O que é Terbinafine?
Terbinafine is an allylamine antifungal medicamento used primarily to treat dermatophyte fungal infections of the skin and nails. It is approved by the Agência Europeia de Medicamentos (EMA) and is considered a first-line tratamento for fungal nail infection (onychomycosis) and tinea infections.
In the context of sexual health, terbinafine is most commonly prescribed for fungal infections of the groin (tinea cruris, also known as “jock itch”) and the genital skin area, which may be associated with or confused with sexually transmitted conditions. Understanding that these are dermatophyte fungal infections (not candidal or STI-related) is important for selecting appropriate tratamento.
Terbinafine is available as oral comprimidos (250 mg) for systemic tratamento of nail and widespread skin infections, and as topical creme (1%) for localised skin fungal infections.
Como funciona Terbinafine work?
Terbinafine is an allylamine antifungal that works by inhibiting squalene epoxidase, a fungal enzyme involved in the early stages of ergosterol biosynthesis. This mechanism differs from azole antifungals (fluconazole, clotrimazole), which act at a later stage in the same biosynthetic pathway.
The process:
- Squalene epoxidase inhibition: Terbinafine inhibits the enzyme that converts squalene to squalene epoxide, an early step in ergosterol synthesis.
- Squalene accumulation: The block causes squalene to accumulate within the fungal cell to toxic levels, as squalene epoxide cannot be formed.
- Ergosterol depletion: The fungal cell membrane becomes deficient in ergosterol, disrupting membrane integrity.
- Dual mechanism of toxicity: Both the depletion of ergosterol and the toxic accumulation of squalene contribute to fungal cell death.
- Fungicidal against dermatophytes: Terbinafine is fungicidal (kills fungi) against dermatophytes at clinically relevant concentrations, contributing to its high cure rates for nail infections.
Why terbinafine is selective for fungi: Squalene epoxidase is present in both humans and fungi, but terbinafine has approximately 10,000 times greater selectivity for the fungal enzyme than the human enzyme.
Limited Candida activity: Terbinafine is predominantly fungistatic (growth-inhibiting) rather than fungicidal against Candida species, which is why it is not the preferred choice for candidal infections.
Para quem é Terbinafine for?
Oral terbinafine is indicated for:
- Onychomycosis (fungal nail infection): Caused by dermatophytes (Trichophyton rubrum, T. mentagrophytes) — the most common indication
- Extensive tinea pedis (athlete’s foot): When topical tratamento is insufficient
- Tinea corporis (ringworm) and tinea cruris (groin ringworm): For widespread or tratamento-resistant cases
Topical terbinafine creme 1% is indicated for:
- Localised tinea pedis (athlete’s foot)
- Tinea corporis (ringworm)
- Tinea cruris (jock itch / groin ringworm)
- Pityriasis versicolor (caused by Malassezia species)
Not appropriate for:
- Vaginal candidiasis (use clotrimazole or fluconazole)
- Oral candidiasis (use nystatin or fluconazole)
- Patients with severe liver disease (oral terbinafine is contraindicated)
- Pregnancy (avoid systemic terbinafine unless clearly necessary; topical use may be acceptable in some cases — médico assessment required)
Dosagem
Oral Terbinafine (systemic tratamento)
| Indication | Dose | Duration |
|---|---|---|
| Fingernail onychomycosis | 250 mg once daily | 6 weeks |
| Toenail onychomycosis | 250 mg once daily | 12 weeks |
| Tinea pedis (extensive) | 250 mg once daily | 2–6 weeks |
| Tinea corporis / tinea cruris (extensive) | 250 mg once daily | 2–4 weeks |
Oral terbinafine can be taken with or without food.
Topical Terbinafine Cream 1%
| Indication | Application | Duration |
|---|---|---|
| Tinea pedis (athlete’s foot) | Once or twice daily | 1–2 weeks |
| Tinea corporis / cruris | Once or twice daily | 1–2 weeks |
| Pityriasis versicolor | Once daily | 2 weeks |
Apply a thin layer to the affected area and 2–3 cm of surrounding skin. Allow to dry.
Efeitos secundários
Oral Terbinafine
Efeitos secundários comuns (afetando 1 a 10 em 100 pessoas):
- Gastrointestinal symptoms: nausea, diarrhoea, abdominal discomfort, loss of appetite
- Headache
- Taste disturbances (dysgeusia) — including loss of taste; usually reversible after stopping but can persist
- Skin rash and urticaria
Menos comuns efeito secundários:
- Elevated liver enzymes (liver function monitoring is recommended)
- Joint and muscle pain (arthralgia, myalgia)
- Dizziness
Rare but serious:
- Hepatotoxicity: Serious liver reactions including cholestasis, hepatitis, and very rarely liver failure — monitor for jaundice, dark urine, pale stools, persistent nausea
- Severe skin reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis (very rare)
- Haematological effects: Agranulocytosis, pancytopenia (very rare)
- Taste loss: Severe, prolonged taste disturbance or complete taste loss has been reported; may last months after stopping tratamento
Topical Terbinafine
Generally well tolerated. Local skin reactions (burning, itching, redness) at the application site are uncommon.
Terbinafine vs alternativas antifungal tratamentos for nail infection
| Treatment | Route | Duration | Cure Rate (Toenail) | Notes |
|---|---|---|---|---|
| Terbinafine | Oral | 12 weeks | ~60–80% | First-line; fungicidal |
| Itraconazole | Oral (pulse) | 3 months | ~50–70% | Alternative; drug interactions |
| Fluconazole | Oral | 6–12 months | ~40–60% | Longer course; weekly dosing |
| Amorolfine | Topical nail lacquer | 6–12 months | ~35–50% | For mild cases; no liver risk |
Oral terbinafine is generally considered the most effective oral tratamento for toenail onychomycosis due to its fungicidal activity against dermatophytes.
Como aceder a Terbinafine online na Europa
Oral Terbinafine is a medicamento sujeito a receita médica (POM) in all estados-membros da UE. It cannot legally be dispensed without a valid receita médica from a licensed medical professional.
Prescrivia operates as a technology intermediary: we do not prescribe medicamentos, employ médicos, or sell medicamentos. Our platform connects pacientes with independent EU-registered médicos who can conduct confidential online health assessments.
The process:
- Complete uma avaliação de saúde: Describe the affected nails or skin, duration of infection, and any relevant medical history including liver disease or other medications.
- Avaliação médica: An independent EU-registered médico reviews your assessment. If terbinafine is clinically appropriate, they may issue a receita médica.
- Dispensa na farmácia: The receita médica is sent to a licensed EU farmácia partner for dispensing and direct delivery.
Important: A Prescrivia não garante that a receita médica will be issued. All prescribing decisions are made independently by qualified medical professionals.
Informação de segurança importante
Do not take oral Terbinafine if you:
- Have active or chronic liver disease
- Have severe kidney disease
- Are pregnant (avoid unless clearly necessary — discuss with médico)
- Are breastfeeding (terbinafine passes into breast milk — avoid)
- Are allergic to terbinafine
Informe o seu médico before taking Terbinafine if you:
- Have any history of liver problems
- Have autoimmune conditions such as lupus (terbinafine has been associated with triggering or worsening cutaneous and systemic lupus erythematosus)
- Are taking other medicamentos metabolised by the CYP2D6 enzyme, including antidepressants (TCAs, SSRIs), antipsychotics, and beta-blockers (terbinafine inhibits CYP2D6)
- Are taking ciclosporin (terbinafine may reduce ciclosporin blood levels)
- Are taking caffeine-containing medicamentos (terbinafine reduces caffeine metabolism)
Fontes
Medical information on this page is based on the following sources:
- Agência Europeia de Medicamentos (EMA). Terbinafine — Summary of Product Characteristics. Available at: ema.europa.eu
- Organização Mundial da Saúde (WHO). WHO Model List of Essential Medicines. 22nd edition, 2021. who.int
- Gupta AK, et al. Onychomycosis: a review of clinical features, epidemiology, and tratamento. Journal of the European Academy of Dermatology and Venereology. 2020.
This content is reviewed periodically to reflect updated clinical guidance. It is provided for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for advice relevant to your individual health circumstances.
Frequently asked questions
- O que é Terbinafine utilizado para?
- Terbinafine is an antifungal medicamento primarily used to treat dermatophyte fungal infections of the nails (onychomycosis) and skin. Common conditions treated include fungal nail infection (tinea unguium), athlete's foot (tinea pedis), ringworm (tinea corporis), and fungal groin infection (tinea cruris). It is available as oral comprimidos and topical creme.
- Quanto tempo dura oral Terbinafine take to work for nail fungal infection?
- Oral terbinafine is taken for 6 weeks for fingernail infections and 12 weeks for toenail infections. However, because nails grow slowly, visible improvement may not be apparent for several months after completing tratamento. Full nail clearance can take 6–12 months or more after the course ends, as the healthy nail gradually grows out replacing the infected nail.
- Is Terbinafine effective against vaginal thrush?
- No. Terbinafine is highly effective against dermatophyte fungi (Trichophyton, Microsporum, Epidermophyton species) but has limited activity against Candida species, which cause vaginal thrush. For vaginal candidiasis, antifungals such as clotrimazole (Canesten Gyno) or fluconazole (Diflucan) should be used instead.
- What are the liver-related risks with oral Terbinafine?
- Oral terbinafine can rarely cause liver enzyme elevations and, very rarely, serious hepatic events including liver failure. The EMA recommends that liver function should be assessed before starting oral terbinafine, and pacientes should be monitored for signs of liver problems during tratamento. Terbinafine should be discontinued if liver problems develop.
- Posso obter Terbinafine online na Europa?
- Oral terbinafine is a medicamento sujeito a receita médica in all estados-membros da UE. Topical terbinafine creme may be available without receita médica in some countries for certain skin conditions. You can access oral terbinafine through online intermediary platforms connecting you with independent EU-registered médicos for a confidential assessment.
Tratamentos
A Prescrivia é apenas uma plataforma intermediária. Não prestamos serviços médicos, não prescrevemos tratamentos nem dispensamos medicamentos. Todas as decisões médicas são tomadas por médicos independentes registados na UE. Todos os medicamentos são dispensados por farmácias licenciadas na UE. Esta plataforma facilita a ligação entre pacientes e prestadores de cuidados de saúde.