Противогрибковый препарат. Тербинафин представляет собой аллиламиновое производное. Обладает широким спектром противогрибкового действия. В терапевтических концентрациях тербинафин оказывает фунгицидное действие в отношении: дерматофитов - Trichophyton, Microsporum, Epidermophyton; дрожжеподобных грибов: Рода Candida: Candida albicans; некоторых диморфных грибов. Pityrosporum orbiculare: Malassezia furfur. Активность в отношении дрожжевых грибов, в зависимости от их вида, может быть фунгицидной или фунгистатической. Тербинафин специфически подавляет ранний этап биосинтеза стеринов в клетке гриба за счет ингибирования фермента скваленэпоксидазы в клеточной мембране гриба. Это приводит к дефициту эргостерина и к внутриклеточному накоплению сквалена, что вызывает гибель клетки гриба. Скваленэпоксидаза не относится к системе цитохрома Р450, поэтому тербинафин не оказывает влияния на метаболизм гормонов или других лекарственных препаратов.
Повышенная чувствительность к компонентам препарата; беременность и лактация (грудное вскармливание); детский возраст до 2 лет.
Применение при беременности и в период грудного вскармливания
В связи с тем, что данные о безопасности применения тербинафина у беременных женщин отсутствуют, Тербизил у данной категории пациентов применяют только в случаях, когда ожидаемый положительный эффект превышает потенциальный риск. Тербинафин выделяется с грудным молоком, поэтому применение препарата в период лактации противопоказано.
Способ применения и дозы
Внутрь, после еды. Длительность курса лечения и режим дозирования устанавливаются в индивидуальном порядке и зависят от локализации процесса и тяжести заболевания. Взрослые. Обычная доза - 250 мг/сут. Онихомикозы: продолжительность терапии в среднем 6–12 недель. При поражении ногтей пальцев кистей и стоп (за исключением большого пальца стопы) или у молодых больных длительность лечения может быть менее 12 недель. При инфекции большого пальца стопы обычно достаточно 3-месячного курса лечения. Некоторым больным, у которых снижена скорость роста ногтей, может потребоваться более длительный срок лечения. Грибковые инфекции кожи: продолжительность лечения при межпальцевой, подошвенной или по типу носков локализации инфекции составляет 2–6 недель, при микозах голеней - 2–4 недели, туловища - 2–4 недели; при микозах, вызванных грибами рода Candida, - 2–4 недели; при микозах волосистой части головы, вызванных грибами рода Microsporum, - более 4 недель. Дети. Обычно назначают 125 мг. При массе тела от 20 до 40 кг - 125 мг/сут. При массе тела более 40 кг - 250 мг/сут. Продолжительность лечения микозов волосистой части головы составляет около 4 недель, при заражении Microsporum canis - может быть более длительной. Пожилым больным препарат назначают в тех же дозах, что и взрослым. Пациентам с печеночной и почечной недостаточностью Тербизил назначают в дозе 125 мг в сутки.
Побочное действие
Со стороны пищеварительной системы: часто - ощущение переполнения желудка, потеря аппетита, диспепсия, тошнота, слабо выраженные боли в животе, диарея; редко - нарушения или утрата вкусовых ощущений (восстановление происходит в пределах нескольких недель после прекращения лечения); в отдельных случаях - холестаз, желтуха, гепатит (хотя причинная связь этих нарушений с приемом Тербизила не установлена, в случае развития гепатобилиарной дисфункции лечение препаратом следует отменить). Со стороны системы кроветворения: в отдельных случаях - нейтропения, тромбоцитопения. Аллергические реакции: часто - сыпь, крапивница: в отдельных случаях - синдром Стивенса-Джонсона, токсический эпидермальный некролиз (при развитии прогрессирующей кожной сыпи лечение Тербизилом следует прекратить).
Передозировка
Симптомы: тошнота, рвота , боли в низу живота. Лечение: промывание желудка с последующим применением активированного угля. При необходимости проводят симптоматическую терапию.
Особые указания
Применение при нарушениях функции печени Пациентам с выраженными нарушениями функции печени дозу препарата следует уменьшить вдвое Применение при нарушениях функции почек Пациентам с выраженными нарушениями функции почек ( КК менее 50 мл/мин или концентрация креатинина в сыворотке более 300 мкмоль/л) дозу препарата следует уменьшить вдвое. Следует учитывать, что если в процессе лечения Тербизилом у больного отмечаются нарушения функции печени (слабость, тошнота неясной этиологии, отсутствие аппетита, желтуха, потемнение мочи или осветление кала) препарат следует отменить. Во время лечения необходимо контролировать уровень печеночных трансаминаз. При лечении Тербизилом следует соблюдать общие правила гигиены для предотвращения возможности повторного инфицирования (через белье или обувь). Следует иметь в виду, что нерегулярное применение или преждевременная отмена препарата приводит к рецидиву заболевания.
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