Allylamines Azoles Griseofulvin





Medication Dosage Form Dosing Other
Terbinafine

(Lamisil®)
Tablet
  • 250 mg ($)

Granules
  • 125 mg/packet
  • 187.5 mg/packet

Cream, OTC
  • 1% cream ($)

Spray, OTC
  • 1% spray ($)
Pediatric (≥ 2 years)
  • Tinea capitis
    • Terbinafine tablets
    • NOTE: Tablet dosing based on one study [PubMed 12195561]
      • Weight 10 - 20 kg - 62.5 mg daily for 4 weeks
      • Weight 20 - 40 kg - 125 mg daily for 4 weeks
      • Weight > 40 kg - 250 mg daily for 4 weeks ($)
    • Terbinafine granules
    • NOTE: Terbinafine granules are FDA-approved for children ≥ 4 years old
      • Weight < 25 kg - 125 mg daily for 6 weeks
      • Weight 25 - 35 kg - 187.5 mg daily for 6 weeks
      • Weight > 35 kg - 250 mg daily for 6 weeks (PI)
  • Tinea corporis, Tinea pedis, Tinea cruris, Tinea manuum (Extensive and/or resistant cases)
    • Terbinafine tablets
    • NOTE: Tablet dosing based on study in children ≥ 2 years old with tinea capitis [PubMed 12195561]
      • Weight 10 - 20 kg - 62.5 mg daily for 2 - 4 weeks
      • Weight 20 - 40 kg - 125 mg daily for 2 - 4 weeks
      • Weight > 40 kg - 250 mg daily for 2 - 4 weeks ($)
  • Tinea versicolor - topical terbinafine applied twice daily for one week (CTE)
    NOTE: Oral terbinafine is not effective for tinea versicolor

Adults
  • May take without regard to food
  • Terbinafine granules are FDA-approved in children ≥ 4 years. Terbinafine tablets have been used in children as young as 2 years - (See PubMed 12195561)
  • Terbinafine is a Moderate CYP2D6 inhibitor
  • May cause taste and smell disturbance
  • Manufacturer recommends pretreatment transaminases (AST, ALT). If normal, then recheck if patient develops clinical signs of liver disease (persistent nausea, jaundice, dark urine, abdominal pain, etc.)
  • Kidney disease - CrCl ≤ 50 ml/min - clearance decreased by 50%. Manufacturer makes no specific dosage recommendations.




Medication Dosage Form Dosing Other
Fluconazole

(Diflucan®)
Suspension
  • 50 mg/5 ml ($)
  • 200 mg/5 ml ($)

Tablet
  • 50 mg ($)
  • 100 mg ($)
  • 150 mg ($)
  • 200 mg ($)
Pediatric

Adults
  • May take without regard to food
  • Fluconazole has many drug interactions
  • Fluconazole is a Strong CYP2C9 inhibitor
  • Fluconazole is a Moderate CYP3A4 inhibitor
  • Kidney disease
    • CrCl ≤ 50 ml/min - give half of recommended dose
    • Regular dialysis - give full dose after each dialysis; on non-dialysis days give half recommended dose

Studies
  • Oral fluconazole during pregnancy and risk of spontaneous abortion and stillbirth (JAMA 2016) - cohort study found a significant increase in risk of spontaneous abortion in women exposed to oral fluconazole when compared to unexposed women and women exposed to topical azoles. [PubMed abstract]
Itraconazole

(Sporanox®)
Capsule
  • 100 mg ($$-$$$$)

Tablet
  • 200 mg ($$$$)

Solution
  • 10 mg/ml ($$$$)
Pediatric (infants)
Pediatric (≥ 1 year)
  • Tinea capitis
    • 5 mg/kg once daily for 2 - 4 weeks
    • Alternative:
      • Weight < 20 kg - 50 mg once daily for 4 weeks
      • Weight > 20 kg - 100 mg once daily for 4 weeks
      • Based on PubMed 11069511

Adults
  • Take with a full meal
  • Itraconazole is contraindicated in patients with heart failure because of negative inotropic effects
  • Itraconazole has many drug interactions
  • Itraconazole is a Strong CYP3A4 inhibitor
  • Itraconazole is a P-glycoprotein inhibitor
  • Kidney disease - Use caution. Manufacturer makes no specific recommendation.




Medication Dosage Form Dosing Other
Griseofulvin
microsize and
ultramicrosize

(Grifulvin V®)
(Gris-Peg®)
Microsize   

Tablet, Grifulvin V®
  • 500 mg ($$-$$$$)
  • 250 mg

Suspension
  • 125 mg/5 ml ($-$$)

Ultramicrosize   

Tablet, Gris-Peg®
  • 125 mg ($$$-$$$$)
  • 250 mg ($$$-$$$$)
Pediatric (Infants)
NOTE: Dosing in infants is based on small case studies [PubMed 22468173]
  • Tinea capitis
    • Griseofulvin microsize
      • 15 mg/kg once daily for 45 - 60 days
    • Griseofulvin ultramicrosize
      • 10 mg/kg once daily for 30 - 60 days

Pediatric
  • Tinea capitis
    • Griseofulvin microsize - 20 - 25 mg/kg once daily for 6 - 8 weeks (CTE)
    • Griseofulvin ultramicrosize - 10 - 15 mg/kg once daily for 6 - 8 weeks (CTE)
  • Tinea corporis
    • Griseofulvin microsize - 10 mg/kg once daily (max 500 mg/day) for 2 - 4 weeks (PI)
    • Griseofulvin ultramicrosize - 7.25 mg/kg once daily (max 375 mg/day) for 2 - 4 weeks (PI)
  • Tinea pedis
    • Griseofulvin microsize - 10 mg/kg once daily (max 500 mg/day) for 4 - 8 weeks (PI)
    • Griseofulvin ultramicrosize - 7.25 mg/kg once daily (max 375 mg/day) for 4 - 8 weeks (PI)

Adults
  • Tinea capitis
    • Griseofulvin microsize - 500 mg once daily for 6 - 8 weeks (CTE)
    • Griseofulvin ultramicrosize - 375 mg once daily for 6 - 8 weeks (CTE)
  • Tinea corporis
    • Griseofulvin microsize - 500 mg once daily for 2 - 4 weeks (PI)
    • Griseofulvin ultramicrosize - 375 mg once daily for 2 - 4 weeks (PI)
  • Tinea pedis
    • Griseofulvin microsize - 500 mg once daily for 4 - 8 weeks (PI)
    • Griseofulvin ultramicrosize - 375 mg twice daily for 4 - 8 weeks (PI)
  • Onychomycosis - toenails
    • Griseofulvin microsize - 500 mg once daily for 6 months (PI)
    • Griseofulvin ultramicrosize - 375 mg twice daily for 6 months (PI)
  • Onychomycosis - fingernails
    • Griseofulvin microsize - 500 mg once daily for 4 months (PI)
    • Griseofulvin ultramicrosize - 375 mg twice daily for 4 months (PI)
  • May take without regard to food
  • Gastrointestinal upset is common
  • May cause photosensitivity. Limit sun exposure, use sunscreen.
  • Lab monitoring (CBC, ALT, AST) during griseofulvin treatment does not appear to be necessary during shorter courses of therapy (≤ 8 weeks) in healthy patients
  • Kidney disease - Manufacturer makes no specific dosage recommendations