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. 2019 Sep 4;5(3):82.
doi: 10.3390/jof5030082.

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

Anarosa B Sprenger  1 , Katia Sheylla Malta Purim  2 , Flávia Sprenger  3 , Flávio Queiroz-Telles  4
Affiliations

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

Anarosa B Sprenger et al. J Fungi (Basel). .

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.

Keywords: Arthrodermataceae/drug effects; administration; allylamines/terbinafine; antifungal agents/administration; dosage/adverse effects/pharmacology; drug compounding; humans; onychomycosis; oral.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Toenails and fingernails affected (n = 63). Nail disease distribution according to groups before the treatment.
Figure 2
Figure 2
Clinical classification according to groups (n = 71). Clinical classification according to groups before the treatment. DLSO + subungual hypertrophy: distal lateral subungual onychomycosis with subungual hypertrophy; DLSO + Onycholysis: distal lateral subungual onychomycosis with onycholysis; SO + Deep Invasion: superficial onychomycosis with deep invasion; PSO: proximal subungual onychomycosis; TDO: total dystrophic onychomycosis.
Figure 3
Figure 3
Response to terbinafine (n = 43). TF: therapeutic failure; CI: clinical improvement; MC: mycological cure; TC: total cure.
See this image and copyright information in PMC

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