Active substanceTerbinafineTerbinafine
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  • Dosage form: & nbsppills
    Composition:

    1 tablet contains: active substance - terbinafine (in the form of hydrochloride) 250 mg, and auxiliary matter: magnesium stearate 1,950 mg, silicon colloidal dioxide 1,950 mg, hypromellose 11,700 mg, sodium carboxymethyl starch 44,850 mg, microcrystalline cellulose 48,300 mg.

    Description:

    Round biconcave tablets with a smooth or slightly rough surface, from white to white with a yellowish, shade of color, with facetted; with risk on one side tablets and labeling "LAMISIL 250" (in a circle) on the other side.

    Pharmacotherapeutic group:Antifungal drug.
    ATX: & nbsp

    D.01.A.E.15   Terbinafine

    Pharmacodynamics:

    Terbinafine is an allylamine. which has a wide range of action against fungi that cause skin, hair and nail diseases, including dermatophytes such as Trichophyton (eg, T. rubrum, T. mentagrophytes, T verrucosum, T. tonsurans, T. violaceum), Microsporum ( for example, M. canis), Epidermophyton floccosum, as well as yeast fungi of the genus Candida (eg C. albicans) and Malassezia (formerly Pityrosporum). In low concentrations terbinafine has a fungicidal effect against dermatophytes, molds and some dimorphic fungi. Activity with respect to yeast fungi, depending on their type, may be fungicidal or fungistatic. Terbinafine specifically suppresses the early stage of the sterol biosynthesis in the fungal cell. This leads to a deficiency of ergosterol and to intracellular accumulation of squalene, which causes death of the fungal cell. The action of terbinafine is carried out by inhibiting the enzyme squalene epoxidase in the cell membrane of the fungus. This enzyme does not belong to the cytochrome P450 system.

    When applying the drug Lamisil® inside in the skin, hair and nails are created concentrations of terbinafine, providing a fungicidal effect.

    Pharmacokinetics:

    After oral administration terbinafine is well absorbed (> 70%); The absolute bioavailability of terbinafine due to the "first pass" effect is approximately 50%. After a single administration of terbinafine inwards at a dose of 250 mg, its maximum concentration in plasma (Cmax) is achieved after 1.5 hours and is 1.3 μg / ml. With the constant intake of terbinafine Cmax on average increased by 25% compared with a single admission; the area under the concentration-time curve (AUC) increased 2.3 times. Based on the increase in AUC, it is possible to calculate the effective half-life (30 hours).

    Food intake moderately affects the bioavailability of the drug (AUC increases by less than 20%), dose adjustment of Lamisil® with simultaneous intake with food is not required.

    Terbinafine is largely associated with blood plasma proteins (99%). It quickly penetrates the dermal layer of the skin and accumulates in the lipophilic stratum corneum of the epidermis.

    Terbinafine also penetrates the secretion of sebaceous glands, which provides a high concentration of the substance in the hair follicles, hair and in the skin, rich in sebaceous glands.It is also shown that terbinafine penetrates the nail plates in the first few weeks after the initiation of therapy.

    Terbinafine is metabolized rapidly and to a significant extent with the participation of at least seven isoenzymes of cytochrome P450, with the main role being played by the isozymes CYP2C9, CYP1A2, CYP3A4, CYP2C8 and CYP2C19. As a result of the biotransformation of terbinafine, metabolites are formed that do not possess antifungal activity and are excreted mainly by the kidneys.

    Multiple application of terbinafine, leading to an increase in its serum concentration, is accompanied by a three-phase excretion with a finite half-life of about 16.5 days.

    There were no changes in the equilibrium concentration of terbinafine in plasma, depending on age.

    In pharmacokinetic studies of a single dose of Lamisil ® in patients with concomitant renal impairment (creatinine clearance <50 ml / min) and liver disease, the possibility of reducing the terbinafine clearance by 50% was demonstrated.

    Indications:

    Mycosis caused by microorganisms sensitive to terbinafine:

    - Onychomycosis caused by mushrooms dermatophytes.

    - Mycosis of the scalp.

    - Fungal skin infections - treatment of dermatomycosis of the trunk, shins, feet, and yeast infections of the skin caused by fungi of the genus Candida (eg, Candida albicans) - In those cases where the localization, severity or prevalence of infection determines the advisability of oral therapy.

    Note: in contrast to the drug Lamizil® for topical use, the drug Lamisil® for oral administration is not effective in multi-colored lichen.

    Contraindications:

    Hypersensitivity to terbinafine or any other component of the drug.

    Children younger than 3 years old, with a body weight of up to 20 kg for this dosage.

    Chronic or active liver disease.

    It is not recommended to use Lamisil ® in patients with impaired renal function (creatinine clearance less than 50 ml / min or creatinine concentration in the blood serum of more than 300 μmol / l), since the use of the drug in this category of patients is not well understood.

    Carefully:

    If you have one of these diseases, always consult a doctor before using the drug.

    Care must be taken when using the drug in patients with oppression of bone marrow hematopoiesis, cutaneous lupus erythematosus or systemic lupus erythematosus.

    The drug should be used with caution in patients with such concomitant diseases as psoriasis or lupus erythematosus due to possible exacerbation of these diseases.

    Pregnancy and lactation:

    The data of experimental studies do not give grounds to assume the presence of undesirable phenomena with respect to fertility and toxic effects on the fetus. Since the clinical experience of using the drug Lamisil® in pregnant women is very limited, do not use the drug during pregnancy, except when the expected benefit of providing therapy for the mother exceeds the potential risk to the fetus.

    Terbinafine excreted in breast milk, so women who receive the drug Lamisil® inside, should not breast-feed.

    Impact on fertility

    There are no data on the effect of Lamisil® on fertility in humans. Studies in rats showed no undesirable effects on fertility and reproductive capacity.

    Dosing and Administration:

    Duration of treatment depends on the indication and the severity of the course of the disease.

    The drug is administered orally after meals.

    Adults

    250 mg once a day.

    Infections of the skin

    Recommended duration treatment:

    Dermatomycosis of the foot (interdigital, plantar or as a socks): 2-6 weeks.

    Dermatomycosis of trunk, drumsticks: 2-4 of the week.

    Candidiasis of the skin: 2-4 weeks.

    Complete disappearance of manifestations of infection and complaints related to it may occur not earlier than a few weeks after Mycological cure.

    Hair and scalp infections head

    Recommended duration treatment:

    Mycosis of the scalp: 4 weeks.

    Mycosis of the scalpare observed mainly in children.

    Onychomycosis

    The duration of treatment is most patients from 6 to 12 weeks.

    When onychomycosis of brushes in most 6 weeks of treatment are sufficient.

    When onychomycosis of the feet in most 12 weeks of treatment are sufficient.

    Some patients who have decreased nail growth rate, can longer treatment is required. Optimal clinical effect a few months later after mycological cure and discontinuation of therapy. This is determined the time period that is needed for regrowth of a healthy nail.

    Application in the elderly

    There is no reason to assume that for individuals elderly people need to change dosing regimen of the drug or that they are noted side effects, different from those in patients younger age. When application in this age group preparation in tablets should be taken into account concomitant violation possibility liver or kidney function.

    Use in children

    Have children older 3x years the drug is prescribed 1 time per day. Single dose depends on the body weight and is: for children with a body weight of 20 to 40 kg-125 mg (1/2 tablet 250 mg); more than 40 kg - 250 mg.

    Side effects:

    The drug Lamisil® is generally well tolerated. Side effects are usually mild or moderate and are transient. The following are undesirable phenomena that have been observed during clinical trials or at post-registration period.

    When assessing the incidence of side effects, the following grades are used: "very often" (≥1 / 100 <1/100), "infrequently" (≥1 / 1000 <1/100), "infrequently" (≥1 / 10000 <1/1000), " very rare "(<1/10000), including individual messages.

    Violations of the blood and lymphatic system: infrequently, anemia; very rarely - neutropenia, agranulocytosis, pancytopenia, thrombocytopenia.

    Immune system disorders: very rarely - anaphylactoid reactions (including angioedema), cutaneous and systemic lupus erythematosus (or their exacerbation).

    Disorders of the psyche: often - depression; infrequent anxiety.

    Disturbances from the nervous system: very often - headache; often - dizziness, taste disorders sensations, until their loss (usually recovery occurs within several weeks after discontinuation treatment). There are separate reports on cases of prolonged disorders of taste sensations. In some cases, against the background intake was noted depletion. Infrequently: paresthesia, hypoesthesia.

    Disturbances on the part of the organ of sight: infrequently - impaired vision.

    Violations from the organ of hearing and labyrinthine disorders: infrequent - noise in the ears.

    Disorders from the liver and bile ducts: rarely hepatobiliary dysfunction (predominantly cholestatic nature), incl. hepatic insufficiency, including very rare cases of severe hepatic insufficiency (some with a fatal outcome or requiring liver transplantation, in most cases,when hepatic insufficiency developed, patients had serious accompanying systemic disease and the cause-and-effect relationship of liver failure with the drug Lamisil® was doubtful), hepatitis, jaundice, cholestasis, increased activity of "liver" enzymes.

    Disorders from the digestive system: very often - bloating, decreased appetite, indigestion, nausea, mild abdominal pain, diarrhea.

    Disturbances from the skin and subcutaneous tissues: very often - a rash, hives; infrequently - photosensitivity reactions; very rarely - Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, multiform erythema, toxic skin rash, exfoliative dermatitis, bullous dermatitis, psoriasis-like rashes on the skin or exacerbation of psoriasis, alopecia.

    Disturbances from musculoskeletal and connective tissue: very often - arthralgia, myalgia.

    General disorders: often - feeling fatigue; infrequent - an increase in body temperature.

    Laboratory and instrumental data: infrequently - weight loss (secondary to the violation of taste sensations).

    Based on spontaneous reports, received during the post-registration period, and literary data are revealed the following undesirable phenomena, frequency due to an inaccurate amount patients can not be established:

    Immune system disorders: anaphylactic reactions, syndrome similar to serum sickness.

    Disturbances on the part of the organ of sight: blurred vision, reduced visual acuity.

    Disturbances from the skin and subcutaneous fabrics: rash with eosinophilia and systemic symptoms (rash, swelling, fever and enlargement of lymph nodes).

    Violations from the organ of hearing and labyrinthine disorders: hearing loss, hearing impairment.

    Vascular disorders: vasculitis.

    Disturbances from the nervous system: loss of smell, including long-term period of time, decrease in olfaction.

    Disorders from the digestive system systems: pancreatitis.

    Disturbances from the musculoskeletal and connective tissue: rhabdomyolysis.

    General disorders: influenza-like syndrome.

    Laboratory and instrumental data: increased activity of creatine phosphokinase in the blood serum.

    If any of the instructions specified in the instruction side effects are aggravated, or you noticed any other side effects not specified in the instructions, report this doctor.

    Overdose:

    There are reports of several cases of overdose (the accepted dose of the drug was up to 5 g), with headache, nausea, epigastric pain and dizziness.

    Recommended in case of an overdose treatment includes measures to remove the drug, primarily by prescribing activated charcoal and washing the stomach; if necessary, conduct symptomatic and supportive therapy.

    Interaction:

    The effect of other medicines on terbinafine

    Plasma terbinafine clearance may accelerated under the influence of drugs - inducers of metabolism, and suppressed by influence of cytochrome P450 inhibitors. When need for simultaneous application the above drugs and the drug Lamisil ® mYou may need to Corresponding correction of the regime dosing of the latter.

    Cimetidine can enhance action terbinafine or increase it concentration in plasma. Cimetidine reduces terbinafine clearance by 33%.

    Fluconazole increases C max and AUC terbinafine by 52% and 69%, respectively, in connection with the inhibition of isoenzymes CYP2C9 and CYP3A4. Such an increase in exposure terbinafine can occur when use of other drugs, inhibiting isozymes CYP2C9 and CYP3A4, e.g., ketoconazole and amiodarone.

    Rifampicin may impair action terbinafine or reduce it concentration in plasma. Rifampicin increases the terbinafine clearance by 100%.

    The influence of terbinafine on other medicines

    In studies in vivo and in vitro It was shown, that terbinafine suppresses metabolism mediated by isoenzyme 2D6 (CYP2D6). These data may Clinically relevant for those drugs, which are metabolized preferably this enzyme: tricyclic antidepressants, beta-adrenoblockers, selective inhibitors re-uptake of serotonin, antiarrhythmic drugs (IA, 1B, 1C class) and monoamine oxidase B inhibitors type, if the applicable at the same time the drug has a small range of therapeutic concentration.

    Terbinafine reduces the clearance of desipramine on 82%.

    In studies on healthy volunteers with active metabolism of dextrofetorphan (antitussive and substrate CYP2D6) terbinafine increased metabolic coefficient dextromethorphan / dextrorphan in urine in a 16-97 times. In this way, terbinafine in persons with high isoenzyme activity CYP2D6 can reduce the activity of the latter.

    Terbinafine reduces caffeine clearance at intravenous administration by 19%.

    Drug interactions, not providing or rendering insignificant influence

    The results of studies conducted in vitro and in healthy volunteers, show that terbinafine possesses little potential for suppress or increase ground clearance most drugs that metabolized with the participation of the system cytochrome P450 (e.g., terfenadine, triazolam, tolbutamide or oral contraceptives), except for those, which are metabolized with participation CYP2D6.

    Terbinafine does not affect the clearance phenazone or digoxin.

    Terbinafine has no significant influence on the pharmacokinetics of fluconazole.

    There were no clinically significant interactions between terbinafine and components of cotrimoxazole (trimethoprim and sulfamethoxazole), zidovudine or theophylline.

    There are reports of several cases menstrual cycle disorders in patients taking Lamisil® together with oral contraceptives, Although the frequency of these violations does not exceed The average frequency of such disorders is patients receiving only oral contraceptives.

    Terbinafine may reduce serum concentration or severity of clinical effects following preparations

    Terbinafine increases clearance cyclosporine by 15%.

    Interaction with food and beverages

    Food products have a slight effect on bioavailability of terbinafine (increase AUC <20%), which does not require a dose change preparation.

    Special instructions:

    Before using Lamisil® in the tablets it is necessary to perform an analysis of the liver function. Hepatotoxicity can occur both in patients with previous liver diseases, and without them. During therapy, a periodic study of liver function is recommended (4-6 weeks after the start of treatment). Treatment with Lamisil® should be stopped immediately if hepatic samples become more active.Patients who are prescribed Lamisil® should be warned that it is necessary to immediately inform the attending physician of the appearance of symptoms such as persistent nausea, decreased appetite, fatigue, vomiting, pain in the right hypochondrium, jaundice, dark urine or light feces. In case of appearance of such symptoms, it is necessary to immediately stop taking the drug and conduct a study of liver function. Serious skin reactions (including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms) were rarely seen with Lamisil®. When using Lamisil ® in tablets, extremely rare cases of changes in the cellular composition of the blood (neutropenia, agranulocytosis, thrombocytopenia, pancytopenia) were noted.

    AT In case of qualitative or quantitative changes in the blood constituents, the cause of the impairment should be determined and the issue of reducing the dose of the drug or, if necessary, discontinuing Lamisil® therapy should be considered.

    It was shown that terbinafine suppresses metabolism mediated by isoenzyme 2D6 (CYP2D6). It is therefore necessary continuously monitor patients receiving concomitantly with drug Lamisil® treatment with drugs, predominantly metabolized with participation of this enzyme (such as tricyclic antidepressants, beta-adrenoblockers, selective inhibitors re-uptake of serotonin, antiarrhythmic drugs 1C class and inhibitors of monoamine oxidase B type) in case, if applied simultaneously the drug has a small range therapeutic concentration.

    Effect on the ability to drive transp. cf. and fur:

    Effect of Lamisil on the ability to drive and work with mechanisms have not been studied. When developing dizziness on the background of drug therapy, patients should not drive vehicles and / or work with mechanisms.

    Form release / dosage:

    Tablets 250 mg.

    Packaging:By 7 or 14 pcs. in PVC / aluminum blister. 1 blister containing 7 or 14 tablets, or 2 blisters containing 14 tablets, together with instructions for use packed in a cardboard box.
    Storage conditions:

    At a temperature of no higher than 30 ° C in a dark place.

    Keep out of the reach of children.

    Shelf life:

    3 years.

    The drug should not be used after the expiration date.

    Terms of leave from pharmacies:On prescription
    Registration number:П N012154 / 01
    Date of registration:30.09.2011 / 04.07.2014
    Expiration Date:Unlimited
    The owner of the registration certificate:Novartis Pharma AGNovartis Pharma AG Switzerland
    Manufacturer: & nbsp
    Representation: & nbspNOVARTIS PHARMA LLCNOVARTIS PHARMA LLC
    Information update date: & nbsp12.03.2018
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