Myconafine (Terbinafine)

• Terbinafine is used to manage infections caused by dermatophyte fungi affecting skin and nails.
• Onychomycosis: eradicates the fungal pathogen and improves nail appearance.
• Tinea pedis (athlete's foot): relieves itching and clears the infection.
• Tinea corporis (ringworm): eliminates the rash and prevents spread.
• Other superficial dermatophyte infections: treats various skin fungal conditions.

• Terbinafine inhibits the fungal enzyme squalene epoxidase, a key step in ergosterol synthesis. By blocking this pathway, the drug causes accumulation of squalene, which is toxic to fungal cells, and depletes ergosterol, compromising cell membrane integrity and leading to fungal cell death.

Terbinafine may cause a range of adverse reactions, most of which are mild and reversible.

Common Side Effects

• Gastrointestinal discomfort such as nausea or abdominal pain.
• Headache or dizziness.
• Altered taste sensation (dysgeusia).
• Skin rash or pruritus.
• Mild, transient elevation of liver enzymes.
• Diarrhea or loose stools.

Serious or Rare Side Effects

• Severe hepatic injury or hepatitis.
• Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Acute generalized exanthematous pustulosis.
• Severe hypersensitivity reactions including anaphylaxis.
• Blood dyscrasias such as agranulocytosis or thrombocytopenia.
• Peripheral neuropathy.

• Before initiating therapy, clinicians should evaluate patient‑specific factors and monitor for potential risks.
• Assess liver function: obtain baseline hepatic enzymes and repeat as clinically indicated.
• Monitor for drug interactions: review concomitant medications, especially CYP2D6 and CYP2C9 substrates.
• Avoid use in patients with known hypersensitivity to terbinafine or related compounds.
• Use caution in renal impairment: dose adjustment may be required.
• Pregnancy and lactation: safety not established; weigh benefits against potential risks.
• Store at ambient temperature: keep in the original pack, protect from moisture and heat.

Terbinafine can affect the metabolism of several co‑administered drugs; careful assessment is required.

Major Interactions (Avoid)

• Strong CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): may increase terbinafine plasma levels.
• Warfarin (CYP2C9 substrate): risk of enhanced anticoagulant effect.
• Rifampin: may markedly reduce terbinafine exposure.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., carbamazepine, phenytoin): may lower terbinafine concentrations.
• Antacids containing aluminum or magnesium: could affect oral absorption.
• Alcohol consumption: may increase risk of hepatic toxicity.