GlaxoSmithKline Consumer Healthcare (Ireland) Ltd
Summary of Product Characteristics last updated on medicines.ie: 3/10/2016
Lamisil AT Cream
Lamisil AT Cream
Terbafine hydrochloride 1.0% w/w.
Excipients/: Each gram of cream contains 40mg stearyl alcohol and 40mg cetyl alcohol.
For a full list of excipients, see section 6.1
Cream. White smooth or almost smooth, glossy cream
4.1 Therapeutic indications
The treatment of tinea pedis (athelete's foot) and tinea cruris (dhobie itch/jock itch) caused by Trichophton (e.g. T. rubrum, T mentagrophytes, T. verrucosum, T. violaceum) and Epidermophyton floccosum.
4.2 Posology and method of administration
Adults and adolescents over 16 years of age
Lamisil AT Cream is applied once daily.
Duration and frequency of treatment
Duration of treatment is once week for tinea pedis and tinea cruris. Relief of clinical symptoms usually occurs within a few days. Irregular use or premature discontinuation of treatment carries the risk of recurrence. If there are no signs of improvement after two weeks, the diagnosis should be verified by a physician.
Dosing in special populations: Paediatric population
The experience with topical LAMISIL AT Cream in children is still limited and its use in children under 16 years cannot therefore be recommended.
There is no evidence to suggest that elderly patients require different dosages or experience side-effects different to those of younger patients.
Method of Adminstration
For cutaneous use: The affected area should be cleaned and dried thoroughly before application of LAMISIL AT Cream. The cream should be applied to the affected skin and surrounding area in a thin layer and rubbed in lightly. In the case of intertriginous infections (interdigital, intergluteal, inguinal) the application may be covered with a gauze strip, especially at night.
Hypersensitivity to terbinafine or to any of the excipients contained in the cream, listed in section 6.1.
4.4 Special warnings and precautions for use
LAMISIL AT Cream is for external use only. Should be used with caution in patients with lesions where alcohol could be irritating. Should not be used on the face. Contact with the eyes should be avoided. May be irritating to the eyes. In case of accidental contact with the eyes, rinse the eyes thoroughly with running water. Lamisil AT Cream contains cetyl alcohol and stearyl alcohol, which may cause local skin reactions (e.g. contact dermatitis).
4.5 Interaction with other medicinal products and other forms of interaction
There are no known drug interactions with LAMISIL AT Cream.
4.6 Fertility, pregnancy and lactation
Pregnancy Foetal toxicity studies in animals suggest no adverse effects (see section 5.3). There is no clinical experience with LAMISIL AT Cream in pregnant women. LAMISIL AT Cream should not be used during pregnancy, unless clearly necessary. Breastfeeding Terbinafine is excreted in breast milk. Therefore mothers should not use LAMISIL AT Cream whilst breast-feeding. Fertility No effect of terbinafine on fertility have been seen in animal studies (see section 5.3)
4.7 Effects on ability to drive and use machines
Lamisil AT Cream has no influence on the ability to drive and use machines.
4.8 Undesirable effects
Local symptoms such as pruritus, skin exfoliation, application site pain, application site irritation, pigmentation disorder, skin burning sensation, erythema and scab may occur at the site of application.
These minor symptoms must be distinguished from hypersensitivity reactions such as widespread pruritus, rash, bullous eruptions and hives, which are reported in sporadic cases, but require discontinuation.
In case of accidental contact with the eyes terbinafine hydrochloride may be irritating to the eyes. In rare cases the underlying fungal infection may be aggravated.
Adverse reactions are listed below by system organ class and frequency. Frequencies are defined as: very common (≥ 1/10); common (≥ 1/100 to < 1/10); uncommon (≥ 1/1,000 to < 1/100); rare (≥ 1/10,000 to < 1/1,000); very rare (< 1/10,000), or not known (can not to be estimated from available data). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.
Immune system disorders:
Not known: Hypersensitivity
Rare: Eye irritation
Skin and subcutaneous tissue disorders
Common: Skin exfoliation, pruritus Uncommon: Skin lesion, scab, skin disorder, pigmentation disorder, erythema, skin burning sensation Rare: Dry skin, dermatitis contact, eczema Not known: Rash
General disorders and administration site conditions
Uncommon: Pain, application site pain, application site irritation Rare: Condition aggravated
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: email@example.com.
The low systemic absorption of topical terbinafine renders overdosage extremely unlikely.
Accidental ingestion of one 30 g tube of LAMISIL AT Cream, which contains 300 mg terbinafine hydrochloride, is comparable to ingestion of one Lamisil 250 mg tablet (adult oral unit dose).
Should a larger amount of LAMISIL AT Cream be inadvertently ingested, adverse effects similar to those observed with an overdosage of Lamisil tablets are to be expected. These include headache, nausea, epigastric pain and dizziness.
Treatment of Overdose
If accidentally ingested, the recommended treatment of overdosage consists of eliminating the active substance, primarily by the administration of activated charcoal, and giving symptomatic supportive therapy if needed.
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Antifungal for topical use, ATC code: D01A E15
Terbinafine is an allylamine which has a broad spectrum of antifungal activity in fungal infections of the skin caused by dermatophytes such as Trichophyton (e.g. T. rubrum, T. mentagrophytes, T. verrucosum, T. violaceum), Microsporum canis and Epidermophyton floccosum.. At low concentrations terbinafine is fungicidal against dermatophytes, moulds and certain dimorphic fungi. The activity against yeasts is fungicidal (e.g. Pityrosporum orbiculare or Malassezia furfur) or fungistatic, depending on the species.
Terbinafine interferes specifically with fungal sterol biosynthesis at an early step. This leads to a deficiency in ergosterol and to an intracellular accumulation of squalene, resulting in fungal cell death. Terbinafine acts by inhibition of squalene epoxidase in the fungal cell membrane.
The enzyme squalene epoxidase is not linked to the cytochrome P-450 system. Terbinafine does not influence the metabolism of hormones or other drugs.
Terbinafine affords a rapid onset of fungicidal action and long lasting protection. In clinical evaluations most athlete's foot patients given a 1 week course of 1% terbinafine cream obtained both symptomatic relief and negative mycological status; with a low incidence of mycological evidence of relapse or re-infection by three months after start of treatment.
5.2 Pharmacokinetic properties
Less than 5% of the dose is absorbed after topical application to humans; systemic exposure is therefore very slight.
Following 7 days usage of LAMISIL AT Cream, concentrations of terbinafine in excess of those required for fungicidal activity are available in the affected stratum corneum for at least 7 days after treatment cessation.
5.3 Preclinical safety data
In long-term studies (up to 1 year) in rats and dogs no marked toxic effects were seen in either species up to oral doses of about 100 mg/kg a day. At high oral doses, the liver and possibly also the kidneys were identified as potential target organs.
In a two-year oral carcinogenicity study in mice, no neoplastic or other abnormal findings attributable to treatment were made up to doses of 130 (males) and 156 (females) mg/kg a day. In a two-year oral carcinogenicity study in rats at the highest dose level, 69 mg/kg a day, an increased incidence of liver tumors was observed in males. The changes, which may be associated with peroxisome proliferation, have been shown to be species-specific since they were not seen in the carcinogenicity study in mice or in other studies in mice, dogs or monkeys.
During the studies of high dose oral terbinafine in monkeys, refractile irregularities were observed in the retina at the higher doses (non-toxic effect level was 50 mg/kg).
These irregularities were associated with the presence of a terbinafine metabolite in ocular tissue and disappeared after drug discontinuation. They were not associated with histological changes.
A standard battery of in vitro and in vivo genotoxicity tests revealed no evidence of a mutagenic or clastogenic potential for the drug.
No adverse effects on fertility or other reproduction parameters were observed in studies in rats or rabbits
6.1 List of excipients
Sodium hydroxide Benzyl alcohol Sorbitan stearate Cetyl palmitate Cetyl alcohol Stearyl alcohol Polysorbate 60 Isopropyl myristate Purified water.
6.3 Shelf life
Aluminium tube and laminated tube: 3 years.
Polypropylene dispenser: 3 years.
6.4 Special precautions for storage
Do not store above 30°C.
6.5 Nature and contents of container
Aluminium tube with membrane, with an interior coating of phenol-epoxy based lacquer, closed with a polypropylene cap, or laminated tube (low density polyethylene, aluminium, low density polyethylene) with a high density polyethylene shoulder, sealed with an aluminium/ethylene multilayer copolymer peel-off and closed with a polypropylene cap with built-in point to pierce the peel off containing 7 g, 7.5 g, 10 g or 15 g LAMISIL AT.
Not all pack sizes may be marketed.
6.6 Special precautions for disposal and other handling
GlaxoSmithKline Consumer Healthcare (Ireland) Limited,
12 Riverwalk, Citywest Business Campus,
Date of first authorisation: 24 January 2003 Date of last renewal: 31 October 2008