wally asked
My doctor prescribed SPORANOX (Itraconazole) for my one bad toenail. i had a bad reaction to it - hives! Since then, no doctor has been willing to prescribe ANY other medication for it. there have got to be other systemic anti-fungals that won't trigger my allergy. What alternatives are there, that I can ask my doctor about?
Answer
There are a variety of anti-fungal medications used for the treatment of toenail infections. Topical anti-fungals such as Jublia (Efinaconazole) and Penlac (ciclopirox) are generally the preferred first line agents due to their relative safety profile. However, their cure rate is significantly less when compared to oral anti-fungal medication.
Systemic (i.e. oral) anti-fungals are more effective than topical products but have safety and drug interaction concerns. Below, we discuss the three most commonly used oral anti-fungal medications (from different medication classes) for toenail infections.
Oral Anti-fungals For Toenail Infections
Lamisil (Terbinafine)
Common Dosage For Toenail Infections
250 mg once daily for 12 weeks or 500 mg once daily dose for one week, every month for three months.
How Well Does It Work
Lamisil has around a 46% cure rate for toenail infections when using the continuous dosage regimen. "Pulse dosing" has cure rate around 28% but may be a safer option.
Additional Information:
Most studies conclude that Lamisil is the most effective medication to cure toenail infections. In addition to a high cure rate, it has lower rates of relapse when compared to the other oral anti-fungal medications. It has relatively few drug interactions but liver function typically needs to be checked at the beginning of therapy and during therapy.
Diflucan (Fluconazole)
Common Dosage For Toenail Infections
150 mg once weekly for six months.
How Well Does It Work
Diflucan has a cure rate around 28% for toenail infections. Unfortunately, Diflucan is associated with a relatively high relapse rate after therapy is complete.
Additional Information:
While Diflucan has more reported drug interactions than Lamisil, the once weekly dosing of the medication makes potential interactions not as clinically significant. Diflucan treated toenail infections tend to have a high relapse rate as the drug does not stay in the nail as long after treatment when compared to Lamisil and Sporanox.
Sporanox (Itraconazole)
Common Dosage For Toenail Infections
200 mg once daily for 12 weeks, or 200 mg for one week each month for three months.
How Well Does It Work
Sporanox has a cure rate around 14% for toenail infections. This cure rate increases to around 23% with the pulse dose regimen.
Additional Information:
Sporanox is generally considered to have the most safety concerns out of the oral anti-fungals (with the exception of ketoconazole). It has a number of major drug intentions, may exacerbate heart conditions and liver function needs to be monitored while taking the drug.
Summary
There are a variety of options for the treatment of toenail fungal infections. While the topical products are considered the safest options, they may not be as effective as oral, systemic anti-fungals. Out of the oral anti-fungals, Lamisil appears to be the safest and most effective option.
