ํ ๋ฅด๋น๋ํ
ํ ๋ฅด๋น๋ํ์ ๊ฒฝ๊ตฌ ๋ฐ ๊ตญ์ ์ ์ ๋ก ์ ๊ณต๋๋ ํฉ์ฑ **์๋ฆด์๋ฏผ๊ณ ํญ์ง๊ท ์ **์ ๋๋ค. **์ฃผ์ ์์ ํน์ง:** * **์ฃผ์ ์ฉ๋:** ๊ฐ์ ๊ณ ์์ด์ ํผ๋ถ์ฌ์๊ท ๊ฐ์ผ(์: ์ํฌ์๊ท , ๋ฐฑ์ ๊ท )์ ๋งค์ฐ ํจ๊ณผ์ ์ ๋๋ค. ๋ํ ์กฐ๋ฅ์ ์ ์ ์ฑ ์ง๊ท ๊ฐ์ผ(์: ์์คํ๋ฅด๊ธธ๋ฃจ์ค์ฆ) ์น๋ฃ์๋ ์ฌ์ฉ๋ฉ๋๋ค. * **์ฐ์ํ ์ํธ์์ฉ ํ๋กํ์ผ:** ์์กธ๊ณ ํญ์ง๊ท ์ (์: ์ผํ ์ฝ๋์กธ, ์ดํธ๋ผ์ฝ๋์กธ)์ ๋ฌ๋ฆฌ ํ ๋ฅด๋น๋ํ์ ์ฃผ์ ์์ฉ ๊ธฐ์ ์ ์ํ ํฌ๋กฌ P-450 ํจ์๊ณ์ ์์กดํ์ง ์์ผ๋ฏ๋ก ์ฝ๋ฌผ ์ํธ์์ฉ์ด ํ์ ํ ์ ๊ณ ํฌ์ ๋ฅ์ ํ ์คํ ์คํ ๋ก ์ด๋ ์ฝ๋ฅดํฐ์ ํฉ์ฑ์ ์ต์ ํ์ง ์์ต๋๋ค. * **์ฝ๋ฆฌํ์ ํน์ง:** ํ ๋ฅด๋น๋ํ์ ์ง์ฉ์ฑ์ด ๋๊ณ **์น๊ฐ์ง์ฑ(keratinophilic)**์ ๋ฑ๋๋ค. ํผ๋ถ, ํผ์ง, ๋ชจ๋ญ์ ๊ด๋ฒ์ํ๊ฒ ๋ถํฌํ๋ฉฐ, ์น๋ฃ๋ฅผ ์ค๋จํ ํ์๋ ์์ฃผ ๋์ ์ด๋ค ์กฐ์ง์์ ์น๋ฃ ๋๋๋ฅผ ์ ์งํฉ๋๋ค(์ด๋ก ์ธํด ํ์ค ์๋ฒ์ด ๊ฐ๋ฅํจ). * **๋ด์ฝ์ฑ:** ์์ํ ํ์์์ ์ผ๋ฐ์ ์ผ๋ก ๋ด์ฝ์ฑ์ด ๋งค์ฐ ์ฐ์ํ๋ฉฐ, ๊ฐ์ฅ ํํ๊ฒ ๋ณด๊ณ ๋๋ ๋ถ์์ฉ์ ๊ฐ๋ฒผ์ด ์์ฅ๊ด ์ฅ์ (๊ตฌํ )์ ๋๋ค.
์์ฉ ๊ธฐ์ : Terbinafine exerts its antifungal activity by interfering with fungal sterol biosynthesis at an early stage. * It selectively and reversibly inhibits the fungal enzyme **squalene monooxygenase** (also known as squalene 2,3-epoxidase). * This blockade prevents the conversion of squalene to lanosterol โ leading to a profound deficiency of **ergosterol** (a critical component of the fungal cell membrane). * Simultaneously, the inhibition causes an intracellular **accumulation of squalene**, which is directly toxic to the fungal cell, leading to rapid cell death. This dual mechanism makes terbinafine primarily **fungicidal** against dermatophytes, though it may only be **fungistatic** against certain yeasts like *Candida spp.*
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Dermatophytic infections (Pulse therapy) ยท 20 mg/kg ยท PO ยท q24h ยท 7 days on, then 21 days off ยท Maintained terbinafine concentrations in hair above therapeutic levels. Higher doses (40 mg/kg) or continuous administration caused emesis and elevated hepatic enzymes.
- Dermatophytic infections ยท 10-20 mg/kg ยท PO ยท q24h ยท Appears to be better tolerated than either ketoconazole or itraconazole.
- Dermatophytic infections (when other drugs are not tolerated) ยท 25 mg/kg ยท PO ยท q24h
- Dermatophyte (M. canis) mycetomas ยท 26-31 mg/kg ยท PO ยท q24h ยท 12-14 weeks ยท Achieved clinical and mycological cure in a case report of two cats.
- Cryptococcal infections (azole-resistant) ยท 10 mg/kg ยท PO ยท q24h ยท Life-long ยท Can rectify clinical signs, though cats with CNS cryptococcus usually require treatment for life.
- Antifungal (Systemic/Dermatophytosis) ยท 20-40 mg/kg ยท PO ยท q24h ยท Not specified
- Localized Malassezia infections ยท Apply a thin layer ยท topical ยท Not specified ยท Not specified ยท Use 1% cream.
- Avian mycotic infections (Aspergillus) ยท 10-15 mg/kg ยท PO ยท q12-24h ยท Appears to be well tolerated by a number of avian species.
- Avian mycotic infections (Aspergillus) ยท 1 mg/mL aqueous solution ยท Nebulization ยท Not specified
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Known hypersensitivity to terbinafine
- Active or chronic liver disease
- Significantly impaired renal function
- Perforated eardrum (for ear gel administration)
- Generalized demodicosis (topical or systemic use)
- Pregnant animals
- Breeding animals
์ด์๋ฐ์
- Vomiting
- Inappetence
- Diarrhea
- Lethargy (reported in cats)
- Hepatotoxicity / Liver failure (very rare, reported in humans)
- Neutropenia (very rare, reported in humans)
- Serious skin reactions like Toxic Epidermal Necrolysis or Stevens-Johnson syndrome (very rare, reported in humans)
- Diarrhoea
- Increased liver enzymes
- Pruritus (cats)
- Topical irritation (due to alcohol content in topical solutions)
- Transient deafness or impaired hearing (in elderly dogs after administration of ear gel)
์ฝ๋ฌผ ์ํธ์์ฉ
- Cyclosporine ยท Terbinafine may increase the elimination and decrease the efficacy of cyclosporine.
- Rifampin ยท May increase terbinafine clearance, potentially requiring higher terbinafine doses. ยท moderate
- Beta-blockers ยท Terbinafine shares the CYP2D6 metabolic pathway and could theoretically alter the metabolism of beta-blockers.
- MAO Inhibitors (e.g., amitraz, selegiline) ยท Terbinafine shares the CYP2D6 metabolic pathway and could theoretically alter the metabolism of MAOIs.
- SSRIs (e.g., fluoxetine) ยท Terbinafine shares the CYP2D6 metabolic pathway and could theoretically alter the metabolism of SSRIs.
- Tricyclic Antidepressants ยท Terbinafine shares the CYP2D6 metabolic pathway and could theoretically alter the metabolism of TCAs.
- Cimetidine ยท May decrease the clearance of terbinafine, potentially increasing plasma concentrations (Clinical Pearl) ยท moderate
๋ชจ๋ํฐ๋ง
- Clinical efficacy (resolution of fungal lesions)
- Baseline liver enzymes prior to therapy
- Periodic liver enzyme monitoring as needed, especially during long-term treatment
- CBC (baseline and periodic)
- Liver function tests (ALT, AST, Bilirubin)
- Renal function tests
- Clinical response (skin scrapings, fungal cultures)
๊ณผ์ฉ๋
There is limited information regarding acute toxicity in veterinary species. In humans, acute ingestions of up to 5 grams have been reported without serious adverse effects. Treatment of massive overdose should be supportive and symptomatic.
VetSheet ์ฝ๋ฌผ ๋ ํผ๋ฐ์ค๋ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์์ฌ๊ฒฐ์ ๋ณด์กฐ ๋๊ตฌ์ด๋ฉฐ, ์ ๋ฌธ์ ํ๋จ์ด๋ ์ ์กฐ์ฌ์ ์ต์ ๋ผ๋ฒจ์ ๋์ ํ์ง ์์ต๋๋ค.