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Systemic allylamine antifungal used once daily for tinea capitis, onychomycosis, and other dermatophyte infections in children.
First-line systemic therapy for tinea capitis in many U.S. guidelines because of high mycologic cure rates and shorter courses than griseofulvin.
Weight-based once-daily dosing improves adherence compared with multi-dose regimens; counsel families about the full 6-week duration.
Hepatotoxicity is rare but serious. Obtain baseline liver enzymes if the child has underlying liver disease or requires prolonged therapy and counsel families about signs of liver injury.
Drug interactions occur through CYP2D6 inhibition; review antidepressants, beta-blockers, and ADHD medicines metabolized by this pathway.
Topical agents (creams, sprays) can treat localized tinea corporis or pedis but are inadequate for scalp disease because of follicular involvement.
Terbinafine is fungicidal against dermatophytes and is the preferred systemic agent for Trichophyton-driven tinea capitis.
Once-daily weight-based dosing, excellent keratin penetration, and high cure rates make terbinafine ideal for scalp and nail dermatophyte infections.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Tinea capitis caused by Trichophyton species | Children | Yes | Dose 125 mg daily for 10–20 kg, 187.5 mg for 20–40 kg, and 250 mg >40 kg for 6 weeks; combine with antifungal shampoo to decrease transmission. |
| Onychomycosis | Adolescents | Yes | Treat fingernails for 6 weeks and toenails for 12 weeks; monitor liver enzymes in long courses. |
| Extensive tinea corporis or cruris | Children and adolescents | No | Consider systemic therapy for widespread or refractory disease when topical agents fail. |
| Refractory tinea pedis in pediatrics | Children | No | Short courses can be used under dermatology supervision when recurrent infections persist despite topical therapy. |
FDA-approved primary uses with Level A evidence
Quick selection guides and diagnostic pearls
When to consider other medications
How to explain treatment to families
Terbinafine is generally well tolerated, but treatment courses last several weeks so proactive monitoring helps catch rare hepatic or taste disturbances early.
Gastrointestinal upset, headache, and mild skin rashes are the most common effects. Clinically significant liver injury and taste or smell disturbances are uncommon but important for families to understand.
Nausea, abdominal discomfort, diarrhea
Common • mild
Elevated liver enzymes
Uncommon • moderate
Serious hepatic injury
Rare • severe
Taste disturbance (dysgeusia)
Uncommon • mild to moderate
Smell disturbance (dysosmia)
Rare • moderate
Rash or urticaria
Uncommon • variable
Organized by affected organ systems
How to discuss side effects with families
Management protocols and monitoring
Common concerns and practical guidance
Enhanced administration guidance for pediatric terbinafine therapy.
Tablets may be taken with or without food; if stomach discomfort occurs choose mealtime dosing. Sprinkle oral granules onto a spoonful of soft, non-acidic food (pudding, mashed potatoes) and have the child swallow immediately without chewing. Complete the full course (usually 6 weeks for tinea capitis) even when the rash improves early.
Keep a dosing log for long regimens. If the child struggles with tablet swallowing, ask about scored halves or compounded suspensions. Baseline and, when clinically indicated, follow-up liver enzymes are recommended for prolonged therapy.
Emergency contact: Seek urgent care for yellowing of the skin or eyes, dark urine, rash with blistering, or swelling of the face or throat.
With consistent dosing and monitoring, terbinafine clears stubborn scalp infections and nail disease safely. Reach out to your care team with any questions during the several-week course.
Different formulations and concentrations
Safe preparation and measuring techniques
Tailored approaches for different ages
Solutions for common challenges
Storage guidelines and safety tips
Expert pearls and evidence-based tips
Terbinafine is an allylamine antifungal that is fungicidal for dermatophytes by collapsing ergosterol synthesis.
Inhibits squalene epoxidase, leading to intracellular squalene accumulation and defective fungal cell membranes.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Clinical pearls to optimize pediatric terbinafine therapy.
Core insights every provider should know
Recent updates that change how we practice
Organized by dosing, administration, and safety
How to explain treatments to families
Real-world cases with evidence-based approaches
Key numbers, algorithms, and decision tools
Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Terbinafine and monitor your child's response to treatment.
Most courses last 6 weeks. Some dermatologists extend to 8 weeks if there is slow clinical response or if Microsporum species are suspected.
Baseline liver enzymes are recommended in children with preexisting liver disease or when therapy will extend beyond 6 weeks. Call immediately for symptoms of liver injury such as jaundice or dark urine.
Tablets are scored and may be split or crushed and mixed with soft food to help younger children swallow, but ensure the full dose is taken and rinse the mouth afterward.