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Terbinex Side Effects

Generic Name: terbinafine

Note: This page contains side effects data for the generic drug terbinafine. It is possible that some of the dosage forms included below may not apply to the brand name Terbinex.

For the Consumer

Applies to terbinafine: oral packet, oral tablet

As well as its needed effects, terbinafine (the active ingredient contained in Terbinex) may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking terbinafine, check with your doctor immediately:

More common:
  • Fever
Less common:
  • Body aches or pain
  • chills
  • cough
  • diarrhea
  • difficulty with breathing
  • ear congestion
  • general feeling of discomfort or illness
  • headache
  • joint pain
  • loss of appetite
  • loss of voice
  • nasal congestion
  • nausea
  • runny nose
  • shivering
  • skin rash or itching
  • sneezing
  • sore throat
  • sweating
  • trouble with sleeping
  • unusual tiredness or weakness
  • upper abdominal or stomach pain
  • vomiting
Rare
  • Dark urine
  • difficulty with swallowing
  • pale skin
  • pale stools
  • redness, blistering, peeling, or loosening of the skin
  • stomach pain
  • unusual bleeding or bruising
  • yellow skin or eyes
Incidence not known:
  • Black, tarry stools
  • bleeding gums
  • bloating
  • blood in the urine or stools
  • chest pain
  • constipation
  • cough or hoarseness
  • dizziness
  • fast heartbeat
  • feeling of discomfort
  • flu-like symptoms
  • general feeling of tiredness or weakness
  • hair loss
  • high fever
  • hives
  • indigestion
  • inflammation of the joints
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • light-colored stools
  • lower back or side pain
  • muscle aches
  • painful or difficult urination
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • persistent loss of appetite
  • pinpoint red spots on the skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • red, scaling, or crusted skin
  • sores, ulcers, or white spots on the lips or in the mouth
  • sores, welting, or blisters
  • stomach pain, continuing
  • swollen glands
  • swollen lymph glands
  • tightness in the chest
  • troubled breathing with exertion
  • ulcers, sores, or white spots in the mouth
  • unexplained bleeding or bruising

Minor Side Effects

Some terbinafine side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:
  • Stomach pain (mild)
Less common:
  • Acid or sour stomach
  • bad, unusual, or unpleasant (after) taste
  • belching
  • change of taste or loss of taste
  • heartburn
  • toothache
Incidence not known:
  • Decreased vision
  • difficulty with moving
  • discouragement
  • feeling sad or empty
  • irritability
  • lack of appetite
  • loss of interest or pleasure
  • loss of sense of smell
  • muscle cramps or spasms
  • muscle stiffness
  • tiredness
  • trouble concentrating

For Healthcare Professionals

Applies to terbinafine: oral granule, oral tablet

General

In general, side effects have been mild to moderate and transient; however, this drug has been associated with serious life-threatening events such as hepatic failure, anaphylaxis, and severe neutropenia. Unless otherwise specified, the listed side effects were reported with the tablets.[Ref]

Nervous system

Taste disturbances were typically noticed 5 to 8 weeks after starting therapy and returned to normal within several weeks after stopping the medication. The taste alteration has been rarely accompanied by a discoloration of the tongue and/or a disturbance in the sense of smell.

Hypogeusia (including ageusia) usually recovered within several weeks after this drug was stopped. Isolated cases of prolonged hypogeusia have been reported.

Taste disturbance (including taste loss), paresthesia, hypoesthesia, tinnitus, and vertigo have also been reported during postmarketing experience. Some cases of taste disturbance were severe enough to cause decreased food intake, weight loss, anxiety, and depressive symptoms.[Ref]

Very common (10% or more): Headache (12.9%)
Common (1% to 10%): Taste disturbance/dysgeusia (including taste loss/ageusia), dizziness
Uncommon (0.1% to 1%): Hypogeusia, ageusia, paresthesia, hypoesthesia, tinnitus
Very rare (less than 0.01%): Vertigo, sedation, lightheadedness
Frequency not reported: Taste alteration
Postmarketing reports: Smell disturbance (including loss of smell), paresthesia, hypoesthesia, hearing impairment, hypoacusis, anosmia (including permanent anosmia), hyposmia[Ref]

Gastrointestinal

Very common (10% or more): Gastrointestinal symptoms, feeling of fullness, abdominal distension, diarrhea, dyspepsia/gastritis, nausea, abdominal pain, flatulence, vomiting, mild abdominal discomfort, abdominal cramps, belching
Common (1% to 10%): Upper abdominal pain
Uncommon (0.1% to 1%): Toothache
Very rare (less than 0.01%): Parotid swelling
Frequency not reported: Mild to moderate gastrointestinal discomfort, gastritis, gastric fullness, nausea and vomiting, discoloration of the tongue, hypogeusia, ageusia, metallic taste, severe sialadenitis
Postmarketing reports: Pancreatitis[Ref]

Vomiting, upper abdominal pain, and toothache have been reported with the oral granules. Vomiting has also been reported during postmarketing experience with the tablets.[Ref]

Dermatologic

An 81-year-old male who had been treated with topical antifungal agents for tinea pedis started this drug (125 mg orally daily) as the lesions did not respond to topical therapy. He was not taking any other medications and had no history of skin disease. No other skin lesions were observed at that time. Two weeks later, he developed erythematous and pustular lesions on his fingers and toes, and an erythematous macular eruption on the limbs. This drug was discontinued, but the eruptions continued to worsen. Histopathology of a punch biopsy from his toe showed intraepidermal sterile pustules containing neutrophils, so-called Kogoj's spongiform pustules. He was then diagnosed with having acrodermatitis continua of Hallopeau and was treated with corticosteroids therapy.

An 80-year-old female experienced DRESS secondary to severe sialadenitis coincident with this drug. The patient was admitted with a generalized pruriginous eruption. She presented with erythematous and edematous widespread confluent plaques, with a scaly annular border. She had initiated therapy 14 days before onset of the generalized rash, for a nonspecific squamous plaque of the trunk. DRESS induced by this drug was diagnosed and therapy was discontinued. Topical therapy was started with 0.5% clobetasol propionate cream applied to the whole body. The rash progressively improved and blood eosinophilia decreased.

A 68-year-old male experienced acute generalized exanthematous pustulosis coincident with this drug. He presented with a symmetrical maculopapular eruption on both lower anterior legs. Within 2 days, the rash generalized with facial involvement. He developed the rash 20 days after initiating oral therapy for onychomycosis. After withdrawal of this drug, the exanthema abated within 10 days under topical therapy with corticosteroids.

Serious skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, exfoliative dermatitis, bullous dermatitis), psoriasiform eruptions or exacerbation of psoriasis, acute generalized exanthematous pustulosis, hair loss, and photosensitivity reactions have also been reported during postmarketing experience.[Ref]

Very common (10% or more): Nonserious forms of skin reactions, rash, urticaria
Common (1% to 10%): Pruritus, erythema
Uncommon (0.1% to 1%): Photosensitivity reactions
Very rare (less than 0.01%): Serious skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, exfoliative dermatitis, bullous dermatitis), photosensitivity (e.g., photodermatosis, photosensitivity allergic reaction, polymorphic light eruption), alopecia/hair loss, psoriasiform eruptions or exacerbation of psoriasis, acute generalized exanthematous pustulosis, toxic skin eruption
Frequency not reported: Reversible alopecia areata of the scalp, pustular psoriasis, acrodermatitis continua of Hallopeau
Postmarketing reports: Serious skin reactions (e.g., drug reaction with eosinophilia and systemic symptoms [DRESS] syndrome)[Ref]

Metabolic

Very common (10% or more): Decreased appetite/anorexia
Frequency not reported: Hypoglycemia, decreased food intake (due to taste disturbance)[Ref]

Arthralgia and myalgia have also been reported during postmarketing experience.[Ref]

Musculoskeletal

Very common (10% or more): Musculoskeletal reactions, arthralgia, myalgia
Very rare (less than 0.01%): Cutaneous and systemic lupus erythematosus
Postmarketing reports: Rhabdomyolysis, increased blood creatine phosphokinase, precipitation and exacerbation of cutaneous and systemic lupus erythematosus[Ref]

Hepatic

Liver enzyme abnormalities (at least 2 times the upper limit of normal) have been reported in 3.3% of patients.

In most liver failure cases, patients had serious underlying systemic conditions; causal association with this drug was unclear.

A 57-year-old male with chronic hepatitis B virus (HBV) infection developed drug-induced acute autoimmune hepatitis coincident with this drug. He was given 250 mg once daily over a 12-week period for dermatophyte toenail onychomycosis. He developed the side effect just prior to completing the course of therapy. He was not taking any other drugs or herbal supplements, did not drink alcohol, and did not appear to suffer a flare of HBV infection. Liver function studies began to normalize 6 weeks after this drug was discontinued.

Cases of liver failure (some leading to death or liver transplant), hepatitis, cholestasis, and increased hepatic enzymes have also been reported during postmarketing experience.[Ref]

Common (1% to 10%): Liver enzyme abnormalities
Rare (0.01% to 0.1%): Serious liver dysfunction (including hepatic failure, increased hepatic enzymes, jaundice, cholestasis, liver decompensation, hepatitis), transient increases in liver enzymes, hepatobiliary dysfunction, cholestatic jaundice, liver failure (some cases leading to death or liver transplant)
Frequency not reported: Development of idiosyncratic and symptomatic hepatobiliary dysfunction, drug-induced autoimmune hepatitis
Postmarketing reports: Idiosyncratic and symptomatic hepatic injury[Ref]

Psychiatric

Common (1% to 10%): Depression
Very rare (less than 0.01%): Anxiety
Frequency not reported: Insomnia
Postmarketing reports: Anxiety (independent of taste disturbance), depressive symptoms (independent of taste disturbance), anxiety (secondary to taste disturbances), depressive symptoms (secondary to taste disturbances)[Ref]

Other

Common (1% to 10%): Pyrexia, tiredness/fatigue
Uncommon (0.1% to 1%): Weight decreased
Rare (0.01% to 0.1%): Malaise (secondary to dysgeusia)
Very rare (less than 0.01%): Chest pain
Frequency not reported: Weight loss (due to taste disturbance), weight decreased (secondary to hypogeusia)
Postmarketing reports: Influenza-like illness

Pyrexia has been reported with the oral granules; it has also been reported during postmarketing experience with the tablets.

Malaise and fatigue have also been reported during postmarketing experience.

Respiratory

Common (1% to 10%): Nasopharyngitis, cough, upper respiratory tract infection, influenza, pharyngolaryngeal pain, rhinorrhea, nasal congestion

Nasopharyngitis, cough, upper respiratory tract infection, influenza, pharyngolaryngeal pain, rhinorrhea, and nasal congestion have been reported with the oral granules.

Ocular

Changes in the ocular lens and retina have been reported; however, the clinical significance is unknown.

Dyschromatopsia, whereby the patient reported a greenish hue in her vision, and photopsia have occurred in a patient after 3 weeks of therapy. This problem resolved within 1 week of discontinuing the drug.[Ref]

Common (1% to 10%): Visual disturbance
Frequency not reported: Changes in ocular lens and retina, dyschromatopsia, photopsia
Postmarketing reports: Reduced visual acuity, visual field defect, blurred vision[Ref]

Hematologic

Agranulocytosis, thrombocytopenia, anemia, and pancytopenia have also been reported during postmarketing experience.[Ref]

Uncommon (0.1% to 1%): Anemia
Very rare (less than 0.01%): Neutropenia, agranulocytosis, thrombocytopenia, pancytopenia
Frequency not reported: Leukopenia, lymphopenia, transient decreases in hematocrit, transient decreases in hemoglobin, transient decreases in leukocytes
Postmarketing reports: Severe neutropenia, altered prothrombin time (prolonged and reduced) with concomitant warfarin[Ref]

Hypersensitivity

Very rare (less than 0.01%): Anaphylactoid reactions (including angioedema)
Frequency not reported: Anaphylaxis, hypersensitivity reactions
Postmarketing reports: Serious hypersensitivity reactions (e.g., angioedema, allergic reactions [including anaphylaxis]), anaphylactic reaction, serum sickness-like reaction[Ref]

Renal

Frequency not reported: Renal function test impairment, transient increases in serum urea, transient increases in serum creatinine[Ref]

Genitourinary

Frequency not reported: Hematuria, transient erectile dysfunction in male patients[Ref]

Cardiovascular

Postmarketing reports: Vasculitis

References

1. "Product Information. Lamisil (terbinafine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.

2. Villars VV, Jones TC "Special features of the clinical use of oral terbinafine in the treatment of fungal diseases." Br J Dermatol 126(suppl (1992): 61-9

3. Shear NH, Gupta AK "Terbinafine for the treatment of pedal onychomycosis: a foot closer to the promised land of cured nails?" Arch Dermatol 131 (1995): 937-42

4. Amichai B, Grunwald MH "Adverse drug reactions of the new oral antifungal agents - terbinafine, fluconazole, and itraconazole." Int J Dermatol 37 (1998): 410-5

5. del Palacio Hernandez A, Lopez Gomez S, Gonzalez Lastra F, Moreno Palancar P, Iglesias Diez L "A comparative double-blind study of terbinafine (Lamisil) and griseofulvin in tinea corporis and tinea cruris." Clin Exp Dermatol 15 (1990): 210-6

6. Ottervanger JP, Stricker BH "Loss of taste and terbinafine." Lancet 340 (1992): 728

7. Beutler M, Hartmann K, Kuhn M, Gartmann J "Taste disorders and terbinafine." BMJ 307 (1993): 26

8. Abecassis S, Roujeau JC, Bocquet H, et al. "Severe sialadenitis: a new complication of drug reaction with eosinophilia and systemic symptoms." J Am Acad Dermatol 51 (2004): 827-30

9. Stricker BHC, Vanriemsdijk MM, Sturkenboom MCJM, Ottervanger JP "Taste loss to terbinafine: a case-control study of potential risk factors." Br J Clin Pharmacol 42 (1996): 313-8

10. Juhlin L "Loss of taste and terbinafine." Lancet 339 (1992): 1483

11. Balfour JA, Faulds D "Terbinafine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial mycoses [published erratum appears in Drugs 1992 May;43(5):699]." Drugs 43 (1992): 259-84

12. Wilson NJE, Evans S "Severe pustular psoriasis provoked by oral terbinafine." Br J Dermatol 139 (1998): 168

13. Carstens J, Wendelboe P, Sogaard H, Thestrup-Pedersen K "Toxic epidermal necrolysis and erythema multiforme following therapy with terbinafine." Acta Derm Venereol 74 (1994): 391-2

14. Bennett ML, Jorizzo JL, White WL "Generalized pustular eruptions associated with oral terbinafine." Int J Dermatol 38 (1999): 596-600

15. Bonsmann G, Schiller M, Luger TA, Stander S "Terbinafine-induced subacute cutaneous lupus erythematosus." J Am Acad Dermatol 44 (2001): 925-31

16. Condon CA, Downs AMR, Archer CB "Terbinafine-induced acute generalized exanthematous pustulosis." Br J Cancer 138 (1998): 709-10

17. Rzany B, Mockenhaupt M, Gehring W, Schopf E "Stevens-Johnson syndrome after terbinafine therapy." J Am Acad Dermatol 30 (1994): 509

18. Verros CD, Rallis E "The role of terbinafine in induction and/or exacerbation of psoriasis." Int J Dermatol 52 (2012): 1155-6

19. Nishiwaki F, Matsumura Y, Morita N, Kore-Eda S, Miyachi Y, Omoto M "Acrodermatitis continua of Hallopeau due to oral terbinafine." Br J Dermatol 157 (2007): 1073-4

20. Papa CA, Miller OF "Pustular psoriasiform eruption with leukocytosis associated with terbinafine." J Am Acad Dermatol 39 (1998): 115-7

21. Wach F, Stolz W, Hein R, Landthaler M "Severe erythema anulare centrifugum-like psoriatic drug eruption induced by terbinafine." Arch Dermatol 131 (1995): 960-1

22. Todd P, Halpern S, Munro DD "Oral terbinafine and erythema multiforme." Clin Exp Dermatol 20 (1995): 247-8

23. Lazaros GA, Papatheodoridis GV, Delladetsima JK, Tassopoulos NC "Terbinafine-induced cholestatic liver disease." J Hepatol 24 (1996): 753-6

24. Fernandes NF, Geller SA, Fong TL "Terbinafine hepatotoxicity: Case report and review of the literature." Am J Gastroenterol 93 (1998): 459-60

25. "Itracanazole, terbinafine possibly linked to liver failure." Am J Health Syst Pharm 58 (2001): 1076

26. Paredes AH, Lewis JH "Terbinafine-induced acute autoimmune hepatitis in the setting of hepatitis B virus infection." Ann Pharmacother 41 (2007): 880-4

27. Gupta AK, DelRosso JQ, Lynde CW, Brown GH, Shear NH "Hepatitis associated with terbinafine therapy: three case reports and a review of the literature." Clin Exp Dermatol 23 (1998): 64-7

28. Lowe G, Green C, Jennings P "Hepatitis associated with terbinafine treatment." BMJ 306 (1993): 248

29. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

30. Gupta AK, Gonder JR, Shear NH, Dilworth GR "The development of green vision in association with terbinafine therapy." Arch Dermatol 132 (1996): 845-6

31. Adverse Drug Reactions Advisory Committee (ADRAC) and the Adverse Drug Reactions Unit of the TGA "Australian Adverse Drug Reactions Bulletin. Available from: URL: http://www.tga.gov.au/adr/aadrb/aadr0608.htm." ([2006 Aug]):

32. Gupta AK, Soori GS, DelRosso JQ, Bartos PB, Shear NH "Severe neutropenia associated with oral terbinafine therapy." J Am Acad Dermatol 38 (1998): 765-7

33. Shapiro M, Li LJ, Miller J "Terbinafine-induced neutropenia." Br J Dermatol 140 (1999): 1196-7

34. Kovacs MJ, Alshammari S, Guenther L, Bourcier M "Neutropenia and pancytopenia associated with oral terbinafine." J Am Acad Dermatol 31 (1994): 806

35. Grunwald MH, Amichai B "Thrombocytopenia associated with oral terbinafine." Int J Dermatol 37 (1998): 634

36. Rossetti G, Livio F, Roulet E, Hofer MF "Anaphylactic reaction and unrelated, subsequent, known side effects during therapy with thiethylperazine." Pediatr Allergy Immunol 16 (2005): 453-5

37. Beltraminelli HS, Lerch M, Arnold A, Bircher AJ, Haeusermann P "Acute generalized exanthematous pustulosis induced by the antifungal terbinafine: case report and review of the literature." Br J Dermatol 152 (2005): 780-3

38. Gupta AK, Kopstein JB, Shear NH "Hypersensitivity reaction to terbinafine." J Am Acad Dermatol 36 (1997): 1018-9

39. Hull PR, Vismer HF "Treatment of cutaneous sporotrichosis with terbinafine." Br J Dermatol 126 Suppl (1992): 51-5

It is possible that some side effects of Terbinex may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

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