Onychomycosis means fungus of the nail. Toenail fungus in particular is most common, difficult to treat and is usually a reoccuring issue. A primary prevention and treatment step is to keep feet clean and dry at all times. Various treatments such as oral medications, topical applications and surgical procedures are necessary in order to kill the infection.
The most commonly prescribed oral medications that are itraconazole (Sporanox) and terbinafine (Laminsil). Oral medications are usually prescribed if the patient is diabetic or has a history of, or, symptoms of cellulitis.
What Decides the Type of Oral Medications Prescribed?
- For infection caused by yeast (Candida) and molds Itraconazole medication is prescribed. It is also recommended for infections caused by dermatophytes.
- For infection caused by dermatophytes such as distal subungual onychomycosis or white superficial onchymycosis terbinafine is prescribed. This is the most common type of toenail fungus infection and hence this medication is commonly prescribed by the doctors.
- For infections caused by Candida as well as dermatophytes Fluconazole medication is prescribed.
- Griseofulvin is commonly prescribed for treating toenail fungus infection in children.
Effects of Oral Medications
Oral medications kill fungus resulting in the growth of infection free nails that slowly replace the infected nail. These treatments must be followed until the infected nails are non existent. The course of treatment may vary from six to twelve weeks depending on the nail’s rate of growth. Prolonged exposure to moist conditions can lead to new or returning fungal infections.
Dosage of Oral Medications
The terbinafine oral medicine for toenail fungus comes in tablet form and is often taken once every day for 12 weeks. Pulse dosing schedule is used for recommending these tablets. Pulse dosing is a method in which a medicine is for example taken daily for one week, once or twice a month and then continues until it is no longer necessary. This way the schedule is easily maintained and is actually more effective at inhibiting fungal growth.
- Oral azoles
This fungal medication is available in both capsule and tablet form and is taken daily for three to eighteen months. These are also often taken on a pulse dosing schedule.
This fungal medication is often recommended twice daily until the infection is non existent. The treatment time is approximately 12 to 18 months. The treatment period is sometimes extended if the physician wants to prevent the infection from reoccuring.
How do Oral Medications Work?
Both oral azoles and terbinafine medications kill fungi that cause these infections. However, killing fungi can not guarantee growth of an infection free nail. Medications such as Griseofulvin that prevent fungal growth work much better at preventing infection in the future.
Common Side Effects of Oral Medications
- Upset Stomach
- Skin rashes
- Visual disturbances
- Photosensitivity (mostly caused by Griseofulvin)
- Change of taste
- Abdominal pain
- Change in skin color
- Dark urine
Facts and Precautions
- Studies have revealed that oral medications such as terbinafine and azoles have a tendency to pass into the milk of nursing mothers. Its effect on a fetus is still unknown and is predicted to be risky.
- These medications do not work well in older aged people as their blood circulation and rate of nail growth to slow with age.
- Oral antifungal medications are not prescribed if you are suffering from liver problems.
- Damage to liver is increased if these medications are taken with alcohol.
- Patients with heart failure history are not prescribed Itraconazole
- Griseofulvin is not recommended to patients who are allergic to penicillin.
Summary: Toenail fungus infections have a tendency to repeat, hence, the treatment has to be continued for days or months until the infected nail is completely replaced by a new non-infected nail. As a prevention measure, the toenail area should always be kept dry and clean always so that the infection does not recur.