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Other oral antifungals
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.
Allylamines and azoles kill fungi. Killing fungi does not guarantee a normal-looking nail.
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 ketoconazole are used less often. Fluconazole seems to help, but not as much as terbinafine or itraconazole.1 And ketoconazole may work, but there is not enough evidence from studies to say just how well it works.3
Oral antifungal medicines often kill fungi but do not immediately improve the appearance of the nail.
Oral antifungals have both minor and dangerous side effects.
Minor side effects include:
Dangerous side effects of oral antifungals include:2
Itraconazole may cause heart failure. Warning signs of heart failure include:
During oral antifungal treatment, your doctor may require blood tests to check your kidney and liver function.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
Terbinafine and azoles pass into breast milk. It is not known whether they harm a fetus. If you are pregnant, could become pregnant, or are breast-feeding, talk to your doctor before you take oral antifungal medicines.
Advanced age lowers your chances for a cure. This may be due to slowed nail growth and, in some people, poor blood circulation to the feet.
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, stomach acid neutralizers, and rifampin (Rifadin).
In some people, a fungal infection comes back after treatment. This is called a recurrence. Recurrence of infection may be a new infection or a regrowth of the original infection that was not eliminated by treatment.
Consider the following about treatment with oral antifungal medicine:
For more information on deciding whether to use oral antifungal medicines, see:
- De Berker D (2009). Fungal nail disease. New England Journal of Medicine, 360(20): 2108–2116.
- U.S. Food and Drug Administration (2001). FDA issues health advisory regarding the safety of Sporanox products and Lamisil tablets to treat fungal nail infections. FDA Talk Paper T01-22. Available online: http://www.fda.gov/bbs/topics/answers/2001/ans01083.html.
- Ferrari J (2008). Fungal toenail infections, search date May 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Last Revised: April 2, 2012
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.