Lamisil

Lamisil is an effective broad-spectrum antifungal drug produced by the pharmaceutical company Novartis Pharma Production (Germany).

Indications Lamisil

The following indications for the use of Lamisil are distinguished:

1. Versicolor (pityriasis versicolor) lichen, caused by microscopic fungi of the genus Malassezia (recently named Pityrosporum orbiculare).
2. Onychomycosis is a lesion of the nail plate caused by fungal dermatophytes.
3. Mycosis of the scalp.
4. Dermatomycosis.
5. Dermatitis caused by yeast spore organisms (eg, Candida fungi).
6. Epidermophytosis of the groin area is a pathological change in the upper layers of the epidermis and nails caused by fungi of the epidermophyton genus.

Release form

The drug Lamisil is available in a variety of forms: ointment, lotion, gel, spray, cream (all for external use), tablets (for oral use).

Sprays are available in 30 ml. The bottle is equipped with a spray element for convenience. The concentration of the main chemical compound terbinafine hydrochloride is 1%.

Lamisil cream is available in special rigid tubes with a capacity of 15 ml and 30 ml. The concentration of the main chemical compound terbinafine hydrochloride is 1% (one gram of the drug contains 10 mg of the active substance).

The only form of release taken orally is tablets, one unit of which contains 0.25 g of the main active substance terbinafine hydrochloride.

The auxiliary chemical compounds vary slightly depending on the form of Lamisil release.

For example, the composition of the tablet is supplemented by microcrystalline cellulose, magnesium stearate, methylhydroxypropylcellulose, sodium starch, colloidal anhydrous silicon dioxide. On pharmacy shelves you can find Lamisil in a package consisting of 7, 14 and 28 tablets.

Excipients of the cream: sodium hydroxide, purified water, benzyl, stearyl and cetyl alcohols, sorbitan stearate, polysorbate 60, cetyl palmitate, isopropyl myristate.

Pharmacodynamics

Terbinafine belongs to the group of allylamines; when used externally, the substance easily penetrates into the deep layers of the skin.

When taken orally, the substance shows a high level of bioavailability, easily binds to blood proteins, freely penetrating into the bloodstream, including the microcurrent of the epidermal layer of the skin, sebaceous glands, keratinized nail plates, and hair follicle bulbs.

This is a cumulative action drug, so systematic, regular use of the drug gives a lasting positive result, providing antifungal protection.

Under the influence of liver enzymes, terbinafine is transformed into its metabolites.

Lamisil has fungicidal and fungistatic properties, which are determined by the dose of the drug administered and the type of fungus that affects it.

The necessary therapeutic effectiveness is ensured by the ability of terbinafine to reduce the amount of ergosterol in cells, which negatively affects the synthesis of fungal membrane stearins, leading to their death.

Terbinafine hydrochloride has a depressing effect on squalene epoxidase, leading to an increase in squalene, which provokes the death of pathogenic spores.
When applied externally, the drug shows a low degree of absorption (only 5%). But Lamisil is effective and its therapeutic effect can be felt after three to five days from the start of therapy. Complete recovery occurs after 3 to 5 weeks.

Terbinafine is able to cleanse the patient's body of the following types of fungi: Trichophyton tonsurans, Trichophyton violaceum, Candida albicans, Epidermophyton floccosum, Trichophyton verrucosum, Pityrosporum orbiculare, Trichophyton mentagrophytes, Microsporum canis, Trichophyton rubrum.

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Pharmacokinetics

The pharmacokinetics of Lamisil are determined by the characteristics of terbinafine hydrochloride. The drug is quickly and completely absorbed into the blood when taken orally. This takes 45 minutes. Its maximum amount (with the introduction of 0.25 g) is achieved after one and a half to two hours after administration and is C _max 0.97 mcg / ml. The distribution time is about 4 hours 35 minutes.

The half-life (T _1/2 ) of the tablet form of the drug is on average 17 hours. Food intake does not affect the bioavailability (about 99%) of the active ingredient.

Terbinafine hydrochloride is excreted from the patient's body only in the form of metabolites through the kidneys along with urine.

With regular long-term use, terbinafine accumulates in diseased tissue layers, providing an antifungal effect.
In case of renal and hepatic insufficiency, the rate of excretion of metabolites from the body may be reduced, which leads to an increase in the amount of Lamisil in the blood.

Dosing and administration

The medicine is used in the treatment of adult patients and adolescents over 12 years of age.

Lamisil cream should be applied only to cleansed and degreased skin. The cream is applied in a thin layer with light massaging movements once or twice a day. The number of procedures depends on the type of fungus and the severity of the disease.

If the infection is accompanied by the appearance of diaper rash, it is advisable to cover the place where the cream is applied from above and fix it with a gauze bandage. Such places are usually the spaces between the fingers and toes, the groin area, the intergluteal region, the skin located in the folds under the breast.

The duration of the treatment course directly depends on the severity of the pathology:

• Athlete's foot - one procedure per day (preferably at night) for one week.
• Dermatophytosis of the groin area – one procedure per day (preferably at night) for one week.
• Superficial candidiasis - one to two daily procedures for one to two weeks.
• Versicolor lichen - one to two daily procedures for two weeks.

A visible therapeutic effect is observed after a few days. Irregular treatment of the affected area and early termination of therapy can provoke a relapse of the disease.

If no relief occurs within two weeks of treatment, you should consult a doctor.

Lamisil spray is designed and used for treating external surfaces only. It is used when large areas of skin are affected. It is strictly forbidden to take it as a product for oral consumption. The spray should be sprayed only on clean and degreased skin.

The duration of therapy and the number of procedures performed directly depend on the severity of the pathology:

• Epidermophytosis and dermatophytosis of the foot - one procedure per day (preferably at night) for one week.
• Trichophytosis and dermatophytosis of the skin of the body - one procedure per day (preferably at night) for one week.
• Onychomycosis - one or two daily procedures for six or even twelve weeks. This time is necessary for the complete replacement of the nail plate.
• Versicolor lichen - two daily procedures over the course of one week.

A visible therapeutic effect is observed after a few days. Irregular treatment of the affected area and early termination of therapy can provoke a relapse of the disease.

If no relief occurs within one week of therapy, you should consult a doctor.

Lamisil gel is applied to a clean, dry, degreased surface of the affected area once a day. The best time to perform the procedure is in the evening.

If the localization of the fungal infection is observed in the folded tissues, in most cases it is accompanied by diaper rash. Therefore, it is advisable to cover such an area with the applied gel on top and fix it with a gauze bandage.

The duration of the treatment course and the number of daily procedures directly depend on the severity of the pathology and on average is:

• Interdigital dermatophytosis, candidiasis or athlete's foot - one procedure per day (preferably at night) for one week.
• Skin candidiasis of the groin area - one procedure per day for one week.
• Dermatophytosis of the skin of the body and groin area - one procedure per day for one week.
• Onychomycosis - one or two daily procedures for six or even twelve weeks. This time is necessary for the complete replacement of the nail plate.
• Versicolor lichen - one to two daily procedures over the course of one week.

A visible therapeutic effect is observed after three to five days. Irregular treatment of the affected area and early termination of therapy can provoke a relapse of the disease.

Lamisil tablets are used regardless of meal time. The drug is prescribed to adult patients (including the elderly) and adolescents who have reached 12 years of age in the amount of 250 mg, which corresponds to one tablet of the drug. The medicine is taken once a day.

This drug is usually not prescribed to children due to the small amount of information about the consequences of its impact on a still growing organism. However, if the health situation requires it, the drug can be used in dosages recommended by pharmacists, depending on the child's body weight.

• If the patient weighs less than 20 kg, he or she should take 62.5 mg per day, which is equivalent to a quarter of a tablet.
• If the child's weight is between 20 and 40 kg, the recommended dose is 125 mg, which is equal to half a tablet.
• For body weight over 40 kg, it is recommended to take 250 mg, which corresponds to one whole tablet.

The duration of use of the antifungal drug Lamisil is determined by the type of fungus affecting the skin, the severity of the disease and the rate at which the pathology regresses.

1. Dermatomycosis of the feet or circular fungal infection of the “sock” type – two to six weeks.
2. Dermatomycosis of the body and shins of the lower extremities - two to four weeks.
3. Cutaneous candidiasis - two to four weeks.
4. Mycosis of the scalp - month.
5. Onychomycosis (fungal disease of the nail plate) - six to twelve weeks. If the patient, due to his individuality, has a reduced rate of growth of the nail plate, then the period of the treatment course should be extended until the moment of complete regrowth of a new healthy plate.
   

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Use Lamisil during pregnancy

The use of the antifungal drug Lamisil during pregnancy is not recommended due to the lack of data on the potential negative effects of terbinafine on the embryo.

There is no data on the ability of terbinafine to penetrate into breast milk. Therefore, during the period of breastfeeding, one should refrain from taking the drug or refuse to breastfeed.

Contraindications

Experts have identified contraindications to the use of Lamisil:

1. Increased individual intolerance to terbinafine or other components of Lamisil.
2. Tendency to allergic reactions.
3. Pathological changes affecting the liver. It is necessary to take into account diseases that were in the past and/or are in remission.
4. Chronic kidney problems.
5. The use of the drug is limited by the patient's age. It is not recommended to use the drug for children under twelve years of age.

Side effects Lamisil

Terbinafine is well tolerated by the patient's body. But in some cases, side effects of Lamisil may appear, which are manifested by symptoms:

1. The body's response in the form of an allergy:

• Hyperemia of the skin.
• Hives.
• A burning and itching sensation.

1. Digestive upset in the form of diarrhea.
2. Nausea and vomiting.
3. Dyspeptic symptoms:

• Flatulence.
• Belching.
• Heaviness and a feeling of fullness in the stomach area.
• Abdominal pain.
• Heartburn.
• Constipation.

1. Impaired sense of taste.
2. Increased transaminase levels.
3. The occurrence of pain in the right hypochondrium.
4. Deterioration of liver function.
5. Headache.
6. Loss of appetite.
7. Pain in joints and muscles.
8. Rapid fatigue of the patient.

If these symptoms worsen, treatment should be stopped and help from a specialist should be sought.

Overdose

As clinical observations have shown, an overdose of Lamisil can manifest itself with symptoms after oral administration of a dose of 3-5 g.

1. Constant or paroxysmal headache.
2. Dizziness.
3. Nausea and vomiting.
4. Pain in the epigastric region.

There is currently no antidote. Treatment for Lamisil overdose is detoxification measures: gastric lavage, administration of adsorbent drugs (various sorbents, activated carbon).

Cases of exceeding the dose of the drug during local application have not been described.

Interactions with other drugs

When taking Lamisil simultaneously with oral contraceptives that affect cytochrome P450 metabolism, terbinafine doses must be adjusted. This may cause irregularities in the menstrual cycle.

A similar clinical picture can be observed with the simultaneous use of an antifungal agent and cyclosporine, as well as a number of drugs belonging to the group of antidepressants.

The use of terbinafine in the same treatment protocol with rifampicin and/or cimetidine requires an increase in the dosage of the antifungal drug.

Simultaneous administration of hepatotoxic drugs or ethanol with Lamisil is undesirable. There is a high probability of developing liver dysfunction.

Terbinafine enhances the pharmacodynamic properties of caffeine and desipramine, which should be taken into account in dosages when using them together.

Concomitant therapy with Lamisil tablets and antiarrhythmic drugs, as well as beta-blockers, requires additional monitoring of liver function.

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Storage conditions

The storage conditions for Lamisil are simple, but mandatory:

1. The place where terbinafine is to be stored must be protected from exposure to direct sunlight.
2. Temperature conditions - no higher than 30 degrees.
3. The antifungal agent must be stored in places that are inaccessible to teenagers and small children.

Shelf life

The expiration date of the drug in question, Lamisil, is somewhat different for different forms of release:

• For cream and ointment – it is 5 years.
• For spray form – 3 years.
• Lamisil tablets can be stored for 5 years (60 months).