The treatment of fungal nail infections is expensive and long-term. It requires a commitment on the part of the patient to take medicine for several months. Unfortunately, topical preparations do not effectively treat fungal nail infections. The FDA has approved a nail lacquer named ciclopirox (Penlac) for fungal nail infections, but it is seldom effective. It may be an option, however, for people who cannot take oral antifungal medications.
Oral Antifungal Medications
There are 3 effective oral antifungal medications - 2 that are FDA approved for fungal nail infections and one that is not FDA approved specifically for nail infections. All 3 medications have significant side effects and interact with many medications. Anyone taking oral antifungal medications must have periodic labs done to monitor liver and blood cell function. The oral antifungal medications are incorporated into the nail; therefore, they continue to work even after the medication is discontinued. None of the oral antifungals can be taken during pregnancy.
Terbinafine (Lamisil) is FDA approved to treat fungal nail infections, and is 70% to 90% effective when used as prescribed. Terbinafine does interact with a few other medications most notably caffeine and cimetidine. The dosage used is 250 mg once a day for 6 weeks for fingernail infections and 12 weeks for toenail infections.
Itraconazole (Sporanox) is also FDA approved to treat fungal nail infections, and is 70% to 80% effective. Itraconazole interacts with many medications and should be taken with food. Itraconazole can be taken daily or as pulse therapy. The daily dose is 200 mg once a day for 6 weeks for fingernail infections and 12 weeks for toenail infections. The pulse dosing is 200 mg twice a day for one week per month repeated for 2 or 3 months.
Fluconazole (Diflucan) is not FDA approved to treat fungal nail infections, but is an effective oral antifungal medication. The advantage of fluconazole is that it stays in the body for a long time and only needs to be taken weekly. Initial studies show that fluconazole is 72% to 89% effective. The dosage used is 450 mg once a week for 4 to 9 months.
