Medical prescription treatments for onychomycosis are often given orally. The decision on which nail fungus treatment is dependent on several factors. Sometimes, if the fungal infection is heavily entrenched or has been in place for many years, it may be that an oral agent is the only way to cure toenail fungus. Patient preference factors into the decision, too. In some cases, a combination of oral and topical treatments is prescribed because this can lead to a more rapid clearance of the infection and full eradication of the onychomycosis.
Because of the potential psychological and physical discomforts, patients must be very cautious when considering oral prescriptions as a toenail fungus treatment. All oral antimycotic (antifungal) treatments used for onychomycosis have the potential to damage the liver. In fact, if the patient has any history of liver disease whatsoever, oral prescription nail fungus treatment should not be used and will not be prescribed by a physician. Even without a history of liver disease, it is usually recommended that the treating physician check liver enzymes before starting oral antifungal onychomycosis treatment. For some treatments, liver function should be checked again after four weeks. Also, any sign of liver disease such as jaundice (yellow skin or whites of the eyes), dark urine, pale colored stools, upper abdominal pain, fatigue or malaise should be reported to the doctor immediately.
Historically, Griseofulvin was the only oral treatment for onychomycosis. While it worked reasonably well, it was associated with a lot of side effects especially at moderately high doses. Griseofulvin also required long treatment courses and the nail fungal infection would often come back once the drug was stopped. Fortunately there are newer, more effective oral antifungal onychomycosis treatments. In fact, there are three main prescriptions in use today.
1) Terbinafine, also known as Lamisil, has become the most popular of the prescription treatments. Terbinafine is given as a 250 mg pill once a day for six weeks if treating fingernails and twelve weeks if treating toenails. Pulse therapy has been effective in some cases. Pulse therapy delivers a higher Lamisil dose but separated by times that no drug is administered. A complete blood count and liver function tests should be performed before treatment is started and after four weeks of therapy.
2) Itraconazole (Sporanox) is usually administered in pulse dosing. The most common treatment schedule is 200 mg orally, once a day for one week per month over three months. Itraconazole can interact with a number of other medications so you must tell your doctor about all of your medications, both prescription and over-the-counter. Liver function tests should be performed before treatment is started and after four weeks of therapy.
3) Fluconazole (Diflucan) is administered once per week (150 or 300 mg) until the symptoms resolve. Treatment times may be six to nine months long before results are seen. This antifungal may interact with several other medications and must be used judiciously. Fortunately no blood tests are required when using fluconazole (though they may be performed anyway).
We found that topical toenail fungus treatments are extremely effective when application is regular and the infection is not a multiple year, severely entrenched condition. Some of the leading treatments found on the internet proved to have high efficacy when used properly and often. This discussion of topical toenail fungus solutions will continue in further detail the next post.