Onychomycosis Medication

Updated: Jul 13, 2017
  • Author: Antonella Tosti, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy for onychomycosis are to reduce morbidity and to prevent complications.

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Antifungals, Systemic

Class Summary

The goals of pharmacotherapy for onychomycosis are to reduce morbidity and to prevent complications.

Terbinafine (Lamisil)

Terbinafine inhibits squalene epoxidase, which decreases ergosterol synthesis, causing fungal cell death. Use the medication until symptoms significantly improve. More studies are needed to establish the efficacy of pulse regimens and the optimal duration of treatment.

Itraconazole (Sporanox)

Itraconazole has fungistatic activity. It is a synthetic triazole antifungal agent that slows fungal cell growth by inhibiting CYP-450–dependent synthesis of ergosterol, a vital component of fungal cell membranes.

Fluconazole (Diflucan)

Fluconazole has fungistatic activity. It is a synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal CYP-450 and sterol C-14 alpha-demethylation, which prevents conversion of lanosterol to ergosterol, thereby disrupting cellular membranes. Treatment should continue until the infection resolves.

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Antifungals, Topical

Class Summary

Treatment of onychomycosis with topical antifungals is typically used as adjunctive therapy in combination with oral agents.

Ciclopirox (Penlac)

Ciclopirox interferes with the synthesis of DNA, RNA, and protein by inhibiting the transport of essential elements in fungal cells.

Efinaconazole (Jublia)

Efinaconazole is a topical triazole antifungal agent. It inhibits fungal lanosterol 14α-demethylase involved in the biosynthesis of ergosterol, a constituent of fungal cell membranes. It is indicated for onychomycosis of the toenail(s) due to Trichophyton rubrum and Trichophyton mentagrophytes.

Tavaborole (Kerydin)

Tavaborole, a topical oxaborole antifungal (boron-containing compound), is indicated for onychomycosis of the toenails due to Trichophyton rubrum or Trichophyton mentagrophytes. It is available as 0.5% topical solution.

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