Document: Terbinafine Dermapharm cream ENG SmPC change

• Terbinafine Dermapharm cream SmPC
• Terbinafine Dermapharm cream ENG SmPC

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Summary of Product Characteristics

1. NAME OF THE MEDICINAL PRODUCT

Terbinafine Dermapharm, 10 mg/g, cream

2. QUALITATIVE AND QUANTITATIVE COMPOSITION

One gram of cream contains 10 mg of terbinafine hydrochloride.

Excipient with known effect

100 mg of Cetostearyl alcohol/gram cream

For the full list of excipients, see section 6.1.

3. PHARMACEUTICAL FORM

Cream

White cream

4. CLINICAL PARTICULARS

4.1 Therapeutic indications

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.

Yeast infections of the skin, mainly those caused by the genus Candida (e.g. Candida albicans).

Pityriasis (tinea) versicolor due to Pityrosporum orbiculare (Malassezia furfur).

4.2 Posology and method of administration

Method of administration

cutanous use

Adults and adolescents (over 12 years)

Duration and frequency of therapy

Tinea pedis: once daily for one week.

Tinea cruris and tinea corporis: once daily for one week.

Candidosis of the skin: once daily for 1 to 2 weeks.

Pityriasis versicolor: once or twice daily for 2 weeks.

Terbinafine Dermapharm may be applied once or twice daily. The skin must be dry and clean. The cream should be applied to the affected skin and surrounding area in a thin layer and subsequently rubbed in lightly.

Relief of symptoms usually occurs within a few days. Irregular use or premature discontinuation of the therapy increases the risk of renewed occurrence of symptoms. If no signs of improvement can be seen after two weeks, the diagnosis should be verified.

Elderly people

There is no evidence to suggest that elderly patients require different dosages or experience side effects different to those of younger patients.

Children

The application of Terbinafine Dermapharm is not recommended in children under 12 years, since no sufficient data is available for the safety of the application. The experience in children is limited.

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.

Terbinafine Dermapharm 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.

Terbinafine Dermapharm should be kept out of the reach of children.

Information concerning excipients

Terbinafine Dermapharm contains the ingredient cetostearyl alcohol. Cetostearyl alcohol may cause local skin reactions (e.g. contact­ derma­titis).

4.5 Interaction with other medicinal products and other forms of interaction

No drug interactions are known with the topical forms of terbinafine.

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). Terbinafine Dermapharm should not be used during pregnancy unless clearly necessary.

Lactation

Terbinafine is excreted in breast milk. Terbinafine Dermapharm 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 has been seen in animal studies (see section 5.3)

4.7 Effects on ability to drive and use machines

Terbinafine Dermapharm has no influence on the ability to drive and use machines.

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 hypersensitivity reactions 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.

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)

Not known (Frequency cannot be estimated based on the available data.)

Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.

Immune system disorders

Not known Hypersensitivity*

Eye disorders

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

*: 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 renders overdosage extremely unlikely.

Accidental ingestion of one 30 g tube of terbinafine cream, which contains 300 mg terbinafine hydrochloride, is comparable to ingestion of one terbinafine 250 mg tablet (adult oral unit dose).

Should a larger amount of terbinafine cream be inadvertently ingested, adverse effects similar to those observed with an overdosage of terbinafine 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. PHARMACOLOGICAL PROPERTIES

Pharmacotherapeutic group: Other antifungals for topical use

ATC code: D01AE15

Terbinafine, an allylamine, is an antimycotic agent with a broad spectrum of activity. At low concentrations terbinafine is fungicidal against mycel forming fungi (dermatophytes and others) and some dimorphic fungi. Depending on the species it is fungicidal or fungi-static against yeast.

Terbinafine inhibits specifically the sterolsynthesis of the fungus at an early stage. This results in a deficiency in ergosterol and an intracellular accumulation of squalene resulting in fungal cell death.

Terbinafine acts by inhibiting the enzyme squalene epoxidase in the cell membrane of the fungus. This enzyme is not linked to the cytochrome P450 system. As far as is known, terbinafine does not influence the metabolism of other medicinal products or hormones.

After topical application in humans less than 5% of the dose is absorbed; the systemic exposure is therefore very slight.

In non-clinical studies effects were only observed in exposures which were significantly higher than the maximum human exposure after topical administration indicating little relevance to clinical use.

6. PHARMACEUTICAL PARTICULARS

6.1 List of excipients

Purified water

Cetostearyl alcohol

Isopropyl myristate

Cetyl palmitate

Sorbitan stearate

Benzyl alcohol

Polysorbate 60

Sodium hydroxide

6.2 Incompatibilities

Not applicable.

6.3 Shelf life

4 years

After first opening of the tube:

6 months

6.4 Special precautions for storage

This medicinal product does not require any special storage conditions.

6.5 Nature and contents of container

Aluminium tubes with a cap of HDPE

Pack sizes:

15 g cream and

30 g cream

Not all pack sizes may be marketed.

6.6 Special precautions for disposal

No specific requirements.

7. MARKETING AUTHORISATION HOLDER

<To be completed nationally>

8. MARKETING AUTHORISATION NUMBER

<To be completed nationally>

9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION

Date of first authorisation: {DD month YYYY}

Date of latest renewal: {DD month YYYY}

<To be completed nationally>

2016-03-08