테르비나핀, 손발톱 무좀, Terbinafine, onychomycosis

손발톱 무좀에 1차적으로 권고하는 경구 약제는 테르비나핀(terbinafine, 라미실정 125 mg)입니다.

손톱 무좀의 경우에는 하루 250 mg, qd, 6주

발톱 무좀의 경우에는 하루 250 mg, qd, 12주

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지속적 요법으로 사용하고 플루코나졸이나 이트라코나졸처럼 pulse dosing을 권고하지는 않습니다. 일부 임상의들이 테르비나핀의 pulse 요법을 부작용 감소, 비용 절감, 순응도 개선 목적으로 사용했지만 임상 시험에서 이득이 입증되지는 않았습니다.

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Pulse regimens vary in dose, duration, and frequency of drug administration. A 2013 meta-analysis of studies that compared cure rates for continuous treatment with one of four pulsed treatment regimens found that overall, continuous treatment was superior to pulsed treatment for achieving mycologic cure and had similar efficacy as pulsed treatment for achieving complete (both clinical and mycologic) cure. Of the pulsed regimens evaluated, only a two-pulse regimen consisting of 250 mg per day for four weeks, then four weeks off, then an additional four weeks of treatment yielded mycologic cure rates similar to continuous therapy.

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지속적 요법으로 테르비나핀을 복용 중인 환자에서는 AST/ALT 수치를 처음 시작시와 6주를 초과하여 지속하는 경우 6주째에 검사를 시행해야 합니다. 그러나 처음 검사 이후에 AST/ALT 수치 검사를 반복할 필요성이 있는지는 의문이었습니다.

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A retrospective study that included laboratory data from 4985 children and adults treated with terbinafine or griseofulvin for dermatophyte infections found rates of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevations, anemia, lymphopenia, and neutropenia during 4309 courses of terbinafine therapy were low and similar to baseline rates. Another retrospective study found a low incidence of laboratory abnormalities among 144 children treated with terbinafine for onychomycosis who had laboratory monitoring. Only six children developed liver function test or complete blood count abnormalities during treatment, all of which were grade 1 events. These findings suggest transaminase monitoring after baseline testing may be unnecessary in patients without underlying hepatic diseases.

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REF. UpToDate 2020.02.20