Terbinafine 250mg QD x 12-16 weeks
Better than griseofulvin and itraconazole in head-head
trials for toenail onychomycosis (see review in J. Am. Board
Fam. Pract. 13:268, 2000--AFP)
Has also ben used in "pulse" dosing:
500 QD x 1wk/mo x 4mos (associated with sig. lower incidence of
both clinical and mycologic cure in one randomized study compared
with 250mg QD x 3mos; Am. Acad. Dermatol. 53:578, 2005--JW)
May cause hepatotoxicity
Itraconazole 200mg QD x 12wks (has also been used in
"pulse" dosing 200mg BID x 1wk/mo x 3mos)--May
cause hepatotoxicity and have a negative inotropic effect
Fluconazole 150-300mg Qwk until infection clears (avg.
Griseofulvin x 6-12mos or more
- Ciclopirox (Penlac) 8% nail lacquer--Indicated for
mild-mod onychomycosis due to Trichophyton rubrum in
immunocompetent patients. May require use for up to
48wks; also removal of unattached infected nail.
See also under "Antifungals"
for other info about these agents