Prescription Treatment Options

Brand Name/Therapy
Form
Liver Toxicity Potential
Drug Interactions
 
Jublia (Efinaconazole)
Available since 2014
Topical
No
N/A *
See more Close
Form
Topical
Liver Toxicity Potential
No
Drug Interactions
N/A *

Jublia contains efinaconazole 10% in a clear solution for topical application. Jublia is a prescription medicine used on the toenail (topical) to treat a fungal infection (onychomycosis) caused by certain fungi.

Common side effects: Skin irritation around the toenail, such as redness, itching, burning, or stinging in the surrounding skin

Drug interactions: Topical administration of Jublia (Efinaconazole Topical Solution, 10% w/w) has very low systemic exposure. Therefore, potential interactions between Jublia and other drugs have not been evaluated.

There are no drug-food, drug-herb, or drug-laboratory interactions that have been established.

Studies have not been done.

?Ask your family physician if Jublia is right for you.

Penlac (Ciclopirox)
Available since 2004
Topical
No
N/A *
See more Close
Form
Topical
Liver Toxicity Potential
No
Drug Interactions
N/A *

Penlac (ciclopirox topical solution, 8% w/w) is available as a nail lacquer. Penlac is a prescription medicine to treat mild to moderate nail fungus, along with a treatment program that includes regular removal of the infected nail.

Common side effects: Skin redness around the nail, shape change, irritation, ingrown toenail and discoloration, application site reaction, burning sensation, dry skin, and itching

Drug interactions: Studies have not been done.

?Ask your family physician if Penlac is right for you.

Lamisil (Terbinafine)
Available since 1993
Oral
Yes
Yes
See more Close
Form
Oral
Liver Toxicity Potential
Yes
Drug Interactions
Yes

Lamisil (terbinafine) is an antifungal medication available as 250mg tablets. Lamisil is a prescription medicine used to treat fungal infections of the nail (toes, fingers).

Common side effects: Headache, nausea, mild abdominal pain, heartburn, diarrhea, swelling or bloating of the abdomen, loss of appetite, skin rashes, joint and muscle pain, mood disorders, loss or disturbance of taste, dizziness, eye disorder, and tiredness

In rare cases, Lamisil can cause liver problems. In very rare cases, problems such as liver failure, some leading to death or the need for a liver transplant, can occur. Stop taking Lamisil tablets and consult your doctor immediately should you develop jaundice (yellowing of skin and/or eyes).

Drug interactions: The following are medications that may interact with LAMISIL:

  • Some antibiotics (e.g. rifampicin)
  • Some antidepressants (e.g. tricyclic antidepressants, selective serotonine reuptake inhibitors including class 1A, 1B and 1C, monoamine oxidase inhibitors Type B, and desipramine)
  • Some medicines used to treat irregular heart rhythm called “antiarrhythmics” (e.g. propafenone and amiodarone)
  • Some medicines used to treat high blood pressure (e.g. beta-blockers such as metroprolol)
  • Some medicines used to treat coughs (e.g. dextromethorphan)
  • Cyclosporine, used to control the immune system and prevent transplant rejection
  • St. John’s wort [Hypericum perforatum], a herbal medicine used to treat depression

?Ask your family physician if Lamisil is right for you.

Sporanox (Itraconazole)
Available since 1993
Oral
Yes
Yes
See more Close
Form
Oral
Liver Toxicity Potential
Yes
Drug Interactions
Yes

Sporanox (itraconazole) is a prescription antifungal medication available in 100mg capsules, used to treat fungal infections of the nails.

Common side effects: Skin rash, high triglyceride and liver tests, nausea, bloating, diarrhea, upset stomach, vomiting, abdominal pain, constipation or excess stomach gas, altered voice, inflammation of the sinuses, inflammation of the nose, upper respiratory tract infection, headache, dizziness, menstrual disorders, erectile dysfunction, confusion, tremors, sleepiness, fatigue, chills, muscle weakness or pain, painful joints, chest pain, swelling, generalized swelling, unpleasant taste, hair loss, inflammation of the pancreas, fever or excessive sweating

Uncommon, but possible side effects

  • Liver toxicity
  • Cardiac toxicity

Drug interactions: A wide variety of drugs may interact with Sporanox® capsules. Never take Sporanox capsules if you are taking any of the following medications:

  • Methadone, quinidine, dofetilide, levavetylmethadol (levomethadyl), cisapride, disopyramide, dronedarone, pimozide and ranolazine (each can result in dangerous or even life-threatening abnormal heartbeats)
  • HMG-CoA reductase inhibitors, such as lovastatin and simvastatin, which could result in a potentially serious breakdown of muscle tissue
  • Triazolam and midazolam (oral), which may worsen or prolong drowsiness
  • Ergot alkaloids, such as dihydroergotamine, ergotamine, ergometrine (ergonovine) and methylergonovine, which could result in a serious or life-threatening decrease in blood flow to the brain and/or limbs (ischemia)
  • Eletripan, a migraine medication, which could result in serious side effects
  • Felodipine, eplerenone and misoldipine medicines for angina (crushing chest pain) or high blood pressure
  • Irinotecan, an anti-cancer drug
  • Lurasidone, an antipsychotic drug
  • Colchine, a medicine to treat gout, when used in subjects with kidney or liver impairment.

Other medications may also interact with Sporanox. This is not a complete list.

?Ask your family physician if Sporanox is right for you.

Treatment Challenges: What to Expect and What to Do

Treating nail fungus infections is challenging. From a patient’s point of view, one of the main frustrations is that nail fungus infections take considerable time to clear, even when the treatment is working. Typically, topical treatments are prescribed for a year and oral treatments require several months of treatment before your nails return to normal.

Having realistic treatment expectations is very important

It’s important that you speak with your physician and the pharmacist so that you understand the expected outcome and duration of treatment, as well as possible side effects of the treatment. Unrealistic expectations often lead to dissatisfaction, poor compliance or failure to continue the treatment as instructed.

Nail fungus infection takes a long time to treat

The appearance of the damaged nail will not return to normal even after the fungi are cleared, until the damaged nail grows out and is replaced by the healthy nail. It takes fingernails about six months to re-grow completely, and toenails require 12-18 months.

The cure rate for nail fungus infection treatments is not 100%. Understand that your treatment may fail and you may need to try again, or use a different treatment regimen. Recurrence is common with this condition.

Treatment Overview

Physician administered or prescribed treatments for nail fungus (onychomycosis) are generally divided into three categories:

Bottle of topical treatment for nail fungus

Topical treatments

Topical treatments are generally applied directly to the affected nails and have a local effect, meaning that they act against the fungi in the nail and nail bed. The main drawback with topical treatments is that a sufficient amount of medication must penetrate the tough nail plate in order to take full effect on the nail bed where the infection lies. The newer topical treatment options are formulated to be able to penetrate through the nail.

!

Safety: Because topical treatments are not absorbed by the body in large quantities, they do not interact with other medications being taken. Topical treatments are much less likely to have severe adverse effects, and their side-effects are usually mild and restricted to the area where the medication is applied.

Prescription pills for nail fungus treatment

Oral treatments

Oral treatments have a systemic effect, meaning the blood stream carries the medication to the nail bed, without needing to bypass the tough nail plate. For severe fungal nail infections that affect the nail root or matrix, oral treatments will often be required.

!

Safety: Because they absorb systemically, oral treatments can interact with other medications and can be toxic to the liver, so liver function needs to be monitored while taking oral antifungal medications.

Doctor treating toenail fungus using light

Physical and light treatment

Parts of or the entire infected nail can be removed. The procedure can be done in your physician's office and is nearly painless. By itself, physical therapy will not kill the fungus or remove it from the nail. It is often done so that topical treatments can be applied directly to the affected part of the nail or nail bed.

Lasers, photodynamic therapy, and diode lasers are a relatively new area where there may be potential for treating fungal infections.

At this time, however, the evidence suggests that laser treatment alone is not very effective for treating fungal nail infections.

Fungal nail infections present some unique challenges, such as the long time required for both treating the nails and for nails to re-grow.

i Combination of treatments

Some evidence suggests that a combination of treatments may increase efficacy and minimize the chance of recurrence. Your doctor may recommend both topical and oral treatment, or both topical and physical treatment to increase your chances of a cure.

i Non-prescription and natural health products

There are also non-prescription and natural health products available. This site is limited to prescription drug products available in Canada.

Dr. Katie Beleznay, Dermatologist

Natural remedies

Natural remedies for treating nail fungus are often advertised heavily on the Internet. Are they effective?

How Do You Prevent Nail Fungus?

Prevention is important to minimize your risk of getting a first nail fungus infection, but it is also important during treatment to increase your chances of a successful treatment and reduce the chances of subsequent nail fungus infections.

  • Public spas, swimming pools, showers and locker rooms are all high-risk areas where fungi are more likely to be picked up. Avoid these high risk areas during treatment if possible and, if you do visit these areas, protect yourself by wearing flip flops, washing your hands and feet thoroughly and drying them afterwards.
  • Wash your feet frequently and keep them dry. Wear cotton socks to absorb the sweat from your feet. Change your socks frequently to keep them dry and fresh.
  • Wear shoes that are comfortable and allow adequate air circulation.
  • Keep your nails cut short and avoid using nail polish while you have an infection.
  • Avoid sharing towels, shoes and other items. This is especially important to prevent transmission to family members.
  • Stay healthy and keep your immune system strong.