that you only use once.

Use the solution on both feet even if one of them looks fine. If one foot looks less infected than the other, put the solution on the less infected foot first.

1. Use the solution after a shower or bath. Before using the solution, make sure your feet are dry, including between your toes.
2. Remove the cap.
3. Put the solution on the sole, top and sides of your foot and all over your toes, including between each toe. This should use about half the tube. Finish treating this foot before treating the other.
4. Leave the solution to dry on your feet for 1 to 2 minutes.
5. Replace the cap and throw the tube away.
6. Wash your hands.
7. Put on your normal shoes and socks.

Do not wash or splash your feet with any water for 24 hours after using the solution.

After 24 hours, wash your feet with warm, soapy water in the bath or shower and gently pat them dry.

How to take terbinafine tablets

Swallow the tablet whole with a drink of water.

You can take terbinafine tablets with or without food. It's best to take your tablets at the same time each day.

The usual dose is 1 tablet, taken once a day. You will usually take the tablets for 2 to 6 weeks. This depends on the type of infection you have and how serious it is.

If you have a fungal nail infection, you will probably need to take the tablets for several months. These infections take a while to clear.

What if I forget to take it or use it?

If you forget to use your terbinafine cream, gel or spray, do not worry. Just apply it as soon as you remember and then keep following your usual routine.

If you forget to take a terbinafine tablet, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just skip the missed dose and take your next one as normal until you have finished the course.

Do not take a double dose to make up for a missed dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicines.

What if I take too much?

If you use too much terbinafine cream, gel or spray or use it more often than you need to, it may make your skin red or irritated. If this happens, use less of the cream, gel or spray the next time.

Taking 1 or 2 extra terbinafine tablets is unlikely to harm you.

Contact 111 for advice now if:

If you need to go to hospital take the packaging, or the leaflet that came with your medicine, and any remaining medicine with you.

Like all medicines, terbinafine can cause side effects, although not everyone gets them.

Side effects usually go away when you stop using or taking the medicine.

Common side effects

These common side effects happen in more than 1 in 100 people.

If you're using the cream, gel, spray or solution, talk to your pharmacist or doctor if these side effects bother you or do not go away:

• peeling or itching skin

If you're taking the tablets, talk to your doctor or a pharmacist if these side effects bother you or do not go away:

• rash
• headache
• diarrhoea
• feeling or being sick (nausea or vomiting)
• a smaller appetite than usual
• stomach ache
• indigestion
• muscle or joint pain

Serious side effects

Some people can have serious side effects when using or taking terbinafine. These happen in less than 1 in 1,000 people.

If you're using the cream, gel, spray or solution, stop using terbinafine and call a doctor straight away if:

• you get an itchy rash with blisters, red raised patches or spots (hives), which starts to spread

If you're prescribed tablets, stop taking them and call a doctor immediately if:

• you get yellow skin or the whites of your eyes turn yellow or if you have pale poo and dark pee – these can be signs of liver problems
• you bruise more easily or get infections more easily – these can be signs of a blood disorder
• you have a high temperature with a rash, itchy skin and unusual tiredness, or if you notice any purple spots under your skin – these can be signs of an inflammation of the blood vessels called vasculitis
• you get severe pain near the top of your stomach that spreads to your back – this can be a sign of an inflamed pancreas
• your muscles feel weak or painful, or your pee is a dark red-brown – these can be signs of muscle problems

Serious allergic reaction

It happens rarely but it is possible to have a serious allergic reaction (anaphylaxis) to terbinafine.

Call 999 or go to A&E if:

These are not all the side effects of terbinafine. For a full list, see the leaflet inside your medicine packet.

You can report any suspected side effect to the UK safety scheme.

What to do about:

• Rash, peeling or itching skin – if you're using the cream, try using smaller amounts or stop using it completely. Avoid clothes that irritate your skin, such as wool or manmade fabrics. If the rash is itchy, pat or tap the area rather than scratching. It may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.
• Headaches – rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller if you need one. Talk to your doctor if the headaches last longer than a week or are severe.
• Diarrhoea – drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
• Feeling or being sick (nausea or vomiting) – stick to simple meals and do not eat rich or spicy food. If you are being sick, try small, frequent sips of water to avoid dehydration. It might help to take your tablets after a meal or snack.
• A smaller appetite than usual – your appetite should get better as your body gets used to the medicine. It may also help to eat smaller and more frequent meals and to eat foods you really enjoy. If your appetite does not improve or you lose a lot of weight, ask your doctor for advice.
• Stomach ache – it can help to eat and drink slowly and have smaller and more frequent meals. Placing a heat pad or covered hot water bottle on your stomach may also help. If you are in a lot of pain, speak to a doctor or pharmacist.
• Indigestion – reduce the amount of tea, coffee, cola or alcohol you drink, and avoid rich, spicy or fatty foods. If indigestion bothers you mostly at night, stop eating 3 to 4 hours before your bedtime, and try propping your head and shoulders up in bed. Ask a pharmacist to recommend an antacid.
• Muscle or joint pain – ask a pharmacist to recommend a painkiller if you need one. Talk to your doctor if the pain lasts longer than a week or is severe.

Terbinafine and pregnancy

There's no clear evidence that terbinafine will harm your unborn baby. But for safety, your doctor will only advise you to use it in pregnancy if the benefits outweigh the risks.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about the benefits and possible harms of taking terbinafine. This will depend on how many weeks pregnant you are and the reason you need to take it. There may be other treatments that are safer for you.

Terbinafine and breastfeeding

It's OK to use terbinafine cream, gel, spray and solution when you're breastfeeding, as long as you are not putting it on or near your nipples.

Terbinafine tablets are generally not recommended if you're breastfeeding. There are other antifungal medicines that are safer. Your doctor will recommend the best medicine for you.

Tell your doctor if you’re:

Terbinafine cream, gel, sprays and solution are generally OK to use when taking other medicines.

However, terbinafine tablets and some medicines can interfere with each other. Tell your doctor if you are taking:

• antidepressants
• beta blockers for heart problems
• oral contraception
• amiodarone, to treat heart problems
• cimetidine, to treat stomach problems such as indigestion
• rifampicin, to treat bacterial infections
• tamoxifen, to treat breast cancer
• warfarin, to treat and prevent blood clots

These are not all the medicines that interfere with terbinafine. For a full list, check the leaflet that comes with your medicine.

Taking terbinafine with painkillers

It is safe to take terbinafine with paracetamol, ibuprofen, diclofenac or naproxen.

However terbinafine tablets can interfere with:

• codeine – terbinafine tablets can affect how well codeine works. If you notice your pain is not as well controlled as usual ask your doctor about other painkillers you could use
• tramadol – terbinafine tablets can increase your chance of getting side effects from tramadol. Speak to your doctor if you get side effects or feel unwell in any other way

Mixing terbinafine with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements with terbinafine.

Important

Tell a pharmacist or doctor if you are taking any other medicines, including herbal medicines, vitamins or supplements.