特比萘芬
Terbinafine
Terbinafine Hydrochloride
別名: Lamisil · Terbinex · Alamil · Daskil · Daskyl · DesenexMax · Finex · Maditez · Micosil · Terekol · Osurnia · Terbinafine hydrochloride · Terbinafinum
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Dermatophytic infections | 10-20 mg/kg | PO | q24h | — | 🌎 NA |
| Dermatophytic infections (when other drugs are not tolerated) | 25 mg/kg | PO | q24h | — | 🌎 NA |
| Adjunctive treatment of nasal Aspergillus infections (if cribriform plate is penetrated) | 5-10 mg/kg | PO | q12h | 3-6 months | 🌎 NA |
| Pythiosis (where advanced disease precludes complete surgical excision) | 10 mg/kg | PO | q24h | — | 🌎 NA |
| Lagendiosis (where disease precludes complete surgical excision) | 5-10 mg/kg | PO | q24h | — | 🌎 NA |
| Antifungal (Systemic/Dermatophytosis) | 20-40 mg/kg | PO | q24h | Not specified | 🌍 EU |
| Localized Malassezia infections | Apply a thin layer | topical | Not specified | Not specified | 🌍 EU |
| Acute otitis externa (S. pseudintermedius, M. pachydermatis) | 1 tube per infected ear | topical | Repeat after 7 days | 2 doses total | 🌍 EU |
- Dermatophytic infections: Appears to be better tolerated than either ketoconazole or itraconazole.
- Adjunctive treatment of nasal Aspergillus infections (if cribriform plate is penetrated): Used with topical therapy.
- Pythiosis (where advanced disease precludes complete surgical excision): Given concurrently with itraconazole (10 mg/kg PO twice daily).
- Lagendiosis (where disease precludes complete surgical excision): Given concurrently with itraconazole (10 mg/kg PO q24h) and repeated aggressive surgical resection.
- Antifungal (Systemic/Dermatophytosis): Doses greater than 30 mg/kg may be required to reach therapeutic levels in the skin of dogs.
- Localized Malassezia infections: Use 1% cream.
- Acute otitis externa (S. pseudintermedius, M. pachydermatis): Ear gel should be instilled in a cleaned ear. Maximum clinical response may not be seen until 21 days after the second administration.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Dermatophytic infections (Pulse therapy) | 20 mg/kg | PO | q24h | 7 days on, then 21 days off | 🌎 NA |
| Dermatophytic infections | 10-20 mg/kg | PO | q24h | — | 🌎 NA |
| Dermatophytic infections (when other drugs are not tolerated) | 25 mg/kg | PO | q24h | — | 🌎 NA |
| Dermatophyte (M. canis) mycetomas | 26-31 mg/kg | PO | q24h | 12-14 weeks | 🌎 NA |
| Cryptococcal infections (azole-resistant) | 10 mg/kg | PO | q24h | Life-long | 🌎 NA |
| Antifungal (Systemic/Dermatophytosis) | 20-40 mg/kg | PO | q24h | Not specified | 🌍 EU |
| Localized Malassezia infections | Apply a thin layer | topical | Not specified | Not specified | 🌍 EU |
- Dermatophytic infections (Pulse therapy): Maintained terbinafine concentrations in hair above therapeutic levels. Higher doses (40 mg/kg) or continuous administration caused emesis and elevated hepatic enzymes.
- Dermatophytic infections: Appears to be better tolerated than either ketoconazole or itraconazole.
- Dermatophyte (M. canis) mycetomas: Achieved clinical and mycological cure in a case report of two cats.
- Cryptococcal infections (azole-resistant): Can rectify clinical signs, though cats with CNS cryptococcus usually require treatment for life.
- Localized Malassezia infections: Use 1% cream.
鳥
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Avian mycotic infections (Aspergillus) | 10-15 mg/kg | PO | q12-24h | — | 🌎 NA |
| Avian mycotic infections (Aspergillus) | 1 mg/mL aqueous solution | Nebulization | Not specified | — | 🌎 NA |
| Avian mycotic infections | 10-15 mg/kg | PO | q12-24h | — | 🌎 NA |
| Avian mycotic infections | 1 mg/mL | Nebulization | Not specified | — | 🌎 NA |
| Aspergillosis (suspected via leukocytosis and pulmonary nodules) | 10-15 mg/kg | PO | q12h | 4 weeks | 🌎 NA |
- Avian mycotic infections (Aspergillus): Appears to be well tolerated by a number of avian species.
- Avian mycotic infections: Suspend a 250 mg tablet in 25 mL water. Can be used in combination with itraconazole.
- Avian mycotic infections: Mix 500 mg terbinafine plus 1 mL Mucomyst plus 500 mL of distilled water.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
特比萘芬（Terbinafine）是一種合成的丙烯胺類（allylamine）抗黴菌藥物，提供口服與外用劑型。
主要臨床特徵：
- 主要用途： 對犬貓的皮癬菌感染（如小孢癬菌、毛癬菌）非常有效。也可用於治療全身性黴菌感染（如麴菌症），特別是在鳥類中。
- 良好的藥物交互作用安全性： 與唑類（azole）抗黴菌藥（如酮康唑、伊曲康唑）不同，特比萘芬的主要作用機制不依賴細胞色素 P-450 酵素系統，因此藥物交互作用明顯較少，且不會抑制哺乳動物的睪固酮或皮質醇合成。
- 藥理學特點： 特比萘芬具有高度脂溶性與嗜角質性（keratinophilic）。它會廣泛分佈於皮膚、皮脂和毛囊中，即使在停藥後，仍能在這些組織中維持數週的治療濃度（這使得脈衝式療法成為可能）。
- 耐受性： 在獸醫病患中通常具有良好的耐受性，最常見的副作用為輕微的腸胃道不適（嘔吐）。
作用機轉
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 → 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.
安全性與警告
禁忌症
- 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
不良反應
- 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)
注意事項
Hepatic and Renal Warning: Use with extreme caution, if at all, in patients with markedly impaired liver or renal function. Dosage adjustments should be considered if use is unavoidable.
- Pregnancy/Nursing: Definitive safety in pregnancy has not been established (FDA Category B in humans). The manufacturer recommends against use in pregnant or nursing individuals, as the drug concentrates in maternal milk at levels 7 times higher than plasma. Use with caution in nursing veterinary patients.
藥物交互作用
Terbinafine may increase the elimination and decrease the efficacy of cyclosporine.
May increase terbinafine clearance, potentially requiring higher terbinafine doses.
Terbinafine shares the CYP2D6 metabolic pathway and could theoretically alter the metabolism of beta-blockers.
Terbinafine shares the CYP2D6 metabolic pathway and could theoretically alter the metabolism of MAOIs.
Terbinafine shares the CYP2D6 metabolic pathway and could theoretically alter the metabolism of SSRIs.
Terbinafine shares the CYP2D6 metabolic pathway and could theoretically alter the metabolism of TCAs.
May decrease the clearance of terbinafine, potentially increasing plasma concentrations (Clinical Pearl)
監測
- 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)
藥物動力學
半衰期
吸收
In humans, oral absorption is >70%, but first-pass metabolism reduces bioavailability to about 40%. Food may slightly enhance absorption.
分佈
Highly lipophilic and keratinophilic. Distributes extensively into the skin, sebum, and adipose tissue, where it can persist for very long periods. >99% bound to plasma proteins.
代謝
Metabolized in the liver.
排除
Eliminated primarily after hepatic metabolism.
過量
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.
可用產品
劑型
- Oral granules
- Aqueous solution (for nebulization)
- 250 mg oral tablets
- 1% topical cream
- 1% topical gel
- 1% topical spray
- 10 mg ear gel (combination product containing terbinafine, florfenicol, and betamethasone)
獸醫用
- Osurnia ear gel (10 mg terbinafine, florfenicol, betamethasone)
人用標示
- Terbinafine HCl Oral Tablets: 250 mg (Lamisil, Terbinex, generic)
- Terbinafine HCl Oral Granules (film-coated): 125 mg/packet & 187.5 mg/packet (Lamisil)
- Topical cream 1%
- Topical spray 1%
- Lamisil 250 mg tablets
- Lamisil 1% cream
- Lamisil 1% gel
- Lamisil 1% spray
各地核准狀態
POM-V
POM-V, POM
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Store tablets at room temperature in tight containers; protect from light.
飼主須知
寵物主人重要須知
- 給藥方式： 強烈建議將此藥物與食物一起餵食。這有助於增加吸收，並顯著降低胃部不適或嘔吐的機率。
- 治療時間： 黴菌感染（如皮癬菌）需要時間痊癒。您可能需要連續給藥數週或數月。除非獸醫師指示，否則即使寵物看起來已經好轉，也不要提早停藥。
- 注意事項： 特比萘芬通常非常安全。但如果您的寵物出現持續嘔吐、食慾不振、嚴重腹瀉或極度疲倦，請聯繫您的獸醫師。
- 罕見但嚴重的症狀： 在極少數情況下，此藥物可能會影響肝臟。如果您發現寵物的眼睛、牙齦或皮膚變黃（黃疸），請立即聯繫獸醫師。
- 費用： 請注意，完整的療程費用可能較高，不過目前已有學名藥（原廠藥的替代品）可供選擇，價格較為親民。
VetSheet 藥物參考供合格獸醫專業人員作臨床決策輔助之用，不能取代專業判斷或廠商最新仿單。