Fungal Nail Infections - Medications

Medications

Antifungal medication is standard treatment for a fungal nail infection. The goals of treatment are to have few or no side effects, provide a long-term cure, and reduce treatment time.

• Antifungal pills (oral medication) offer the best chance of a cure. However, they also require close monitoring for dangerous side effects and are generally reserved for moderate-to-severe or difficult-to-treat fungal nail infections. Pills include terbinafine (Lamisil), itraconazole (Sporanox), and fluconazole (Diflucan).
• Antifungal topical medication (creams, lotions, gels, and lacquers) are applied to the infected nail and surrounding areas of the skin. However, they may not be as effective as oral medications. They may be used for mild-to-moderate infections and to help prevent an infection from returning or to prevent athlete's foot from spreading to the nails. Topical medications include terbinafine (Lamisil) and ciclopirox (Penlac).

Factors to consider when choosing a fungal nail infection treatment include:

• The type and location of infection. Fingernail and toenail infections are usually treated with different medications, and the treatment time for fingernails is usually shorter. If you have a mild fungal infection or are concerned about the risks of oral antifungal medication, consider using a topical treatment, such as Lamisil or Penlac.
• Your susceptibility to fungal nail infection. If you develop fungal nail infections often, you may need longer-term treatment.
• The medication. Griseofulvin (Fulvicin U/F, Grifulvin V) was one of the first oral antifungal medications. However, it did not provide a long-term cure, had serious side effects, and required a long treatment time (12 to 18 months). The newer oral antifungals are more effective, relatively safe for healthy individuals, and don't take as long to work.
• Your risk factors for dangerous side effects from oral antifungal medications. If you have a history of blood or liver disease or plan to drink alcohol during antifungal treatment, oral medication is not a safe treatment option for you.
• Drug interactions. Commonly prescribed medications can affect the levels of antifungal medication in your body. Similarly, other medications can build up in the bloodstream when taken with antifungal pills. Let your health professional know what other medications you are taking before taking oral antifungal medications.
• The dosing method, if you are taking oral medication. Depending on the medication and the severity of the infection, you may be able to choose between pulse therapy (taking medication daily for 1 week per month for 2, 3, or 4 months) or continuous therapy (taking medication each day).
• The medication cost for the entire course of treatment. Some oral antifungals cost more than others. Pulse dosing is often less expensive than continuous therapy.

For more information on deciding whether to use oral antifungal medications, see:

Should I take oral antifungal medication to treat a fungal nail infection?