Toenail Fungus Treatment Options Table

When it is used

Topical Treatments

Jublia® (efinaconazole)

Used for treatment of mild to moderate fungal toenail infections that does not involve the crescent shaped area of the nailbed.

Penlac® (ciclopirox and generics)

Used for treatment of mild to moderate fungal nail infections that does not involve the crescent shaped area of the nailbed.

Oral Treatments

Lamisil® (terbinafine and generics)

Used for treatment of fungal nail infections.

Sporonox® (itraconazole)

Used for treatment of fungal nail infections.

How it works

Topical Treatments

Jublia® (efinaconazole)

Works by blocking the production of ergosterol, an important part of the fungal membrane. Without ergosterol, the fungi cannot function and eventually they die off, reducing the infection.

Penlac® (ciclopirox and generics)

Works by preventing certain types of fungus from growing and reproducing.

Oral Treatments

Lamisil® (terbinafine and generics)

Works by killing fungi and preventing certain types of fungi from growing and reproducing.

Sporonox® (itraconazole)

Works by inhibiting the production of a compound known as ergosterol, which is found in the cell membrane of fungi. Without ergosterol, the fungi cannot function and eventually they die off, reducing the infection.

Dosage

Topical Treatments

Jublia® (efinaconazole)

Applied to the affected nail, around the cuticle folds of the skin next to the toenail, and underneath the toenail if possible once daily.

Penlac® (ciclopirox and generics)

Applied to the affected nail, nail bed, undersurface of the nail plate, and surrounding skin once daily.

Accumulated lacquer should be removed with alcohol weekly

Oral Treatments

Lamisil® (terbinafine and generics)

Taken orally (by mouth) once per day.

Sporonox® (itraconazole)

Taken orally (by mouth) twice per day for 1 week, followed by a 3 week drug-free interval. Usually 3 courses of treatment are given for toenail infections.

Side Effects*

Topical Treatments

Jublia® (efinaconazole)

Side effects:

Common:
Can include redness, itching, burning, and stinging sensation where the drug is applied.

Uncommon side effects:
Can include serious skin reactions (skin becomes very red, itchy, swollen, blistered, or crusted), in which case you should stop using the medication and seek medical attention.

Special notes:

No removal of dead, damaged, or infected tissue is needed.

Clip your toenails every 4 weeks. Clip the unaffected toenails first before the affected ones.

Avoid the use of toenail polish, cosmetic toenail products, or pedicures from non-healthcare professionals.

Penlac® (ciclopirox and generics)

Side effects:

Rash, dryness, itching, redness, burning sensation of skin where the drug is applied.

The drug can also affect the nail by changing its shape or colour, causing irritation, and causing an ingrown toenail where the drug is applied.

Special notes:

Nail should be filed, trimmed, and cleaned with alcohol weekly.

Infected, growing part of nail needs to be removed periodically by a healthcare professional.

Do not use nail polish or other nail cosmetic products on the treated nails.

Oral Treatments

Lamisil® (terbinafine and generics)

Side effects:

Very common:
Headache, nausea, mild abdominal pain, stomach discomfort after a meal, diarrhea, bloating of abdomen, loss of appetite, skin rashes, joint and muscle pain.

Common:
Mood disorder (depression), disturbance or loss of sense of taste, dizziness, eye disorder, and tiredness.

Uncommon:
Low red blood cells (symptoms include pale skin or nail beds, unusual tiredness/weakness, breathlessness on exertion), anxiety, tingling or numbness, decreased skin sensitivity, increased sensitivity to sun, ringing/hissing in ears, fever, and weight loss.

Rare:
Liver problems (symptoms include yellowing of eyes and skin), abnormal liver function tests.

Stop taking the medication and seek immediate medical attention if the following occur:
Liver problems (symptoms include persistent nausea and vomiting, abdominal pain, fatigue, loss of appetite, dark urine, pale stool, and yellowing of eyes/skin), blood problems (symptoms include sore throat, fever, unusual bleeding or bruising), inflammation of blood vessels or pancreas (symptoms include severe upper stomach and back pain), serious allergic reactions, serious skin reactions (symptoms include blistering and peeling skin), severe muscle damage (symptoms include muscle pain, weakness, and dark urine.

Special notes:

No removal of dead, damaged or infected tissue is needed.

Your doctor may routinely monitor your liver function and blood for potential effects caused by this medication.

Sporonox® (itraconazole)

Side effects:

Common:
Skin rash, high triglyceride test results, high liver test results, and digestive system problems (e.g., nausea, bloating, diarrhea).

Other:
Upset stomach, vomiting, abdominal pain, constipation or excess gas in stomach, cough, fluid in the lungs, altered voice, inflammation of the sinuses, inflammation of the nose, upper respiratory tract infection, headache, dizziness, menstrual disorders, erectile dysfunction, confusion, tremor, sleepiness, fatigue, chills, muscle weakness or pain, painful joints, pain, chest pain, swelling, generalized swelling, unpleasant taste, hair loss, inflammation of the pancreas, fever or excessive sweating.

Talk with your doctor/pharmacist immediately if the following occur:
Heart problems (symptoms include shortness of breath, unusual swelling of feet/ankles/legs, sudden weight gain, feeling unusually tired, coughing up white/pink phlegm, unusually fast heartbeat, waking up at night), blurry or double vision, ringing in ears, decreased ability to control urine, or urinating more than usual.

Stop taking the medication and seek immediate medical attention if the following occur:
Liver problems (symptoms include feeling unusually tired, loss of appetite, nausea, vomiting, abdominal pain, yellowing of eyes/skin, dark- coloured urine, pale stools), nerve problems (symptoms include tingling, numbness, reduced sense of touch, weakness in limbs, pain, pins and needles, prickling, or burning), serious allergic reaction (symptoms include skin rash, itching, hives, difficulty breathing, shortness of breath, swelling of the face), severe skin reaction (symptoms include widespread rash with peeling skin and blisters in the mouth, eyes, and genitals, rash with small pustules or blisters), oversensitivity to sunlight, hearing loss.

Special notes:

No removal of dead, damaged or infected tissue is needed.

Your doctor may routinely monitor your liver function and blood for potential effects caused by this medication.

Interactions

Topical Treatments

Jublia® (efinaconazole)

Studies have not been done.

Penlac® (ciclopirox and generics)

Studies have not been done.

Oral Treatments

Lamisil® (terbinafine and generics)

The following are some, but not all of the medications that may interact with LAMISIL**:

Some antibiotics

Some antidepressants (such as 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 (such as propafenone and amiodarone).

Some medications used to treat high blood pressure (such as beta-blockers such as metroprolol).

Theophylline, used to relieve bronchospasm in asthma.

Some medicines used to treat cough (such as dextromethorphan).

Cyclosporine, used to control the immune system, used to prevent transplant rejection.

St. John's wort (Hypericum perforatum), a herbal medicine used to treat depression.

Sporonox® (itraconazole)

A wide variety of drugs may interact with this medication. Never take this medication if you are taking any of the following medications**:

Methadone, quinidine, dofetilide, levavetylmethadol (levomethadyl), cisapride, disopyramide, dronedarone, pimozide and ranolazine which could result in dangerous or even life-threatening abnormal heartbeats.

HMG-CoA reductase inhibitors such as lovastatin and simvastatin, which could result in 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 nisoldipine medicines for angina (crushing chest pain) or high blood pressure.

Irinotecan, an anticancer drug.

Lurasidone, an antipsychotic drug.

Colchine, a medicine to treat gout, for people with kidney or liver impairment.

* Please note that side effects listed is not a complete exhaustive list of all possible side effects. For complete listing please view the product monograph.

** Please note that this is not a complete list of possible medications that may interact with the product. Please tell your doctor and pharmacist all the medications (including over the counter products, supplements, and natural products) that you're taking before starting on this medication.

Use the Doctor Discussion Guide to discuss treatment options with your doctor.