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Oral Antifungal Medicine for Fungal Nail Infections

Examples

Allylamines

Generic NameBrand Name
terbinafineLamisil

Azoles

Generic NameBrand Name
fluconazoleDiflucan
itraconazoleOnmel, Sporanox

Other oral antifungals

Generic NameBrand Name
griseofulvinGrifulvin V

All of these medicines are by prescription only. Allylamines and azoles are classes of drugs. Their effectiveness and side effects may vary.

Terbinafine tablets are taken once a day for 6 weeks for fungal fingernail infections, and for 12 weeks or longer for fungal toenail infections. Terbinafine tablets can be used according to a pulse dosing schedule. Pulse dosing refers to taking medicine daily for 1 week a month for 2, 3, or 4 months. Some people find it easier to stay with this medicine schedule, and the treatment is likely to be cheaper.

Oral azoles (tablets or capsules) are taken daily for 3 to 18 months, depending on the medicine. Oral azoles can be used according to a weekly pulse dosing schedule. Pulse dosing refers to taking medicine daily for 1 week a month for 2, 3, or 4 months. Some people find it easier to stay with this medicine schedule, and the treatment is likely to be cheaper.

Griseofulvin is taken twice a day until nails are clear of infection. For infections in the fingernails, griseofulvin may be taken for 6 to 8 months. For infections in toenails, griseofulvin may be taken for 12 to 18 months to cure an infection and to prevent reinfection.

How It Works

Allylamines and azoles kill fungi. Griseofulvin prevents the growth of fungi. Killing fungi does not guarantee a normal-looking nail.

Why It Is Used

Oral antifungal medicines are used to treat fungal nail infections. Often the medicine used depends on the type of infection you have.

  • Terbinafine is a medicine for fungal nail infections caused by dermatophytes, including distal subungual onychomycosis and white superficial onychomycosis. Most fungal nail infections are caused by this type of fungus. Terbinafine may also be effective against some molds (nondermatophytes).
  • Itraconazole is a medicine for infections caused by molds and yeast (Candida). It can also be used for dermatophytes.
  • Fluconazole is a medicine for Candida infections and can also be used against dermatophytes. It may be used if you are taking a lot of other medicines.
  • Griseofulvin is more effective against fingernail infections than toenail infections and is rarely used for toenail infections. It is only effective against infections caused by dermatophytes.

How Well It Works

Oral antifungals may cure fungal nail infections. Most research has been on using these medicines for toenail infections.

Oral antifungals to treat fungal nail infections include terbinafine (Lamisil) and itraconazole (Sporanox). Studies comparing these two medicines found that terbinafine cured the infection in 55% of people and itraconazole cured the infection in 26% of people after 16 weeks of treatment.1

Fluconazole (Diflucan)and griseofulvin (Grifulvin V) are used less often. Fluconazole seems to help, but not as much as terbinafine or itraconazole.1 And griseofulvin may work, but there is not enough evidence from studies to say just how well it works.2

Oral antifungal medicines often kill fungi but do not immediately improve the appearance of the nail.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.
  • Shortness of breath and chest pain.

Call your doctor right away if you have:

  • Hives.
  • Symptoms of liver problems, such as:
    • Nausea that doesn't go away, vomiting, or belly pain.
    • Loss of appetite.
    • Fatigue.
    • Yellowing of skin.
    • Urine that is dark.
    • Stools that are pale.
  • Symptoms of heart problems, such as:
    • Shortness of breath at rest, with mild exertion, or when lying flat.
    • Severe swelling of feet, ankles, legs, or abdomen.
    • Weight gain.
    • Fatigue.
    • Coughing up white or pink mucus.
    • Faster-than-usual heart rate.

Common side effects of this medicine include:

  • Headaches.
  • Stomach upset.
  • Itching or skin rashes.
  • Fever.
  • Diarrhea.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

During oral antifungal treatment, your doctor may require blood tests to check your kidney and liver function.

Terbinafine and azoles may cause liver damage or failure, requiring a liver transplant. A small number of deaths after liver failure has been linked to these medicines.

Itraconazole may cause heart failure. Your doctor will talk with you about what signs to watch for when taking this medicine.

Commonly prescribed medicines can increase or decrease terbinafine or azole levels in your body. Also, other medicines can build up in the your blood when taken with terbinafine or an azole. Before you take oral antifungal medicines, let your doctor know what other medicines you are taking.

Oral azoles are best absorbed into the body when taken with cola, orange juice, or food. Some medicines may reduce your body's absorption of azole medicine. These include cimetidine (Tagamet), stomach acid neutralizers, and rifampin (Rifadin).

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Do not use this medicine if you are pregnant, breast-feeding, or planning to get pregnant. If you need to use this medicine, talk to your doctor about how you can prevent pregnancy.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

  1. De Berker D (2009). Fungal nail disease. New England Journal of Medicine, 360(20): 2108–2116.
  2. Ferrari J (2011). Fungal toenail infections, search date March 2011. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.

Credits

By Healthwise Staff
Patrice Burgess, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Last Revised August 15, 2013

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