A Week of Oral Terbinafine Pulse Regimen Every Three Months to Treat all Dermatophyte Onychomycosis

Abstract

Terbinafine has proved to treat numerous fungal infections, including onychomycosis, successfully. Due to its liver metabolization and dependency on the cytochrome P450 enzyme complex, undesirable drug interaction are highly probable. Additionally to drug interactions, the treatment is long, rising the chances of the appearance of side effects and abandonment. Pharmacokinetic data suggest that terbinafine maintains a fungicidal effect within the nail up to 30 weeks after its last administration, which has aroused the possibility of a pulse therapy to reduce the side effects while treating onychomycosis. This study’s goal was to evaluate the effectiveness of three different oral terbinafine regimens in treating onychomycosis due to dermatophytes. Sixty-three patients with onychomycosis were sorted by convenience in three different groups. Patients from group 1 received the conventional terbinafine dose (250 mg per day for 3 months). Group 2 received a monthly week-long pulse-therapy dose (500 mg per day for 7 days a month, for 4 months) and group 3 received a 500 mg/day dose for 7 days every 3 months, totaling four treatments. There were no statistical differences regarding the effectiveness or side effects between the groups. Conclusion: A quarterly terbinafine pulse regimen can be a possible alternative for treating onychomycosis caused by dermatophytes.

Constant Voltage Iontophoresis Technique to Deliver Terbinafine via Transungual Delivery System: Formulation Optimization Using Box–Behnken Design and In Vitro Evaluation

“…Terbinafine is a synthetic allylamine group of antifungal agents reported to be effective against different kinds of dermatophytes that cause onychomycosis by inhibiting squalene monooxygenase enzyme, thereby hinder sterol synthesis in fungi [ 35 ]. Low minimum fungicidal concentration (0.003–0.006 µg/mL) [ 36 ] and the possibility of anodal iontophoresis due to positive charge [ 37 , 38 ] instigated this present research to optimize the transungual delivery of terbinafine for improved delivery using constant low voltage iontophoresis technique.…”

In adult patients with onychomycosis, does continuous therapy with oral terbinafine result in increased rates of cure compared with pulsed therapy?

“…A 2019 open-label prospective cohort study compared the effectiveness of continuous and varying pulse regimens of terbinafine in patients with onychomycosis (n=63). 2 Patients were between 24 and 70 years old with 54% men. Onychomycosis was diagnosed via clinical manifestations and confirmed with mycological culture.…”