How long does it take for Terbinafine to work on toenail fungus?
By
Dr Natalia Marceli Stephanes (PhD)
Author bio
Dr Natália Marcéli Stephanes PhD is a Pharmacist with expertise in Drugs Administration and Toxicity; Discovery of New Drugs; Cancer Treatment; Biochemical Analyzes and Hematological Analyzes. She writes and reviews content on these topics.
Dr Natália Marcéli Stephanes’ Highlights:
- Pharmacist at the Department of Health of Santa Catarina State, Brazil
- PhD with a focus on oncology treatment
- Years of experience in commercial pharmacy
- Bachelor, Master and PhD degrees in Pharmacy at the Federal University of Santa Catarina
Professional Experience:
From her undergraduate studies to her Master’s and Doctorate degrees in Pharmacy, Dr Natália Marcéli Stephanes has participated in numerous scientific studies in the field of oncology and onco-hematology at the University Hospital of the Federal University of Santa Catarina, Brazil. Her research has focused on understanding the molecular and biochemical bases of malignant neoplasms and investigating safer and more effective therapeutic alternatives.
Dr Natália Marcéli Stephanes has also served as an assistant professor of haematology for undergraduate students at the Federal University of Santa Catarina. Additionally, she held the position of professor of Hospital Pharmacy at the Qualificar Technical School in Brazil, where she developed instructional materials for use in the Pharmacy Postgraduate Program at the Leonardo Da Vinci University Center.
In addition to her academic experiences, Dr Natália Marcéli Stephanes possesses a strong expertise in commercial pharmacy, with in-depth knowledge of medications, their routes of administration, desired effects, adverse effects, and toxicity.
Currently, Dr Natália Marcéli Stephanes works as a Pharmacist at the Health Department of Santa Catarina State, where her role entails providing pharmaceutical scientific consulting services to judges.
Education:
- 2016 Bachelor in Pharmacy at the Federal University of Santa Catarina, Brazil
- 2018 Master in Pharmacy at the Federal University of Santa Catarina, Brazil
- 2023 PhD in Pharmacy at the Federal University of Santa Catarina, Brazil
The main publications of Dr Natália Marcéli Stephanes are:
Falchetti M ; Delgobo M, Zancanaro H, Almeida K, Das Neves RN, Dos Santos B, Stefanes NM, et al. Bishop Omics-based identification of an NRF2-related auranofin resistance signature in cancer: Insights into drug repurposing. Comput. Biol. Med [Internet]. 2023; 152:106347.
Feuser PM, Matos dos Santos PC, Cordeiro AP, Stefanes NM, Walter LO, Maioral MF, Santos-Silva MC, et al. Antineoplastic activity of free 4-nitrochalcone and encapsulated in poly(thioether-ester) nanoparticles obtained by thiol-ene polymerization in two human leukemia cell lines (Jurkat and K562). J Drug Deliv Sci Technol [Internet]. 2022; 67:102924.
Jacques AV, Stefanes NM, Walter LO, Perondi DM, Efe FL, Souza LFS, Sens L, et al. Synthesis of chalcones derived from 1-naphthylacetophenone and evaluation of their cytotoxic and apoptotic effects in acute leukemia cell lines. Bioorg. Chem [Internet]. 2021; 116:105315.
Duarte BF, Vieira DSC, Lisboa ML, Stefanes NM, Grando LJ, Santos-Silva MC. Características clínico-epidemiológicas de pacientes portadores de carcinoma de células escamosas de boca. Arquivos Catarinenses de Medicina. 2021; 50(2): 232–245.
Machado V, Jacques AV, Stefanes NM, Santos-Silva MC, Biavatti MW. Anti-leukemic activity of semisynthetic derivatives of Lupeol. Nat. Prod. Res. 2021; 35(22):4494-4501.
Bigolin A, Maioral MF, Stefanes NM, Mascarello A, Chiaradia-Delatorre LD, Nunes RJ, Yunes RA, et al. A novel sulfonamide derivative as a strong and selective apoptotic agent against hematological malignancies. Chem. Pap. 2020; 74:2965–2976.
Bigolin A, Maioral MF, Stefanes NM, Zatelli GA, Philippus AC, Falkenberg MB, Santos-Silva MC. Cytotoxic mechanisms of primin, a natural quinone isolated from Eugenia hiemalis, on hematological cancer cell lines. Anticancer Drugs. 2020; 31(7):709-717.
Maioral MF, Stefanes NM, Neufeldt PD, Chiaradia-Delatorre LD, Nunes RJ, Santos-Silva MC. Aldehyde biphenyl chalcones induce immunogenic apoptotic-like cell death and are promising new safe compounds against a wide range of hematologic cancers. Future Med. Chem. 2020; 12(8):673–688.
Perondi DM, Jacques AV, Stefanes NM, Maioral MF, Sens L, Pacheco LA, Cury NM, et al. A novel thiosemicarbazone as a promising effective and selective compound for acute leukemia. Anticancer Drugs. 2019; 30(8):p 828-837.
Rengifo AFC, Stefanes NM, Toigo J, Mendes C, Argenta DF, Dotto MER, Santos-Silva MC, et al. PEO-chitosan nanofibers containing carboxymethyl-hexanoyl chitosan/dodecyl sulfate nanoparticles loaded with pyrazoline for skin cancer treatment. Eur. Polym. J. 2019; 119:335-343.
Rengifo AFC, Stefanes NM, Toigo J, Mendes C, Santos-Silva MC, Nunes RJ, Parize AL, et al. A new and efficient carboxymethyl-hexanoyl chitosan/dodecyl sulfate nanocarrier for a pyrazoline with antileukemic activity. Mater. Sci. Eng. C [Internet]. 2019; 105:110051.
Maioral MF, Stefanes NM, Bigolin A, Zatelli GA, Philippus AC, Falkenberg MB, Santos-Silva MC. Miconidine acetate, a new selective and cytotoxic compound with synergic potential, induces cell cycle arrest and apoptosis in leukemia cells. Invest. New Drugs. 2019; 37:912–922.
Srefanes NM, Toigo J, Maioral MF, Jacques AV, Chiaradia-Delatorre LD, Perondi DM, Ribeiro AAB, et al. Synthesis of novel pyrazoline derivatives and the evaluation of death mechanisms involved in their antileukemic activity. Bioorg. Med. Chem. 2019; 27(2):375-382.
Maioral MF, Bodack CN, Stefanes NM, Bigolin A, Mascarello A, Chiaradia-Delatorre LD, Yunes RA, et al. Cytotoxic effect of a novel naphthylchalcone against multiple cancer cells focusing on hematologic malignancies. Biochim. 2017; 140:48-57.
You can view some of Dr Natália’s work below and links to her professional profile below.
Research Gate: https://www.researchgate.net/profile/Natalia-Stephanes
Linkedin: https://www.linkedin.com/in/nataliamarceli/
In this brief article, we will discuss the approximate time taken by Terbinafine to work on toenail fungus, which is one of the most common fungal infections. We will also discuss the safe and effective use of Terbinafine for maximum symptom relief and other alternatives available if the medication fails to treat your condition.
How long does it take for Terbinafine to work on toenail fungus?
Terbinafine can typically take anywhere from 6 to 24 weeks to work on toenail fungus (1). However, the exact treatment duration can vary from person to person.
Some individuals may experience faster results, while others may require more extended treatment periods. The severity of the fungal infection plays a crucial role in determining the treatment duration. More severe infections may take longer to clear up completely (1).
Oral Terbinafine is often considered more effective for toenail fungus because it stays in the nails for a longer time, allowing it to target and eradicate the fungus more efficiently. This sustained presence in the nails contributes to better treatment outcomes compared to topical applications alone.
It’s essential to follow your healthcare provider’s instructions and complete the full course of treatment for the best chance of success in treating toenail fungus.
How does Terbinafine work against toenail fungus?
Terbinafine works against toenail fungus by targeting and inhibiting an enzyme called squalene epoxidase, which is essential for the synthesis of ergosterol, a crucial component of the fungal cell membrane (2).
By blocking this enzyme, Terbinafine disrupts the production of ergosterol, weakening the fungal cell walls and leading to their eventual death.
In simpler terms, Terbinafine interferes with the growth and structure of the toenail fungus, making it unable to survive and thrive. As a result, the fungal infection gradually clears up, and new healthy nail growth can take its place (2).
Terbinafine is considered far more effective for toenail fungus compared to other antifungal agents like Itraconazole, Fluconazole and Griseofulvin (3).
Dosage form recommendations of Terbinafine for toenail fungus
Terbinafine for toenail fungus is commonly available in two dosage forms: oral tablets and topical cream.
Oral tablets
These are taken by mouth and are usually prescribed for more severe or widespread toenail fungus infections. The tablets are absorbed into the bloodstream, allowing Terbinafine to reach the infected nails through the blood supply.
Oral tablets are effective as the medication stays in your nails for a longer period, helping to treat the infection more efficiently.
The recommended dosage for onychomycosis (toenail fungus) in adults is 250 mg once a day. The typical treatment duration with oral tablets is 12 weeks (4). However, in some cases, your healthcare provider may adjust the dosage or treatment duration based on individual factors.
Topical cream
The topical cream is applied directly to the affected toenails and the surrounding skin. It is typically recommended for mild to moderate toenail fungus infections or as a maintenance treatment after using oral tablets.
While topical creams are convenient to apply, they may not penetrate as deeply into the nail bed as oral tablets.
What are the common side effects of Terbinafine when used for toenail fungus?
Terbinafine, although it is well-tolerated, can cause some side effects when used for toenail fungus or any other reason. These include (5):
- Headache
- Itching
- Changes in mood (feeling sad, worthless, restless, or other mood changes)
- Loss of energy or interest in daily activities
- Diarrhoea
- Indigestion
- Sleep disturbances
Terbinafine may also cause some less common or rare side effects, including: (5)
- Loss of appetite
- Extreme tiredness
- Pain in the right upper part of the stomach
- Dark urine
- Pale stools
- Yellowing of the skin or eyes
- Severe skin rash that keeps getting worse
- Fever, sore throat, and other signs of infection
- Swelling of the face, throat, tongue, lips, and eyes
- Difficulty swallowing or breathing
- Hoarseness
- Swollen lymph glands
- Peeling, blistering, or shedding skin
These side effects can vary from person to person, and not every individual experiences these side effects. However, one should get immediate medical attention if an allergic reaction occurs.
What are the alternatives to Terbinafine for toenail fungus?
If you cannot use Terbinafine for toenail fungus due to reasons like allergic reactions or other contraindications, there are alternative antifungal options that your doctor may explore. These alternatives include medications like Itraconazole, Fluconazole, Griseofulvin, etc (6).
However, it is crucial to consult your healthcare provider before starting any alternative treatment, as they will consider your specific medical history and conditions to determine the most suitable option for you.
Conclusion
In this article, we have discussed the time taken by Terbinafine to work for toenail fungus. We have also discussed the clinical significance of Terbinafine in the treatment of toenail fungal infections and some alternative options if the medication fails to work effectively.
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References
1.-
National Health Service. How and when to take or use terbinafine. [Internet]. London: National Health Service (NHS); [Cited 2023 Aug 1]. Available from: https://www.nhs.uk/medicines/terbinafine/how-and-when-to-take-or-use-terbinafine/
2.-
Maxfield L, Preuss CV, Bermudez R. Terbinafine. 2023 May 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31424802. https://www.ncbi.nlm.nih.gov/books/NBK545218
3.-
Darkes MJ, Scott LJ, Goa KL. Terbinafine: a review of its use in onychomycosis in adults. Am J Clin Dermatol. 2003;4(1):39-65. doi: 10.2165/00128071-200304010-00005. PMID: 12477372. https://pubmed.ncbi.nlm.nih.gov/12477372/
4.-
Tausch I, Bräutigam M, Weidinger G, Jones TC. Evaluation of 6 weeks treatment of terbinafine in tinea unguium in a double-blind trial comparing 6 and 12 weeks therapy. The Lagos V Study Group. Br J Dermatol. 1997 May;136(5):737-42. PMID: 9205509. https://pubmed.ncbi.nlm.nih.gov/9205509/
5.-
National Library of Medicine. Terbinafine: MedlinePlus Drug Information [Internet]. Bethesda (MD): U.S. National Library of Medicine; 2022 [cited 2023 Aug 1]. Available from: https://medlineplus.gov/druginfo/meds/a699061.html
6.-
Gupta AK, Stec N. Recent advances in therapies for onychomycosis and its management. F1000Res. 2019 Jun 25;8:F1000 Faculty Rev-968. doi: 10.12688/f1000research.18646.1. PMID: 31297182; PMCID: PMC6600855. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600855/
