Cutaneous candidiasis (off-label use): Topical: Cream 1%: Apply to affected area once or twice daily for 1 to 2 weeks (Lamisil Canadian product monograph).
Tinea infections:
Tinea corporis/tinea cruris (OTC labeling): Topical:
Cream 1%, gel 1%, spray 1% (spray is for tinea cruris only): Apply to affected and surrounding area(s) once daily until clinical resolution, typically 1 week (Goldstein 2021; manufacturer's labeling).
Tinea pedis (OTC labeling)/tinea manuum (off-label use): Topical:
Cream 1%, gel 1%: Apply to affected and surrounding area(s) once or twice daily (cream) or once daily (gel) until 1 week after clinical resolution, typically for 2 weeks total (Korting 2001; Weinstein 2002; manufacturer's labeling).
Tinea versicolor (off-label use): Topical:
Cream 1%, spray 1%: Apply to affected area(s) and immediate surrounding skin twice daily for 1 to 2 weeks (Aste 1991; Vermeer 1997; Lamisil Canadian product monograph).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Terbinafine (topical): Pediatric drug information")
Pityriasis (tinea) versicolor: Limited data available: Children ≥12 years and Adolescents: Topical: Solution (spray): Apply to affected area once daily for 1 week (Bradley 2017; Red Book [AAP 2015])
Tinea corporis (ringworm): Children ≥12 years and Adolescents: Topical: Cream, gel: Apply to affected area once daily for at least 1 week
Tinea cruris (jock itch): Children ≥12 years and Adolescents: Topical: Cream, gel, solution (spray): Apply to affected area once daily for at least 1 week
Tinea pedis (athlete’s foot): Children ≥12 years and Adolescents: Topical:
Cream: Apply between the toes to affected area twice daily for at least 1 week; apply on the bottom or sides of feet twice daily for 2 weeks
Gel: Apply to affected area once daily at bedtime for at least 1 week
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External, as hydrochloride:
LamISIL AT: 1% (12 g, 30 g, 42 g) [contains benzyl alcohol, cetyl alcohol]
LamISIL AT Jock Itch: 1% (12 g) [contains benzyl alcohol, cetyl alcohol]
Generic: 1% (15 g, 30 g)
Solution, External, as hydrochloride:
LamISIL AT Spray: 1% (125 mL [DSC]) [contains alcohol, usp, propylene glycol]
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Cream, External:
LamISIL: 1% (15 g, 30 g) [contains benzyl alcohol, cetyl alcohol]
Solution, External, as hydrochloride:
LamISIL: 1% (30 mL) [contains alcohol, usp, propylene glycol]
Topical: Wash affected area with soap and water prior to use and dry completely; wash hands after use.
Spray: Hold 4 to 6 inches from skin during application.
For external use only; avoid contact with eyes or mouth. Do not use on nails, scalp, or for vaginal yeast infections. Apply to clean, dry affected area in sufficient quantity to cover. Wash hands after use.
Dermatologic fungal infections: Treatment of tinea pedis (athlete's foot), tinea cruris (jock itch), and tinea corporis (ringworm).
Cutaneous candidiasis; Tinea manuum; Tinea versicolor
Terbinafine may be confused with terbutaline
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Dermatologic: Burning sensation of skin, contact dermatitis, exfoliation of skin, pruritus, skin irritation, skin rash, stinging of the skin, xeroderma
Local: Local irritation
There are no contraindications listed within the manufacturer's labeling.
Canadian labeling: Hypersensitivity to terbinafine or any component of the formulation
Concerns related to adverse events:
• Local irritation: If irritation/sensitivity develops, discontinue therapy and institute appropriate alternative therapy.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
Other warnings/precautions:
• Appropriate use: For topical use only. Not intended for ophthalmologic, oral, or vaginal administration. Do not use on nails or scalp.
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Shehab 2009).
None known.
There are no known significant interactions.
Systemic absorption is limited following topical application. If antifungal treatment cannot be delayed until after pregnancy, topical therapy when appropriate may be considered (Kaul 2017).
Following oral administration, terbinafine is present in breast milk (refer to the Terbinafine [Systemic] monograph for additional information).
Systemic absorption is limited following topical application. Breastfeeding mothers should not apply topical formulations to the breast and infants should avoid contact with treated skin.
Synthetic allylamine derivative that inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi. This results in a deficiency in ergosterol within the fungal cell membrane and results in fungal cell death.
Absorption: Limited (<5%)
Distribution: Distributed to sebum and skin predominantly
Half-life elimination: 14 to 35 hours
Cream (LamISIL AT External)
1% (per gram): $0.41
Cream (LamISIL AT Jock Itch External)
1% (per gram): $0.68
Cream (Terbinafine HCl External)
1% (per gram): $0.54
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