Toenail fungus can be treated
Nail infections generally won’t go away on their own, but treatment options are available. It’s important to see a doctor, who will suggest the treatment that best suits you.
Both prescription and non-prescription treatment options are available for treating toenail fungus (onychomycosis) infections.
Prescription Options
A toenail fungus infection is a real health issue.
Jublia® (Efinaconazole)
Topical
Topical
Liver Toxicity Potential
NO
Drug Interactions
N/A
Available since
2014
Jublia contains efinaconazole 10% in a clear solution for topical application. Jublia is a prescription medicine to be applied to the toenail.
Common Side Effects
Skin irritation around the toenail, such as redness, itching, burning or stinging in the surrounding skin.
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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 a doctorPenlac® (Ciclopirox)
Topical
Topical
Liver Toxicity Potential
NO
Drug Interactions
N/A
Available since
2004
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 discolouration, application site reaction, burning sensation, dry skin, and itching.
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Lamisil® (Terbinafine)
Oral
Oral
Liver Toxicity Potential
YES
Drug Interactions
YES
Available since
1993
Lamisil (terbinafine) is a systemic (oral) medication available as 250 mg tablets. Lamisil is a prescription medicine used to treat fungal infections (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).
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Drug Interactions
The following are medications that may interact with Lamisil:
- Some antibiotics (e.g., rifampicin)
- Some antidepressants (e.g., tricyclic antidepressants, selective serotonin 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 metoprolol)
- 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
Sporanox® (Itraconazole)
Oral
Oral
Liver Toxicity Potential
YES
Drug Interactions
YES
Available since
1993
Sporanox (itraconazole) is a systemic (oral) medication available in 100 mg capsules and is used to treat fungal infections.
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 include liver toxicity and cardiac toxicity.
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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, levacetylmethadol (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)
- Eletriptan, a migraine medication, which could result in serious side effects
- Felodipine, eplerenone and nisoldipine medicines for angina (crushing chest pain) or high blood pressure
- Irinotecan, an anti-cancer drug
- Colchicine, 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.
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Next step
If you have questions about any of these treatments,
you should consult a doctor.
Lifestyle and non-prescription options
Alternative treatment options include lifestyle changes and non-prescription products. An active lifestyle can be a factor in getting a toenail fungus infection. So you can take actions in your daily life to help reduce your risk. For example, wear breathable shoes, change your socks and keep your feet clean and dry.
Please note that some of the non-prescription products listed below are indicated to treat other types of foot fungus, and not specifically toenail fungus infections.
EMTRIX®
Topical
Topical
Active Ingredient(s)
CARBAMIDE (UREA),
LACTIC ACID
Use
NAIL FUNGUS INFECTION
Emtrix is available as a solution to help treat localized fingernail and toenail infections. It helps reduce the growth of certain fungi known to cause fingernail and toenail infections.
Treatment Considerations
Transient minor irritation to the skin next to the affected nail can occur; if irritation worsens or persists, stop use and consult a healthcare professional. Harmless discolouration (whitening) of the affected nail may occur. In rare cases, the affected nail may become loose and detach from the nail bed. If this occurs, stop use and consult a healthcare professional.
Ask a doctorEXCILOR® EXCILOR FORTE
Topical
Topical
Active Ingredient(s)
ACETIC ACID
Use
FUNGAL NAIL BED INFECTION
Excilor and Excilor Forte are liquid formulas used to help treat infection by changing the pH level inside the nail, which creates a hostile environment for fungi.
Treatment Considerations
Do not use if you are pregnant or breastfeeding. In the case of Excilor Forte, burning sensation, itching or mild, localized pain may occur.
Consult a healthcare practitioner if symptoms persist or worsen. In the case of diabetes, consult your doctor regularly if you have foot problems.
Ask a doctorFUNGI NAIL®
Topical
Topical
Active Ingredient(s)
UNDECYLENIC ACID
Use
ATHLETE'S FOOT, RINGWORM
Fungi Nail is an ointment used to relieve itching, burning and cracking associated with athlete’s foot and ringworm.
Treatment Considerations
This product is not effective on the scalp or nails. If irritation occurs or there is no improvement within 4 weeks, stop use and contact a doctor. Do not use on children under 2 years of age unless directed by a doctor.
Ask a doctorFUNGI CURE®
Topical
Topical
Active Ingredient(s)
UNDECYLENIC ACID
Use
ATHLETE'S FOOT, RINGWORM
Fungi Cure’s liquid formulation is used for the cure of ringworm and athlete’s foot on the fingers and toes. It also relieves the associated irritation, redness, itching, scaling, cracking, burning, discomfort and soreness.
Treatment Considerations
This product is not effective on the scalp or nails. Do not use for the infection of the scalp. If irritation occurs or if there is no improvement within 4 weeks, stop use and consult a doctor. Persons under 18 years of age or those with highly sensitive or allergic skin should use only as directed by a doctor. Do not use on children under 2 years of age unless directed by a doctor.
Ask a doctorFLEXITOL®
Topical
Topical
Active Ingredient(s)
UNDECYLENIC ACID
Use
ATHLETE'S FOOT
Flexitol is a liquid treatment for athlete’s foot. It also relieves the associated skin itching, scaling, cracking, burning, redness, soreness and irritation.
Treatment Considerations
Do not use for infection of the nails. If irritation occurs or there is no improvement within 4 weeks, stop use and contact a doctor. Do not use on children under 2 years of age, except on the advice of a doctor.
Ask a doctorPhysical and light treatments
Parts of an infected toenail or even the entire toenail can be removed, and a doctor can do the procedure in their office. By itself, such 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 relatively new treatments that may have 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.
Toenail fungus infections present some unique challenges, such as the amount of time required for proper treatment, as well as the time needed for toenails to regrow.
Home remedies for toenail fungus
Home remedies for toenail fungus are often advertised heavily on the Internet. Are they effective?
Watch video to find out
Reality Check
Having realistic treatment expectations is very important
It’s important that you speak with a doctor and the pharmacist to understand the expected outcome and duration of treatment as well as its possible side effects. Unrealistic expectations often lead to dissatisfaction, poor compliance or failure to continue the treatment as instructed.
Some evidence suggests that a combination of treatments may increase efficacy and minimize the chance of toenail fungus recurrence. Thus, a doctor may recommend both topical and oral treatment, or both topical and physical treatment, to increase your chances of a cure.
A toenail fungus infection takes time to treat
While most prescribed treatments are effective, it takes time to cure a toenail fungus infection. The appearance of the damaged nail will not return to normal until it grows out and is replaced by the healthy nail, even after the fungi are cleared. Keep in mind that nails grow slowly! Even though the medication is working, it can take 12 to 18 months for toenails to regrow completely.
TOPICAL TREATMENTS
Topical treatments are generally applied directly to the affected nails and have a local effect: they act against the fungi in the nail and nail bed. The body absorbs topical treatments in smaller quantities, so they interact less with other medications. Side effects are usually mild and restricted to the area that you apply the medication to.
ORAL TREATMENTS
Oral treatments are carried by the blood stream to the nail bed without needing to get past the tough nail plate. Because they absorb systemically, oral treatments can interact with other medications and be toxic to the liver. Thus, liver function needs to be monitored when you take oral antifungal medications.
