Consumer medicine information

Terbinafine Sandoz

Terbinafine

BRAND INFORMATION

Brand name

Terbinafine Sandoz

Active ingredient

Terbinafine

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Terbinafine Sandoz.

WHAT IS IN THIS LEAFLET

This leaflet answers some common questions about Terbinafine Sandoz.

It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking this medicine against the benefits they expect it will have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

WHAT TERBINAFINE SANDOZ IS USED FOR

Terbinafine Sandoz is used to treat infections caused by dermatophytes, a type of fungi, including the following:

  • fungal infections of the finger nails and toe nails
  • tinea (ringworm) infections of the groin and body
  • tinea infections of the feet ("athlete's foot").

It contains the active ingredient terbinafine.

Terbinafine belongs to a group of medicines called antifungal agents of the allylamine type.

It works by killing the fungi which cause the infection.

Ask your doctor if you have any questions about why this medicine has been prescribed for you. Your doctor may have prescribed it for another reason.

This medicine is not addictive.

This medicine is available only with a doctor's prescription.

BEFORE YOU TAKE TERBINAFINE SANDOZ

When you must not take it

Do not take this medicine if you have an allergy to:

  • terbinafine, the active ingredient, or to any of the other ingredients listed at the end of this leaflet under Product Description.

Some of the symptoms of an allergic reaction may include:

  • shortness of breath
  • wheezing or difficulty breathing
  • swelling of the face, lips, tongue or other parts of the body
  • rash, itching or hives on the skin.

Do not take this medicine if you have or have had any of the following medical conditions:

  • problems with your kidneys
  • a problem with your liver. This medicine is not recommended if you currently have a liver problem because it may make the problem worse. If you have had a liver problem in the past but your liver is now functioning normally, your doctor may prescribe Terbinafine Sandoz, but may want to check your liver function before and during treatment with this medicine.

Do not take this medicine after the expiry date printed on the pack or if the packaging is torn or shows signs of tampering. If it has expired or is damaged, return it to your pharmacist for disposal.

If you are not sure whether you should start taking this medicine, talk to your doctor.

Before you start to take it

Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.

Tell your doctor if you have or have had any of the following medical conditions:

  • skin problems such as rash, red skin, blistering of the lips, eyes or mouth, skin peeling, fever (possible signs of serious skin reactions), rash due to high level of a specific type of white blood cells (eosinophilia)
  • blood disorders or weakness, unusual bleeding, bruising or frequent infections
  • thickened patches of red/silver skin (psoriasis) or facial rash, joint pain, muscle disorder, fever (cutaneous and systemic lupus erythematosus).

Tell your doctor if you are pregnant or plan to become pregnant. There is no experience with use of this medicine during pregnancy. If your doctor thinks it is necessary for you to take it, he/she will discuss with you the risks and benefits involved.

Tell your doctor if you are breastfeeding. Breastfeeding is not recommended since terbinafine, the active ingredient in Terbinafine Sandoz, passes into the breast milk and might affect your baby.

If you have not told your doctor about any of the above, tell him/her before you start taking Terbinafine Sandoz.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including any that you get without a prescription from your pharmacy, supermarket or health food shop.

Some medicines and Terbinafine Sandoz may interfere with each other. These include:

  • some medicines used to treat depression and other mental disorders, including obsessive-compulsive disorders and panic attacks (e.g. some antidepressants such as tricyclic antidepressants, selective serotonin reuptake inhibitors including class 1A, 1B and 1C, monoamine oxidase inhibitors Type B, desipramine)
  • some medicines for Parkinson's disease
  • beta-blocker medicines used to treat high blood pressure, heart problems and migraines (e.g. metoprolol)
  • some antiarrhythmic medicines used to treat irregular heart beat (e.g. amiodarone)
  • some medicines to treat stomach ulcers (e.g. cimetidine)
  • some antibiotics (e.g. rifampicin)
  • caffeine
  • warfarin, a medicine used to prevent blood clots
  • cyclosporin, a medicine used to help prevent organ transplant rejection or to treat certain problems with the immune system
  • oral contraceptives (birth control pills). Problems with your period, such as bleeding between periods, may occur while you are taking Terbinafine Sandoz.
  • some medicines used to treat fungal infections (e.g. fluconazole, ketoconazole)
  • some medicines used to treat cough (e.g. dextromethorphan).

These medicines may be affected by Terbinafine Sandoz or may affect how well it works. You may need different amounts of your medicines, or you may need to take different medicines.

Your doctor and pharmacist have more information on medicines to be careful with or avoid while taking this medicine.

HOW TO TAKE TERBINAFINE SANDOZ

Follow all directions given to you by your doctor or pharmacist carefully. They may differ from the information contained in this leaflet.

If you do not understand the instructions, ask your doctor or pharmacist for help.

How much to take

The usual dose of Terbinafine Sandoz is one 250 mg tablet each day.

If you have kidney problems, the dose may be reduced to one-half a tablet each day.

Ask your doctor or pharmacist if you are unsure of the correct dose for you. They will tell you exactly how much to take.

Follow the instructions they give you. If you take the wrong dose, Terbinafine Sandoz may not work as well and your problem may not improve.

How to take it

Swallow the tablets whole with a full glass of water.

If your stomach is upset after taking your medicine, try taking it immediately after a light meal.

If you need to break the tablet, hold it with both hands and snap along break line.

When to take Terbinafine Sandoz

Take your medicine at about the same time each day. Taking it at the same time each day will have the best effect. It will also help you remember when to take it.

How long to take Terbinafine Sandoz

The length of your treatment can vary and depends on several parameters such as the type of infection you have, what part of the body is affected and how you respond to the treatment.

Fungal skin infections (tinea):
If you have a tinea infection of the feet (athlete's foot), the usual duration of treatment is 2 to 6 weeks.

If you have a tinea infection of the body or groin, the usual duration of treatment is 2 to 4 weeks.

However, the symptoms of infection may continue for several weeks after the fungi have been killed.

Fungal nail infections:
As fungal nail infections usually take longer to heal than fungal skin infections, you will usually take the tablets for 6 weeks to 3 months. The length of your treatment depends on which of your nails is infected and how fast they grow. In some cases you may need to take the tablets for up to 6 months.

It may take several months after you stop taking Terbinafine Sandoz for your nail to look completely normal. That is because the infected part of the nail has to grow out and be replaced by a healthy nail.

If you forget to take it

Take your dose as soon as you remember, and continue to take it as you would normally.

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to.

Do not take a double dose to make up for the dose that you missed. This may increase the chance of you getting an unwanted side effect.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering to take your medicine, ask your pharmacist for some hints.

If you take too much (overdose)

Immediately telephone your doctor or the Poisons Information Centre (telephone Australia 13 11 26 or New Zealand 0800 POISON or 0800 764766) for advice, or go to Accident and Emergency at the nearest hospital, if you think that you or anyone else may have taken too much Terbinafine Sandoz. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

Symptoms of an overdose may include headache, nausea (feeling sick), stomach pain and dizziness.

WHILE YOU ARE TAKING TERBINAFINE SANDOZ

Things you must do

Make sure to take your dose every day and continue taking it until your doctor tells you to stop. This will ensure that all of the infection is gone and will lessen the chance of the infection coming back once you stop taking this medicine.

Make sure to have any blood tests done that are ordered by your doctor. Any side effects on your liver, kidneys or blood can be detected by blood tests.

If you are about to be started on any new medicine, remind your doctor and pharmacist that you are taking Terbinafine Sandoz.

Tell any other doctors, dentists and pharmacists who treat you that you are taking this medicine.

If you become pregnant while taking this medicine, tell your doctor immediately. Your doctor can discuss with you the risks and benefits of taking it during pregnancy.

Tell your doctor immediately if you notice any of the following:

  • fever
  • sore throat
  • mouth ulcers
  • "flu-like" symptoms (chills, aching joints, swollen glands, lack of energy)
  • any other signs of infection, apart from the fungal infection you are being treated for.

Things you must not do

Do not take Terbinafine Sandoz to treat any other complaints unless your doctor tells you to.

Do not give your medicine to anyone else, even if they have the same condition as you.

Do not stop taking your medicine or lower the dosage without checking with your doctor.

Things to be careful of

Be careful driving or operating machinery until you know how Terbinafine Sandoz affects you. This medicine may cause tiredness, sleepiness, dizziness or light-headedness in some people. If you have any of these symptoms, do not drive, operate machinery or do anything else that could be dangerous.

Make sure to keep the infected areas dry and cool and change clothing that is in direct contact with the infected areas every day. This will help to clear up the infection and make sure that it does not return.

SIDE EFFECTS

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Terbinafine Sandoz.

All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.

Do not be alarmed by the following lists of side effects. You may not experience any of them.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor or pharmacist if you notice any of the following and they worry you:

  • nausea (feeling sick) or vomiting
  • upset stomach (heartburn, cramps, wind, belching)
  • loss of appetite
  • diarrhoea
  • aching joints or muscles
  • headache
  • light headedness
  • tiredness, sleepiness
  • skin rash due to high level of a specific type of white blood cells
  • psoriasis (thickened patches of red skin, often with silvery scales)
  • other skin problems
  • loss of or change in sense of taste which usually returns to normal within several weeks after stopping Terbinafine Sandoz treatment
  • blurred vision, decreased sharpness of vision
  • hair loss
  • tingling or numbness
  • decreased physical sensitivity
  • smell disorders or loss of smell
  • anxiety (with symptoms such as sleep disturbances, fatigue, loss of energy or diminished ability to think or concentrate) and depressive symptoms (e.g. depressed mood) due to taste disturbances
  • decreased hearing, impaired hearing and/or perception of noises in the absence of sound (e.g. hissing, ringing) in ears
  • increased skin sensitivity to light.

If you notice any of the following, tell your doctor immediately or go to Accident and Emergency at your nearest hospital:

  • chest pain
  • signs of a severe allergic reaction such as swelling of the face, lips, tongue, throat or other part of the body; shortness of breath, wheezing or troubled breathing; dizziness, redness, itching or rash on the skin; flushing, crampy abdominal pain, loss of consciousness; joint pain, stiffness, rash, fever or swollen/enlarged lymph nodes
  • possible signs of a serious liver problem such as persistent nausea, loss of appetite, unusual tiredness, vomiting, pain in the upper right abdomen, yellowing of the skin and/or eyes, dark urine or pale bowel motions
  • possible signs of serious skin reactions such as painful red areas, large blisters, peeling of layers of skin, bleeding in the lips, eyes, mouth, nose or genitals. These signs may be accompanied by fever and chills, aching muscles and feeling generally unwell.
  • possible signs of a blood problem such as constant "flu-like" symptoms (fever, sore throat, mouth ulcers, chills, swollen glands, lack of energy)
  • possible signs of diseases that affect certain types of blood cells: unusual bleeding or bruising
  • possible signs of a disease that affects the level of red blood cells including abnormal pale skin, mucosal lining or nail beds, unusual tiredness or weakness or breathlessness on exertion
  • possible signs of blood vessel inflammation: rash, fever, itching, tiredness or if you notice appearance of purplish-red spots under the skin surface
  • possible signs of pancreas inflammation: severe upper stomach pain with radiation to the back
  • possible signs of muscle necrosis: unexplained muscle weakness and pain or dark (red-brown) urine.

The above list includes serious side effects that may require medical attention. Serious side effects are rare.

Tell your doctor or pharmacist if you notice anything else that is making you feel unwell. Other side effects not listed above may also occur in some people.

AFTER TAKING TERBINAFINE SANDOZ

Storage

Keep your medicine in the original container.

If you take it out of its original container it may not keep well.

Keep your medicine in a cool dry place where the temperature stays below 25°C.

Do not store Terbinafine Sandoz or any other medicine in the bathroom or near a sink. Do not leave it on a window sill or in the car.

Heat and dampness can destroy some medicines.

Keep it where children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Keep your medicine where it is protected from light.

Disposal

If your doctor tells you to stop taking this medicine or the expiry date has passed, ask your pharmacist what to do with any medicine that is left over.

PRODUCT DESCRIPTION

What it looks like

Terbinafine Sandoz comes in one strength:

Terbinafine Sandoz 250mg - white or almost white, round, scored, convex tablet, coded 'TER 250' on one side.

Available in blister packs of 42 tablets.

Ingredients

Active ingredient:

  • Terbinafine Sandoz 250mg - 250mg terbinafine as terbinafine hydrochloride.

Inactive ingredients:

  • sodium starch glycollate
  • hypromellose
  • colloidal anhydrous silica
  • potato starch
  • magnesium stearate.

This medicine does not contain lactose, sucrose, gluten, tartrazine or any other azo dyes.

Supplier

Sandoz Pty Ltd
ABN 60 075 449 553
54 Waterloo Road
Macquarie Park, NSW 2113
Australia
Tel: 1800 726 369

Novartis New Zealand Ltd
PO Box 99102
Newmarket, Auckland 1149
New Zealand
Tel: 0800 354 335

This leaflet was revised in May 2018.

Australian Register Number

250mg tablets: AUST R 101685 (blisters)

Published by MIMS July 2018

BRAND INFORMATION

Brand name

Terbinafine Sandoz

Active ingredient

Terbinafine

Schedule

S4

 

1 Name of Medicine

Terbinafine hydrochloride.

2 Qualitative and Quantitative Composition

Terbinafine Sandoz tablets contain terbinafine hydrochloride.
Terbinafine hydrochloride is a white to off-white, finely crystalline powder. It is soluble in isopropyl alcohol (> 70 mg/mL at 25°C) and ethanol (> 70 mg/mL at 25°C), and slightly soluble in water (6.3 mg/mL at 25°C).
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Terbinafine Sandoz 250 mg tablets: white or almost white, round, scored on both sides, convex tablet, coded TER 250 on one side.

4 Clinical Particulars

4.1 Therapeutic Indications

Treatment in adults of ringworm (tinea corporis, tinea cruris and tinea pedis) due to infection caused by dermatophytes such as Trichophyton (e.g. T. rubrum, T. mentagrophytes, T. verrucosum, T. violaceum), Microsporum canis and Epidermophyton floccosum, where oral therapy is considered appropriate owing to the site, severity or extent of the infection, and the infection is not responsive to topical therapy.
Onychomycosis in adults (fungal infection of the nail) caused by dermatophyte fungi.

4.2 Dose and Method of Administration

Dosage.

Adults.

Skin infections.

250 mg once a day.

Onychomycosis.

250 mg once a day.
Duration of treatment. The duration of treatment varies according to the indication and the severity of the infection.

Skin infections.

Likely treatment durations are as follows.
Tinea pedis (interdigital, plantar/ moccasin type): 2 to 6 weeks.
Tinea corporis, cruris: 2 to 4 weeks.
Complete resolution of the signs and symptoms of infection may not occur until several weeks after mycological cure.

Onychomycosis.

For most patients the duration for successful treatment is between six weeks and three months.
Infections of finger and toenails (other than big toe) usually respond to the shorter duration of treatment, particularly in patients of younger age with a normal rate of nail outgrowth. In patients with slow nail growth, treatment for up to three months is usually adequate. However, for infections in the big toe, or if nail growth is very poor, treatment for up to six months may be necessary.
Optimal clinical effect is seen some months after mycological cure and cessation of treatment. This is related to the period required for outgrowth of healthy nail tissue.

Method of administration.

Terbinafine Sandoz tablets should be taken orally. The bioavailability of terbinafine is not affected by a light meal.

4.3 Contraindications

Hypersensitivity to terbinafine or to any of the excipients in the formulation.
Severe, chronic or active hepatic disease (see Section 4.4 Special Warnings and Precautions for Use).

4.4 Special Warnings and Precautions for Use

Effect on vision.

During high-dose studies in monkeys, refractile irregularities were observed in the retina at doses that were 30 to 60 times the human dose (non-toxic effect level 50 mg/kg). The clinical relevance of this observation is unknown. However, the ocular effects in monkeys were not confirmed in humans in the placebo-controlled trials, where the incidence of ophthalmic abnormalities was lower in the terbinafine-treated patients (1.1%) compared with those who received placebo (1.5%).

Transient decreases in absolute lymphocyte counts (ALC).

Transient decreases in absolute lymphocyte counts (ALC) have been observed in controlled clinical trials. In placebo-controlled trials, 8/465 terbinafine-treated patients (1.7%) and 3/137 placebo-treated patients (2.2%) had decreases in ALC to below 1,000/mm3 on two or more occasions. The clinical significance of this observation is unknown. However, in patients with known or suspected immunodeficiency, physicians should consider monitoring complete blood counts in individuals using terbinafine therapy for greater than six weeks.

Effect on blood.

Patients taking terbinafine are at a risk of developing agranulocytosis, thrombocytopenia, pancytopenia and neutropenia, which are very rarely associated with terbinafine. The problem usually resolves within a few days to a week of withdrawal of terbinafine. Patients taking terbinafine should be advised to report symptoms of infections. Prescribers should examine the patients to determine the correct aetiology of any blood dyscrasias that occurs in patients treated with terbinafine, and consideration should be given for possible change in medication regimen, including discontinuation of treatment with terbinafine.

Effect on lipids.

In chronic toxicity studies in rats, oral terbinafine, at a dose of 309 mg/kg/day, increased serum cholesterol levels. This effect was more marked in female than in male rats. Effects on triglyceride levels were not consistent among the various studies. In monkeys a daily dose of 300 mg/kg increased triglyceride levels and chylomicron concentrations. In a small clinical study, a daily dose of 250 mg for eight weeks did not result in detectable changes in the plasma lipid profile. In other clinical trials, there was no evidence of a significant change in the plasma lipid profile of patients.

Dermatological effects.

Serious skin reactions (e.g. Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms) have been very rarely reported in patients taking terbinafine tablets. If progressive skin rash occurs, terbinafine should be discontinued.
Terbinafine should be used with caution in patients with pre-existing psoriasis or lupus erythematosus as precipitation and exacerbation of psoriasis and cutaneous and systemic lupus erythematosus have been reported in a postmarketing setting.

Use in hepatic impairment.

Terbinafine is contraindicated for patients with chronic or active hepatic disease. Before prescribing terbinafine, liver function tests should be performed since hepatotoxicity may occur in patients with and without pre-existing liver disease. Therefore periodic monitoring (after 4-6 weeks of treatment) of liver function tests is recommended. Terbinafine Sandoz tablets should be immediately discontinued in case of elevation of liver function tests. Very rare cases of liver failure (some leading to liver transplant or death) have been reported with the use of terbinafine tablets. In the majority of hepatic failure cases, the patients had underlying systemic conditions (see Section 4.8 Adverse Effects (Undesirable Effects)). Patients prescribed Terbinafine Sandoz tablets should be warned to report immediately any symptoms of persistent nausea, anorexia, fatigue, vomiting, right upper abdominal pain or jaundice, dark urine or pale stools. Patients with these symptoms should discontinue taking oral terbinafine and the patient's hepatic function should be immediately evaluated.

Use in renal impairment.

The use of Terbinafine Sandoz tablets in patients with impaired renal function (creatinine clearance less than 50 mL/minute or serum creatinine of more than 300 micromol/L) has not been adequately studied and therefore is not recommended.

Use in the elderly.

There is no evidence to suggest that elderly patients require different dosages or experience side effects different from those in younger patients. When using tablets in this age group, the possibility of impairment of liver or kidney function should be considered (see Section 4.4 Special Warnings and Precautions for Use).

Paediatric use.

There is no experience with terbinafine in children and its use cannot be recommended. Terbinafine Sandoz should be kept out of reach of children.

Effects on laboratory tests.

Transient increases in serum urea, serum creatinine and liver enzymes.
Transient decreases in haematocrit, haemoglobin and leucocytes.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Cytochrome P450.

The plasma clearance of terbinafine may be accelerated by medicines, which induce metabolism and may be inhibited by medicines, which inhibit cytochrome P450 (CYP450). Where co-administration of such agents is necessary, the dosage of terbinafine may need to be adjusted accordingly.

Warfarin.

There have been spontaneous reports of increase or decrease in prothrombin time in patients taking oral terbinafine and warfarin concomitantly. However, a causal relationship between terbinafine and these changes has not been established.

Contraceptives.

Cautious use of Terbinafine Sandoz is advised in women taking oral contraceptives since a few cases of menstrual disorders have been reported in patients taking this medicine combination, although the incidence of these disorders remains within the background incidence of patients taking oral contraceptives alone.

The following medicinal products may increase the effect or plasma concentration of terbinafine.

Cimetidine.

Cimetidine decreased the clearance of terbinafine by 33%.

Fluconazole.

Fluconazole significantly increased the Cmax and AUC of terbinafine, due to inhibition of both CYP2C9 and CYP3A4 enzymes. Similar increase in exposure may occur when other medicines, which inhibit both CYP2C9 and CYP3A4, such as ketoconazole and amiodarone, are concomitantly administered with terbinafine.

The following medicinal products may decrease the effect or plasma concentration of terbinafine.

Rifampicin.

Rifampicin increased the clearance of terbinafine by 100%.

Effect of terbinafine on other medicinal products.

In vitro and in vivo studies showed negligible potential for interaction with the medicines that are metabolised via the CYP450 system (e.g. terfenadine, triazolam, tolbutamide or oral contraceptives) except those with CYP2D6-mediated metabolism (see below).
Terbinafine does not interfere with the metabolism of antipyrine or digoxin. Terbinafine clearance is unaffected by cyclosporin.
There was no effect of terbinafine on the pharmacokinetics of fluconazole. Further, there was no clinically relevant interaction between terbinafine and the potential comedications cotrimoxazole (trimethoprim and sulfamethoxazole), zidovudine or theophylline.

Terbinafine may increase the effect or plasma concentration of the following medicinal products.

Compounds predominantly metabolized by CYP2D6.

Terbinafine inhibits the CYP2D6-mediated metabolism, therefore patients receiving concomitant treatment with medicines predominantly metabolised by this enzyme, such as tricyclic antidepressants (TCAs; e.g. desipramine), beta-blockers, selective serotonin reuptake inhibitors (SSRIs), antiarrhythmics Class 1A, 1B and 1C and monoamine oxidase inhibitors (MAOIs) Type B, should be followed, especially if the co-administered medicine has a narrow therapeutic window.
In studies in healthy subjects characterised as extensive metabolisers of dextromethorphan (antitussive medicine and CYP2D6 probe substrate), terbinafine significantly increased the dextromethorphan/ dextrorphan metabolic ratio in urine. Thus, terbinafine may convert extensive CYP2D6 metabolisers to poor metaboliser status.

Caffeine.

Terbinafine decreased the clearance of caffeine administered intravenously by 19%.

Terbinafine may decrease the effect or plasma concentration of the following medicinal products.

Cyclosporin.

Terbinafine increased the clearance of cyclosporin by 15%.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

Foetal toxicity and fertility studies in animals suggest no adverse effects.
(Category B1)
Since clinical experience in pregnant women is not available, Terbinafine Sandoz should not be used during pregnancy unless the potential benefits outweigh any potential risks.
Terbinafine is excreted in breast milk; therefore, mothers receiving oral treatment with Terbinafine Sandoz should not breastfeed.

4.7 Effects on Ability to Drive and Use Machines

No studies on the effects of terbinafine tablets treatment on the ability to drive and use machines have been performed. Patients who experience dizziness as an undesirable effect should avoid driving vehicles or using machines.

4.8 Adverse Effects (Undesirable Effects)

In general, terbinafine is well tolerated. In clinical trials, adverse events occurred in 10.4% of patients taking terbinafine and 5.6% of patients taking placebo. Most adverse events were mild to moderate in severity and of a short duration.
Adverse drug reactions from clinical trials experience are listed by MedDRA system organ class. Within each system organ class, the adverse drug reactions are ranked under heading by frequency, with the most frequent reactions first. The frequency category for each adverse drug reaction is based on the following convention (CIOMS III): very common (≥ 1/10); common (≥ 1/100 to, < 1/10); uncommon (≥ 1/1,000 to, < 1/100); rare (≥ 1/10,000 to, < 1/1,000); very rare (< 1/10,000).

Gastrointestinal disorders.

Very common: nausea, vomiting, flatulence, mild abdominal discomfort, abdominal cramps, anorexia, diarrhoea, dyspepsia/ gastritis, belching, abdominal distension, decreased appetite.

Immune system disorders.

Very rare: cutaneous and systemic lupus erythematosus, anaphylactoid reactions (including angioedema).

Psychiatric disorders.

Common: depression.
Uncommon: anxiety.

Skin and subcutaneous tissue disorders.

Very common: urticaria, rash.
Common: pruritus, erythema.
Uncommon: photosensitivity reactions.
Very rare: psoriaform eruptions or exacerbation of psoriasis, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, acute generalised exanthematous pustulosis, erythema multiforme, toxic skin eruption, dermatitis exfoliative, dermatitis bullous, alopecia. In the event of an allergic or severe skin reaction, terbinafine treatment should be discontinued.

Musculoskeletal and connective tissue disorders.

Very common: musculoskeletal reactions (arthralgia, myalgia).

Hepatobiliary disorders.

Rare: transient increases in hepatic enzymes, hepatobiliary dysfunction, cholestatic jaundice, liver failure (some leading to liver transplant or death). In the majority of liver failure cases, the patients had underlying systemic conditions (See Section 4.3 Contraindications).

Blood and lymphatic system disorders.

Uncommon: anaemia.
Very rare: haematological disorders such as neutropenia, agranulocytosis, pancytopenia and thrombocytopenia.

Nervous system disorders.

Very common: headache.
Common: dysgeusia* including ageusia*, dizziness, tiredness/ fatigue.
Uncommon: paraesthesia and hypoaesthesia.
Very rare: sedation, light-headedness, chest pain.

Eye disorders.

Common: visual impairment.

Ear and labyrinth disorders.

Uncommon: tinnitus.

General disorders.

Uncommon: pyrexia.

Investigations.

Uncommon: weight decreased**.
*Hypogeusia, including ageusia, which usually recover within several weeks after discontinuation of the medicine. Isolated cases of prolonged hypogeusia have been reported.
**Weight decreased secondary to dysgeusia.

Other adverse drug reactions from post-marketing spontaneous reports.

The following adverse drug reactions have been derived from post-marketing experience with terbinafine tablets via spontaneous case reports and literature cases. Because these reactions are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency which is therefore categorized as not known. Adverse drug reactions are listed according to system organ classes in MedDRA.

Immune system disorders.

Anaphylactic reaction, serum sickness-like reaction.

Psychiatric disorders.

Anxiety and depressive symptoms secondary to taste disturbances.

Ear and labyrinth disorders.

Hypoacusis, impaired hearing.

Eye disorders.

Vision blurred, visual acuity reduced.

Vascular disorders.

Vasculitis.

Nervous system disorders.

Anosmia including permanent anosmia, hyposmia.

Skin and subcutaneous tissue disorders.

Drug rash with eosinophilia and systemic symptoms.

Gastrointestinal disorders.

Pancreatitis.

Musculoskeletal and connective tissue disorders.

Rhabdomyolysis.

General disorders and administration site conditions.

Influenza-like illness.

Investigations.

Blood creatine phosphokinase increased.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at http://www.tga.gov.au/reporting-problems.

4.9 Overdose

A few cases of overdosage (up to 5 g) have been reported.

Signs and symptoms.

Studies in animals suggest that in a high dose situation, such as accidental overdose, central nervous symptoms (CNS) may appear. The relevance of those effects to man is unknown. However, these effects can be monitored.

Central nervous system.

Headache and dizziness.

Gastrointestinal system.

Nausea and epigastric pain.

Treatment.

The recommended treatment of overdosage consists in eliminating the medicine, primarily by the administration of activated charcoal, and giving symptomatic supportive therapy, if needed.
Activated charcoal may reduce absorption of the medicine if given within one or two hours after ingestion. In patients who are not fully conscious or have impaired gag reflex, consideration should be given to administering activated charcoal via a nasogastric tube, once the airway is protected.
For information on the management of overdose, contact the Poison Information Centre on 131126 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Terbinafine is an allylamine with antifungal activity mainly against dermatophytes, including Trichophyton (e.g. T. rubrum, T. mentagrophytes, T. verrucosum, T. violaceum), Microsporum canis and Epidermophyton floccosum.

Mechanism of action.

Terbinafine interferes specifically with fungal sterol biosynthesis at an early step. This leads to a deficiency in ergosterol and to an intracellular accumulation of squalene, resulting in fungal cell death. Terbinafine acts by inhibition of squalene epoxidase in the fungal cell membrane. The enzyme squalene epoxidase is not linked to the cytochrome P450 system. Terbinafine does not influence the metabolism of hormones or other medicines. When given orally, the drug concentrates in skin and nails at levels associated with antifungal activity.

Clinical trials.

No data available.

5.2 Pharmacokinetic Properties

Absorption.

A single oral dose of Terbinafine Sandoz 250 mg tablets resulted in peak plasma concentrations of 1.23 microgram/mL within two hours of administration. The absorption half-life of terbinafine was 0.8 hours and the distribution half-life was 4.6 hours.
An increase in the AUC of terbinafine of less than 20% is observed when administered with food.

Distribution.

Terbinafine binds strongly to plasma proteins (99%). It concentrates in the lipophilic stratum corneum. Terbinafine is also secreted in sebum, thus achieving high concentrations in hair follicles, hair and sebum rich skins. There is also evidence from animal studies that terbinafine is distributed into the nail plate in the first few weeks after commencing therapy.
Animal studies also indicate that terbinafine accumulates in all lipophilic tissues including the retinal and choroid tissues. In studies conducted so far, no ophthalmological abnormalities attributable to terbinafine have been reported in humans.

Metabolism.

Terbinafine is extensively metabolised in the body. Biotransformation results in metabolites with no antifungal activity.

Excretion.

Terbinafine and its metabolites are excreted predominantly in the urine. The elimination half-life is 17 hours. There is no evidence of accumulation in individuals with normal hepatic and renal function. No age dependent changes in pharmacokinetics have been observed. In patients with renal impairment (creatinine clearance less than or equal to 50 mL/minute) or hepatic cirrhosis, the clearance of terbinafine is decreased by approximately 50% compared to normal volunteers.

5.3 Preclinical Safety Data

Genotoxicity.

No data available.

Carcinogenicity.

In a two-year rat carcinogenicity study, small but significant increases in hepatocellular carcinomas, adenomas and combined tumours were seen in males at a dietary dose of 69 mg/kg/day. No increase in hepatic tumours was seen in female rats at a dietary dose of 97 mg/kg/day.

6 Pharmaceutical Particulars

6.1 List of Excipients

Terbinafine Sandoz tablets also contain inactive (excipients) ingredients:
Magnesium stearate, colloidal anhydrous silica, hypromellose, sodium starch glycollate, potato starch.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.
For information on interactions with other medicines and other forms of interactions, see Section 4.5 Interactions with Other Medicines and Other Forms of Interactions.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C.
Protect from light.

6.5 Nature and Contents of Container

Terbinafine Sandoz 250 mg tablets are available in blisters or bottles of 14, 28 and 42 tablets.
Not all presentations may be marketed in Australia.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking to your local pharmacy.

6.7 Physicochemical Properties

The chemical name of terbinafine hydrochloride is (E)-N-(6,6-dimethyl-2-hepten-4-ynyl)-N -methyl-1-naphthalenemethanamine hydrochloride. Its molecular formula is C21H25N.HCl (Molecular weight: 327.9).

Chemical structure.

Its chemical structure is:

CAS number.

78628-80-5.

7 Medicine Schedule (Poisons Standard)

S4.

Summary Table of Changes