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Terbinafine for Onychomycosis

 

Am Fam Physician. 2018 Aug 1;98(3):online.

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TERBINAFINE (LAMISIL) FOR ONYCHOMYCOSIS

BenefitsHarms

1 in 3 treated were clinically cured when compared with those receiving placebo

None were harmed

1 in 3 treated were clinically cured when compared with griseofulvin

1 in 10 treated were clinically cured when compared with azoles

1 in 7 treated with terbinafine plus an azole were clinically cured when compared with terbinafine alone

TERBINAFINE (LAMISIL) FOR ONYCHOMYCOSIS

BenefitsHarms

1 in 3 treated were clinically cured when compared with those receiving placebo

None were harmed

1 in 3 treated were clinically cured when compared with griseofulvin

1 in 10 treated were clinically cured when compared with azoles

1 in 7 treated with terbinafine plus an azole were clinically cured when compared with terbinafine alone

Study Population: Patients 36 to 68 years of age with toenail onychomycosis confirmed by positive culture or fungal elements noted on microscopy

Efficacy End Points: Cure of toenail onychomycosis by clinical appearance and microscopic evaluation; time to cure and recurrence rate also monitored

Harm End Points: Adverse events associated with medication (headaches, dyspepsia, nausea, rash, taste disorders, viral infection, fatigue, hepatotoxicity, medication interactions)

Narrative: Toenail onychomycosis is reported to have a prevalence of 2% to 14% in the Western adult population. It is a common presenting condition in most primary care clinics.1 Although onychomycosis can be painful, patients most often present for cosmetic concerns associated with nail appearance. Treatment is important, especially in older adults and patients with diabetes mellitus because onychomycosis can lead to cellulitis and foot ulcers in these populations. Oral medications are the preferred treatment for onychomycosis given increased rates of cure over topical medications.2

A recent Cochrane review was published comparing terbinafine (Lamisil) to other antifungal medications for treatment of onychomycosis.3 This review evaluated 48 randomized controlled trials based in Western countries and involved 10,200 participants, comparing terbinafine vs. placebo, terbinafine vs. azoles, terbinafine vs. griseofulvin, and terbinafine plus an azole vs. terbinafine alone. Terbinafine was found to be effective for treatment compared with

Author disclosure: No relevant financial affiliations.

References

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1. de Berker D. Clinical practice. Fungal nail disease. N Engl J Med. 2009;360(20):2108–2116....

2. Westerberg DP, Voyack MJ. Onychomycosis: current trends in diagnosis and treatment. Am Fam Physician. 2013;88(11):762–770.

3. Kreijkamp-Kaspers S, Hawke K, Guo L, et al. Oral antifungal medication for toenail onychomycosis. Cochrane Database Syst Rev. 2017;(7):CD010031.

4. Scher RK, Tavakkol A, Sigurgeirsson B, et al. Onychomycosis: diagnosis and definition of cure. J Am Acad Dermatol. 2007;56(6):939–944.

 

 

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