Terbinafine (Lamisil®) and itraconazole (Sporanox® ) are popular oral medications for the treatment of toenail fungus. Both are expensive and the treatment regimen involves 3 months of therapy. Itraconazole has been shown to be effective with a pulse dosing regimen. This means that the medication is taken daily for 7 days and then 21 days off the medication, for 12 weeks. This significantly reduces the cost of the medication. Terbinifine has classically been prescribed as a continuous dose, the treatment regimen is typically 250 mg per day for 12 weeks. In a recent study, the authors compared results from trials of continuous and intermittent terbinafine (Lamisil) and intermittent itraconazole (Sporonox). The three treatments regimens were as follows:
- Intermittent terbinafine: 250 mg/day for 4 weeks followed by 4 weeks of no terbinafine and then 4 weeks of terbinafine 250 mg/day.
- Pulse itraconazole: pulse of 200 mg twice daily for 7 days on, 21 days off, 7 days on, 21 days off, 7 days on (total of 3 pulses).
- Continuous terbinafine: 250 mg/day for 12 weeks
The participants were followed for a year and a half and mycological cure rates were found to be 83% for the pulse terbinafine group, 78% mycological cure rate for the continuous terbinafine group and 56% for the pulse itraconazole group. Very few adverse events were recorded and none of the events required interruption of the drug regimen. Adverse events did not differ significantly from one group to another.
The authors concluded that the intermittent terbinafine regimen was a safe and effective treatment for toenail fungus, and more effective than the itraconazole therapy.
Gupta AK et al. J Eur Acad Dermatol Venereol. 2009 Mar;23(3):256-62. The use of an intermittent terbinafine regimen for the treatment of dermatophyte toenail onychomycosis.
More information on treatments for toenail fungus.
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