Terbinafine is effective and safe for the treatment of onychomycosis. Terbinafine is an allylamine, which inhibits squalene epoxidase, resulting in an accumulation of squalene and a deficiency of ergosterol. The accumulation of squalene may be associated with fungicidal action.176 In one study the clinical relapse rate was recorded in 11% of patients when followed up for up to 96 weeks from the start of therapy.33 A substantial number of high-quality studies demonstrate the effectiveness of continuous terbinafine in the treatment of toenail onychomycosis, some of which have stated that this may be the most effective agent available for this indication.177,178
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