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.
How It Works
Allylamines and azoles kill
fungi. Griseofulvin prevents the growth of fungi.
Killing fungi does not guarantee a normal-looking nail.
Why It Is Used
Oral antifungal medicines are used
fungal nail infections. Often the medicine used
depends on the
type of infection you have.
- Terbinafine is a medicine for fungal nail infections
caused by dermatophytes, including
distal subungual onychomycosis and white superficial onychomycosis. Most fungal nail infections are caused by this type of
fungus. Terbinafine may also be effective against some molds
- Itraconazole is a medicine for infections caused by
molds and yeast (Candida). It
can also be used for dermatophytes.
- Fluconazole is a medicine for Candida infections and can also be used against
dermatophytes. It may be used if you are taking a lot
of other medicines.
- Griseofulvin is more effective against fingernail infections than
toenail infections and is rarely used for toenail infections. It is only
effective against infections caused by dermatophytes. It is the only antifungal
currently approved by the U.S. Food and Drug Administration (FDA) for fungal
nail infections in children.
How Well It Works
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.3
Oral antifungal medicines often kill fungi but do not
immediately improve the appearance of the nail.
Oral antifungals have both minor and
dangerous side effects.
Minor side effects include:
- Stomach upset.
- Skin rashes.
- Changes in taste sensation (rare, and with terbinafine
- Visual disturbances (rare, and with terbinafine only).
- Increased sensitivity of skin to sunlight (photosensitivity-with
Dangerous side effects of oral antifungals include:2
- Drug interactions. 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.
Liver damage or failure, requiring a liver transplant.
A small number of deaths after liver failure have been linked to terbinafine
and azoles. Warning signs of liver failure include:
- Nausea, vomiting, belly pain.
- Loss of appetite.
- Dark urine.
- Changes in skin color.
Itraconazole may cause
heart failure. Warning signs of heart failure
- Shortness of breath at rest, with mild exertion, or when lying
- Severe swelling of feet, ankles, legs, or abdomen.
- Weight gain.
- Coughing up white or pink mucus.
- Faster-than-usual heart rate.
During oral antifungal treatment, your doctor may require
blood tests to check your kidney and liver function.
Reference for a full list of side effects. (Drug Reference is not available in
What To Think About
Terbinafine and azoles pass into
breast milk. It is not known whether they harm a fetus. It is not known whether
griseofulvin passes into breast milk. If you are pregnant, could become
pregnant, or are breast-feeding, talk to your doctor before you take oral
Advanced age lowers your chances for a
cure. This may be due
to slowed nail growth and, in some people, poor blood circulation to the
Griseofulvin was one of the first
oral antifungal medicines. But it does not provide a long-term cure, has
serious side effects, and requires a long treatment time (12 to 18 months). The
newer oral antifungals are much more effective, relatively safe for healthy
people, and don't take as long to work.
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
Griseofulvin should be taken with fatty foods for
better absorption into the body.
In some people, a fungal
infection comes back after treatment. This is called a recurrence. Recurrence of infection may be a new
infection or a regrowth of the original infection that was not eliminated by
Consider the following about treatment with oral
- Oral antifungal medicines are not recommended if you have liver
- Do not drink alcohol while taking these medicines, as this
increases your risk of liver damage.
- Itraconazole (Sporanox) is not recommended if you have a history
- Griseofulvin should not be taken if you have
lupus or are allergic to penicillin.
For more information on deciding whether to use oral
antifungal medicines, see:
Nail Infection: Should I Take Antifungal Pills?
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.
U.S. Food and Drug Administration (2001). FDA issues
health advisory regarding the safety of Sporanox products and Lamisil tablets
to treat fungal nail infections. FDA Talk Paper T01-22.
Available online: http://www.fda.gov/bbs/topics/answers/2001/ans01083.html.
Ferrari J (2008). Fungal toenail infections,
search date May 2008. Online version of BMJ Clinical Evidence: