Terbicip (Terbinafine Hydrochloride)
Also sold as: Terbicip, Lamisil, Fungotek, Terbiforce, Zimig
Pregnancy
Cat B
Lactation
Avoid
Schedule
H
Forms
Tablet 250mg +3
Indications
- Onychomycosis (fungal nail infection — oral; first-line for dermatophytes)
- Tinea capitis (scalp ringworm — oral; drug of choice)
- Tinea corporis/cruris/pedis (topical for limited disease; oral for extensive)
- Pityriasis versicolor (topical)
Adult Dosing
Onychomycosis (toenails)
250 mg PO once daily for 12 weeks
Continuous therapy. Nail must grow out to show effect — assess at 3 months; visual cure at 6–12 months.
Onychomycosis (fingernails)
250 mg PO once daily for 6 weeks
Tinea capitis
250 mg PO once daily for 4–6 weeks (dermatophytes)
Weight-adjusted in children (see paediatric)
Tinea corporis/cruris (oral)
250 mg PO once daily for 2–4 weeks
Topical (tinea)
Apply to affected area OD or BD for 1–2 weeks (cream/solution)
Pediatric Dosing
Oral granules (Lamisil granules) available for sprinkling in food — useful for children
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl < 50 mL/min | Reduce dose by 50% (125 mg/day) or avoid — limited data |
Hepatic Adjustment
CONTRAINDICATED in chronic or active liver disease — hepatotoxicity risk. Check LFTs before starting.
Pregnancy & Lactation
Pregnancy: Category B
Animal studies reassuring. However, insufficient human data — avoid systemic use in pregnancy unless essential. Onychomycosis is not urgent — delay treatment until after delivery. Topical use considered safer.
Lactation: Avoid
Excreted in breast milk in significant amounts — manufacturer advises against breastfeeding during treatment. Topical use: apply to areas not in contact with infant.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| CYP2D6 substrates (amitriptyline, desipramine, metoprolol, codeine → morphine conversion) | Terbinafine is a potent CYP2D6 inhibitor — elevated levels of these drugs; bradycardia with metoprolol; excess morphine from codeine | Major |
| Rifampicin | Reduces terbinafine levels by ~100% — avoid or use higher dose | Major |
| Cimetidine | Reduces terbinafine clearance — levels rise | Moderate |
| Warfarin | Possible INR changes — monitor INR | Moderate |
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Side Effects
Common
- Nausea and dyspepsia (most common)
- Abdominal discomfort
- Headache
- Rash, urticaria
- Taste disturbance (dysgeusia — can be persistent)
- Diarrhoea
Serious / Discontinue If
- Hepatotoxicity (rare — stop if jaundice/hepatitis symptoms)
- Severe skin reactions (Stevens-Johnson, toxic epidermal necrolysis — rare)
- Pancytopenia (rare — monitor FBC in long courses)
- Persistent taste loss (ageusia — rare, usually reversible within months)
- Lupus-like syndrome
Contraindications
- Active or chronic liver disease
- Hypersensitivity to terbinafine
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Terbicip 250mg | Cipla | 14 tab ₹195 |
| Zimig 250mg | GSK | 14 tab ₹225 |
| Terbiforce 250mg | Mankind | 14 tab ₹175 |
| Fungotek 250mg | Wockhardt | 14 tab ₹185 |
Monitoring Required
- LFTs at baseline; repeat if symptoms develop
- Clinical response at 3 and 6 months (nail regrowth)
- FBC if prolonged treatment
- Taste perception
- Mycopathology (nail clipping KOH + culture at start — confirm dermatophyte)
Patient Counseling Points
- Take with or without food — absorption not significantly affected
- Nails grow slowly — do not expect visible improvement for 3–6 months
- Report yellow eyes, dark urine, or severe abdominal pain — liver side effect
- Report persistent taste changes — rare but can persist after stopping
- Avoid alcohol — additional liver risk
- Inform your doctor if you take metoprolol, amitriptyline, or codeine — dose adjustments may be needed
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Clinically reviewed by: Dr. Padmavathi Rao, MD (Dermatology), Senior Consultant Dermatologist
Last reviewed: 2026-04-01
References
- BNF — Terbinafine
- ESCMID Onychomycosis Guidelines
- IDSA Dermatophytosis Guidelines
- Indian Journal of Dermatology — Terbinafine Review