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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
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.
Griseofulvin is taken twice a day until nails are clear of infection. For
infections in the fingernails, griseofulvin may be taken for 6 to 8 months. For
infections in toenails, griseofulvin may be taken for 12 to 18 months to cure
an infection and to prevent reinfection.
Allylamines and azoles kill
fungi. Griseofulvin prevents the growth of fungi.
Killing fungi does not guarantee a normal-looking nail.
Oral antifungal medicines are used
fungal nail infections. Often the medicine used
depends on the
type of infection you have.
Oral antifungals may cure fungal
nail infections. Most research has been on using these medicines for toenail
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), ketoconazole (Nizoral), and griseofulvin (Grifulvin V) are used less often. Fluconazole seems to help, but not as much as terbinafine or itraconazole.1 And ketoconazole and griseofulvin may work, but there is not enough evidence from studies to say just how well they work.2
Oral antifungal medicines often kill fungi but do not
immediately improve the appearance of the nail.
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
Call 911 or other emergency services right away if you have:
Call your doctor right away if you have:
Common side effects of this medicine include:
Reference for a full list of side effects. (Drug Reference is not available in
During oral antifungal treatment, your doctor may require
blood tests to check your kidney and liver function.
and azoles may cause liver damage or failure, requiring a liver transplant.
A small number of deaths after liver failure has been linked to these medicines.
Itraconazole may cause
heart failure. Your doctor will talk with you about what signs to watch for when taking this medicine.
Commonly prescribed medicines can increase or
decrease terbinafine or azole levels in your body. Also, other medicines
can build up in the your blood when taken with terbinafine or an azole. Before
you take oral antifungal medicines, let your doctor know what other medicines
you are taking.
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 (Tagamet), stomach acid neutralizers, and rifampin
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Do not use this medicine if you are pregnant, breast-feeding, or planning to get pregnant. If you need to use this medicine, talk to your doctor about how you can prevent pregnancy.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
De Berker D (2009). Fungal nail disease. New England Journal of Medicine, 360(20): 2108–2116.
Ferrari J (2011). Fungal toenail infections, search date March 2011. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
June 27, 2012
Patrice Burgess, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine
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