Terbinafine is an antifungal medicine that fights infection. It belongs to a class of drugs called allylamines, and it’s available as a cream, gel, or oral tablet.
Terbinafine is used to treat a variety of fungal infections, including athlete’s foot, ringworm, and nail fungus.
This article will focus on how to use terbinafine safely and effectively in children. Getting the terbinafine dosage pediatric patients need is crucial for getting rid of their infection, and it’s important to balance that with safety.
We’ll cover:
- What conditions terbinafine is used for
- How much terbinafine to give your child
- What side effects to watch out for
- What precautions to take when giving your child terbinafine
What is terbinafine used for in children?
Terbinafine is an antifungal medication that is sometimes prescribed to children for certain fungal infections.
Onychomycosis (Nail Fungus)
Terbinafine is often prescribed for onychomycosis, a fungal infection of the nails. If your child has a nail infection, your doctor may recommend terbinafine. The treatment usually lasts for about six weeks for fingernail infections and twelve weeks for toenail infections.
It’s important to confirm the diagnosis of nail fungus before starting treatment.
Tinea Infections (Ringworm)
Terbinafine can be effective against various types of tinea (ringworm) infections, but itraconazole may be another option. These include:
- Tinea capitis (scalp ringworm)
- Tinea corporis (body ringworm)
- Tinea cruris (groin ringworm)
- Tinea pedis (athlete’s foot)
For tinea capitis, the terbinafine dosage for children over four years old is based on weight:
- Less than 55 pounds (25 kg): 125 mg per day
- 55 to 77 pounds (25-35 kg): 187.5 mg per day
- More than 77 pounds (35 kg): 250 mg per day
Treatment for tinea capitis lasts for six weeks.
Terbinafine may be used “off-label” for other tinea infections, such as athlete’s foot or ringworm of the body or groin. In those cases, the medication is usually prescribed for two to six weeks.
Terbinafine dosage guidelines for kids
Terbinafine is an antifungal medicine used to treat fungal infections such as ringworm, athlete’s foot, and fungal nail infections. It’s available as an oral medication (tablets and granules) and as a topical cream or gel.
It’s important to consult with a doctor or other qualified healthcare professional before giving terbinafine to children because of potential side effects. The information below is for educational purposes only, and it does not substitute for medical advice.
Weight-based dosing
If a doctor prescribes terbinafine tablets or granules for your child, it will be based on their weight. It’s important to get an accurate weight measurement to make sure your child gets the correct dosage.
Here are some typical dosage guidelines:
- Children older than 4 years old and weighing less than 55 pounds (25 kg): 125 mg/day
- Children weighing between 55 pounds and 77 pounds (25-35 kg): 187.5 mg/day
- Children weighing more than 77 pounds (35 kg): 250 mg/day
The duration of treatment depends on the type of infection being treated. For tinea capitis (ringworm of the scalp), it is typically 6 weeks.
How to give oral granules
Terbinafine oral granules should be given with food. You can sprinkle the granules onto a spoonful of food, such as mashed potatoes or pudding. Don’t mix the granules with applesauce or other fruit-based foods, as this can affect how well the medicine works.
Terbinafine granules have a slightly bitter taste, so you may need to find creative ways to make them more palatable for your child. Try mixing the granules with a small amount of flavored yogurt or ice cream.
Topical formulations
Topical terbinafine (cream, lotion, or gel) is generally recommended for children over 12 years old, but ketoconazole cream is another option to consider. For children in this age group, apply a 1% cream, lotion, or gel to the affected area twice daily for 1-4 weeks, or as directed by your doctor.
Precautions and contraindications
Before you begin giving your child terbinafine, there are several things you should know.
Liver function
If your child has active liver disease or chronic liver disease, they should not take terbinafine, and the doctor should check your child’s liver function during treatment.
If your child is taking terbinafine, it’s important to watch for symptoms of liver problems, such as:
- Jaundice (yellowing of the skin or the whites of the eyes)
- Dark urine
- Pale-colored bowel movements
Kidney function
If your child has problems with their kidneys, your doctor may need to adjust the dosage of terbinafine.
When kidney function is reduced (Creatinine Clearance (CrCl) is 50 mL/min or less), terbinafine isn’t cleared from the body as quickly. It’s important for the doctor to monitor kidney function during treatment.
Drug interactions
Some drugs can interact with terbinafine, affecting how it works in the body. For example, rifampicin, a drug used to treat infections, can lower the amount of terbinafine in the blood, making it less effective.
On the other hand, cimetidine, a drug used to reduce stomach acid, can increase the amount of terbinafine in the blood, potentially leading to side effects.
It’s important for the doctor to know all the medications your child is taking, to avoid potential drug interactions.
Hypersensitivity
If your child is hypersensitive or allergic to terbinafine or any of the inactive ingredients in the medication, they should not take it.
If your child is taking terbinafine, watch for signs of an allergic reaction, such as:
- Rash
- Itching
- Swelling
What are the side effects of terbinafine for children?
Like any medication, terbinafine can cause side effects. Most are mild, but it’s important to be aware of the potential for more serious issues.
Common Side Effects
The most common side effects of terbinafine in children are:
- Gastrointestinal Issues: These include headache, loss of appetite, indigestion, nausea, mild abdominal pain, and diarrhea. To manage these, try giving your child terbinafine with food. Make sure they stay hydrated, and consider smaller, more frequent meals.
- Skin Reactions: Rash and hives are also fairly common. For mild skin reactions, talk to your doctor about whether an over-the-counter antihistamine or topical cream might help.
Serious Adverse Effects
While rare, some serious side effects require immediate medical attention:
- Liver Toxicity: Terbinafine can sometimes affect the liver.
- Severe Skin Reactions: In very rare cases, children can develop severe skin reactions like Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN). If your child develops a progressive skin rash, stop giving them terbinafine and contact their doctor immediately.
What kind of monitoring is needed?
Because of the potential for serious side effects, doctors often recommend certain tests during treatment with terbinafine:
- Liver Function Tests: Regular blood tests to check how your child’s liver is working.
- Hematologic Monitoring: Monitoring complete blood counts, as terbinafine can sometimes affect blood cell production.
- Psychiatric Monitoring: Keep a close eye out for any changes in your child’s mood or behavior. Report any concerns to their doctor.
Remember, this information is not a substitute for professional medical advice. Always talk to your doctor about any questions or concerns you have about your child’s medication.
Important things to keep in mind
Here are some things to think about if your child’s doctor suggests terbinafine.
Pregnancy and breastfeeding
If you are pregnant, you should avoid terbinafine unless the potential benefit of the medicine is more important than any potential risk to the fetus.
Terbinafine is present in breast milk, so talk with your doctor about the risks and benefits of continuing to breastfeed while taking the medication.
Immunocompromised patients
If your child’s immune system isn’t working as well as it should, they may be at higher risk of secondary infections while taking terbinafine.
Be sure to watch closely for any signs of a new infection.
Finishing the medicine and follow-up
It’s essential that your child finish the entire course of terbinafine, even if their symptoms start to get better. If they stop taking the medicine too soon, the fungal infection could come back.
Also, be sure to schedule any follow-up appointments with the doctor so they can see how well the medicine is working and check for any side effects.
Sun exposure
Terbinafine can make your child’s skin more sensitive to the sun, so it’s important to take precautions like wearing protective clothing and using sunscreen.
Key Takeaways
Terbinafine is a prescription medication that can treat fungal infections in kids. The dosage depends on the specific fungal infection and the child’s weight. So, follow your doctor’s instructions carefully and watch for side effects. It’s important to keep your pediatrician in the loop if your child is taking terbinafine.
Terbinafine can be a valuable tool in treating fungal infections in children, but it’s not something to take lightly. Only use it under the guidance of a healthcare professional who can monitor your child’s progress and adjust the treatment plan as needed.