Lamisil
1. NAME OF THE MEDICINAL PRODUCT
Lamisil 1% cutaneous spray, solution.
2. QUALITATIVE AND QUANTITATIVE COMPOSITION
Active substance: 10 mg terbinafine hydrochloride per 1 g spray (1%w/w).
Excipient(s) with known effect: propylene glycol (E1520) (50mg/g).
For the full list of excipients, see section 6.1.
3. PHARMACEUTICAL form
Cutaneous spray, solution.
Clear, colourless to faintly yellow liquid.
4. Clinical particulars
4.1 Therapeutic indications
Lamisil spray is indicated in the treatment of fungal infections of the skin caused by dermatophytes and pityriasis (tinea) versicolor in adults (see section 4.4)
4.2 Posology and method of administration
Cutaneous use
Posology
Adults
Lamisil spray is applied once or twice daily, depending on the indication.
Duration and frequency of treatment:
|
Interdigital type tinea pedis: |
Once a day for 1 week |
|
Tinea corporis, cruris: |
Once a day for 1 week |
|
Pityriasis versicolor: |
Twice a day for 1 week |
Relief of clinical symptoms usually occurs within a few days. Irregular use or premature discontinuation of treatment carries the risk of recurrence.
Method of administration
The affected area should be cleaned and dried thoroughly before the application of Lamisil Spray. A sufficient amount of spray solution should be applied to wet the treatment area(s) thoroughly, and to cover the affected skin and surrounding area.
Dosing in special populations:
Pediatric population
Lamisil sprayis not recommended for use in children due to insufficient data on safety and efficacy.
Elderly patients
There is no evidence to suggest that elderly patients require different dosages or experience side effects different from those in younger patients.
4.3 Contraindications
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
4.4 Special warnings and precautions for use
Lamisil spray should be used with caution in patients with lesions where alcohol could be irritating.It should not be used on the face.
Lamisil spray is for external use only. It may be irritating to the eyes.
In case of accidental contact with the eyes, rinse eyes thoroughly with running water.
Lamisil spray should be kept out of the reach of children.
In case of accidental inhalation, consult a physician if any symptoms develop or persist.
Information concerning excipients
Lamisil spray contains propylene glycol, which may cause skin irritation.
4.5 Interaction with other medicinal products and other forms of interaction
No drug interactions are known with Lamisil spray.
4.6 Fertility, pregnancy and lactation
Pregnancy
There is no clinical experience with terbinafine in pregnant women. Foetal toxicity studies in animals suggest no adverse effects (see section 5.3).
Lamisil spray should not be used during pregnancy unless clearly necessary.
Breast-feeding
Terbinafine is excreted in breast milk. Lamisil spray should not be used during breast-feeding.
In addition, infants must not be allowed to come into contact with any treated skin, including the breast.
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 spray has no or negligible influence on the ability to drive and use machines.
Undesirable effects
Summary of the safety profile
Local symptoms such as pruritus, skin exfoliation, application site pain, application site irritation, pigmentation disorder, skin burning sensation, erythema, scab, etc.may occur at the site of application. These harmless symptoms must be distinguished from hypersensitivityreactions incl. rash, which are reported in sporadic cases and require discontinuation of therapy. In case of accidental contact with the eyes terbinafine may be irritating to the eyes. In rare cases the underlying fungal infection may be aggravated.
Tabulated list of adverse reactions
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.
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|
System Organ Class (SOC) Frequency |
Adverse Reaction |
|
|
Immune system disorders Not known |
Hypersensitivity* |
|
|
Eye disorders Rare |
Eye irritation |
|
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Skin and subcutaneous tissue disorders Common Uncommon
Rare Unknown |
Skin exfoliation, pruritus Skin lesion, scab, skin disorder, pigmentation disorder, erythema, skin burning sensation Dry skin, dermatitis contact, eczema Rash* |
|
General disorders and administration site conditions Uncommon
Rare |
Pain, application site pain, application site irritation Condition aggravated |
|
*: Based on post-marketing experience
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 the national reporting system listed in Appendix V.
4.9 Overdose
The low systemic absorption of topical terbinafine spray renders overdosage extremely unlikely.
Accidental ingestion of the contents of one 30 ml bottle of Lamisil spray, which contains 300 mg terbinafine hydrochloride, is comparable to one Lamisil 250 mg tablet (adult oral unit dose).
Should a larger amount of Lamisil spraybe 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.
In case of accidental oral ingestion, the alcohol content (28.87% v/v) of Lamisil spray has to be considered.
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. PHARMACOLOGICAL PROPERTIES
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 and moulds. 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 P450 system. Terbinafine does not influence the metabolism of hormones or other substances.
5.2 Pharmacokinetic properties
Less than 5% of the dose is absorbed after topical application to humans; systemic exposure is thus very slight.
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 tumours 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. PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Purified water
Ethanol 96%
Propylene glycol (E1520)
Macrogol cetostearyl ether
6.2 Incompatibilities
Not applicable.
6.3 Shelf life
3 years.
12 weeks after first opening.
6.4 Special precautions for storage
Do not store above 30C. Do not refrigerate or freeze.
6.5 Nature and contents of container
Lamisil spray is available in 15 and 30 ml, white round HDPE bottles with a crimped mouth and spray pump.
6.6 Special precautions for disposal and other handling
For manipulation of the spray pump the bottle can be held in the upright or inverted position.
When using the spray for the first time, the patient will need to depress the actuator a few times (usually up to 3 actuations) before the solution is dispensed.
7. MARKETING AUTHORISATION HOLDER
<[To be completed nationally]>
8. MARKETING AUTHORISATION NUMBER(S)
<[To be completed nationally]>
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
Date of first authorisation: <{DD/MM/YYYY}> <{DD month YYYY}>
Date of last renewal: 9 May 2007
<[To be completed nationally]>
10. DATE OF REVISION OF THE TEXT
3 March 2015