Lamisil

Lamisil is an effective antifungal drug of a wide spectrum produced by the pharmaceutical company Novartis (Novartis) Pharma Production (Germany).  

Indications Lamisil

The following indications for the use of Lamizil are distinguished:

1. Multicolored (lichen) lichen, provoked by microscopic fungi of the genus Malassezia (the recent name Pityrosporum orbiculare).
2. Onychomycosis - defeat of the nail plate with fungal dermatophytes.
3. Mycosis of the scalp.
4. Dermatomycosis.
5. Dermatitis, provoked by yeast spore organisms (eg, Candida fungi).
6. Epidermophytosis of the inguinal region - a pathological change in the upper layers of the epidermis and nails by fungi of the genus epidermophyton.

Release form

The drug Lamisil is represented by a rather diverse form of release: 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 spraying 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 active ingredient).

The only form of oral ingestion is a tablet, one unit of which contains 0.25 g of the main active ingredient terbinafine hydrochloride.

Auxiliary chemical compounds vary somewhat depending on the form of the release of Lamizil.

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

Cream aids: 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, the substance with the external method of use easily penetrates into the deeper layers of the skin.

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

This drug is a cumulative effect, so systematic, regular intake of the drug gives a persistent positive result, providing antifungal protection.

Under the action of hepatic 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 the affected fungus.

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

Terbinafine hydrochloride acts depressingly on squalene epoxidase, leading to an increase in squalene, which provokes the death of pathogenic spores.
With external treatment, the medicine 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 purify the body of a patient from such fungi: Trichophyton tonsurans, Trichophyton violaceum, Candida albicans, Epidermophyton floccosum, Trichophyton verrucosum, Pityrosporum orbiculare, Trichophyton mentagrophytes, Microsporum canis, Trichophyton rubrum.

[1], [2], [3], [4], [5]

Pharmacokinetics

Pharmacokinetics Lamisil is determined by the characteristics of terbinafine hydrochloride. The drug with internal reception quickly and completely absorbed into the blood. This takes 45 minutes. The maximum amount (with the input of 0.25 g) is achieved after one and a half to two hours after administration and is C _max 0.97 μg / ml. The distribution time is about 4 hours and 35 minutes.

The half-life (T _1/2 ) of the tablet form of the medication is averaged to 17 hours. The intake of food 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 the urine.

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

Dosing and administration

The drug is used in the treatment of adult patients and adolescents who have reached the age of 12 years.

Lamizil cream should only be applied to cleansed and skimmed skin. The cream is superimposed by a thin layer of light massaging movements one to two times a day. The number of procedures performed depends on the type of fungus and the severity of the disease.

If infection is accompanied by the appearance of intertrigo, then the place of application of the cream should preferably be covered from above and fixed with a gauze bandage. Such places usually are the gaps between the fingers and toes, the inguinal zone, the interannual area, the skin that is in the folds under the breast.

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

• Dermatophytosis of the foot - one procedure during the day (preferably at night) for one week.
• Dermatophytosis of the inguinal zone - one procedure during the day (preferably at night) for one week.
• Superficial candidiasis - one or two daily procedures for one to two weeks.
• Multicolored lichen - one - two daily procedures for two weeks.

Apparent therapeutic effect is observed after a few days. Irregularity in the treatment of the affected area and early cessation of therapy can provoke a relapse of the disease.

If during the two-week treatment there is no relief, it is necessary to contact the doctor.

Lamisil Spray is designed and used to treat only the outer surfaces. It is used in the defeat of large areas of the skin. It is strictly forbidden to take it as a product of oral intake. The spray should only be sprayed on a clean and defatted skin.

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

• Epidermophytosis and foot dermatophytosis - one procedure during the day (preferably at night) for one week.
• Trichophytosis and dermatophytosis of the trunk skin - one procedure during the day (preferably at night) for one week.
• Onychomycosis - one or two daily procedures for six, or even twelve weeks. This time is necessary for a complete replacement of the nail plate.
• Multicolored lichen - two daily procedures for one week.

Apparent therapeutic effect is observed after a few days. Irregularity in the treatment of the affected area and early cessation of therapy can provoke a relapse of the disease.

If no relief comes during one week of therapy, it is necessary to consult a doctor.

Lamizil gel is applied to the clean, dry, defatted surface of the affected area once during the day. The best time for the procedure is evening time.

If the localization of fungal damage is observed in the folding tissues, in most cases it is accompanied by diaper rash. Therefore, such a site, with the gel applied, it is desirable to cover up and fix it with a gauze bandage.

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

• Interdigital dermatophytosis, candidiasis or epidermophytia of the foot - one procedure during the day (preferably at night) for one week.
• Cutaneous candidiasis of the inguinal zone - one procedure during the day for one week.
• Dermatophytosis of the skin of the body and inguinal zone - one procedure during the day for one week.
• Onychomycosis - one or two daily procedures for six, or even twelve weeks. This time is necessary for a complete replacement of the nail plate.
• Multicolored lichen - one - two daily procedures for one week.

Apparent therapeutic effect is observed after three to five days. Irregularity in the treatment of the affected area and early cessation of therapy can provoke a relapse of the disease.

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

Children this drug is usually not appointed because of the small amount of information about the effects of its effects on an even growing body. But nevertheless, if the health situation compels, the drug can be applied in the dosages recommended by pharmacists, depending on the body weight of the child.

• With a body weight of less than 20 kg, the patient should take 62.5 mg per day, which corresponds to the fourth part of the tablet.
• If the weight of the child is in the range of 20 to 40 kg, the recommended dose is 125 mg, which corresponds to half the tablet.
• With a body weight of more than 40 kg, it is recommended to take 250 mg, which corresponds to one whole tablet.

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

1. Dermatomycosis of the feet or round fungal lesion by the type of "sock" - two - six weeks.
2. Dermatomycosis of the body and legs of the lower limbs - two - four weeks.
3. Cutaneous candidiasis - two to four weeks.
4. Mycosis of the scalp is a month.
5. Onychomycosis (fungal disease of the nail plate) - six to twelve weeks. If the patient, due to his individuality, has a reduced growth rate of the nail plate, then the period of the treatment course should be prolonged until the complete new growth of the new healthy plate.
    

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[6]

Use Lamisil during pregnancy

Use during the pregnancy of an antifungal drug Lamisil is not recommended due to a lack of data on the possibilities of negative effects of terbinafine on the embryo.

There is no data on terbinafine's ability to penetrate into mother's milk. Therefore, during the period of feeding the newborn should refrain from taking the drug or refuse to feed.

Contraindications

Specialists have identified contraindications to the use of Lamizil:

1. Increased individual intolerance to terbinafine or other component constituents of Lamizil.
2. Propensity to allergic reactions.
3. Pathological changes affecting the liver. Diseases that were in the past and / or in the remission phase should be considered.
4. Chronic disorders in the work of the kidneys.
5. The use of the drug is limited by the age of the patient. It is not recommended to use the drug for children under the age of twelve.

Side effects Lamisil

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

1. Response of the body in the form of allergies:

• Hyperemia of the skin.
• Hives.
• Burning sensation and itching.

1. Indigestion in the form of diarrhea.
2. Nausea and vomiting.
3. Dyspeptic phenomena:

• Flatulence.
• Belching.
• Heaviness and feeling of overflow in the stomach.
• Pain in the abdomen.
• Heartburn.
• Constipation.

1. Disturbance of taste sensations.
2. Increased transaminase levels.
3. The appearance of pain in the right hypochondrium.
4. Deterioration of the liver.
5. Headache.
6. Impairment of appetite.
7. Pain in the joints and muscles.
8. Rapid fatigue of the patient.

If this symptomatology becomes worse, the treatment should be discontinued and seek the help of a specialist.

Overdose

As shown by clinical observations, an overdose of Lamizil may manifest symptoms after oral administration of a dose in 3-5 g.

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

At the moment there is no antidote. Therapy with an overdose of Lamizil is the carrying out of detoxification measures: gastric lavage, intake of adsorptive drugs (various sorbents, activated carbon).

Cases of exceeding the doses of the drug during topical application have not been described.

Interactions with other drugs

At the same time taking Lamizil with oral contraceptives, which affect the metabolism of cytochrome P450, it is necessary to adjust the dose of terbinafine. In this case, there may be a malfunction in the regularity of 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 a single treatment protocol with rifampicin and / or cimetidine requires an increase in the dosage of the antifungal drug.

Simultaneous reception of hepatotoxic drugs or ethanol with Lamizil is undesirable. The probability of development of violations of the hepatic function is great.

Terbinafine enhances the pharmacodynamic characteristics of caffeine and desipramine, which should be taken into account in dosages when combined.

Joint therapy of tablets Lamizil and antiarrhythmic drugs, as well as beta-blockers requires additional monitoring of liver function.

[7], [8]

Storage conditions

The storage conditions of Lamizil are simple, but are mandatory in the performance of:

1. The place where terbinafine is supposed to be stored must be protected from direct sunlight.
2. The temperature regime is not more than 30 degrees.
3. Store the antifungal agent in places that are not available to adolescents and small children.

Shelf life

Shelf life of the drug in question Lamizil somewhat does not match for different forms of release:

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