Nail fungus. Just the words can make you cringe. If you’ve ever had it, you know the frustration of trying to get rid of it. The discolored, thickened, and sometimes painful nails can make you feel self-conscious and even interfere with activities like walking and wearing certain shoes.
Onychomycosis, the medical term for nail fungus, is more than just a cosmetic issue. It’s an infection that gets into the nail, changing its structure and often making it difficult to treat. Studies suggest that anywhere from 2% to 14% of people will experience nail fungus, so it’s a pretty common problem.
While there are plenty of over-the-counter creams and ointments promising to cure nail fungus, they often fall short, especially when the infection is severe or has been around for a while. That’s where prescription pills come in. Unlike topical treatments, these oral antifungal medications work from the inside out, attacking the fungus throughout your system.
But are nail fungus prescription pills the right choice for you? This article will give you a complete look at prescription pills for nail fungus, exploring how well they work, what side effects you might experience, and what factors to consider when deciding on a treatment plan. We’ll rely on research and expert opinions to give you the information you need.
What is nail fungus (onychomycosis)?
Nail fungus, also called onychomycosis, is a common condition that begins as a white or yellow spot under the tip of your fingernail or toenail. As the fungal infection goes deeper, nail fungus may cause your nail to discolor, thicken, and crumble at the edge. If you think you have nail fungus, you’re probably right; it’s a fairly common condition.
Types of onychomycosis
- Distal Lateral Subungual Onychomycosis (DLSO): This is the most common type of nail fungus. It starts at the edge of the nail and spreads toward the cuticle.
- Superficial White Onychomycosis (SWO): This type affects the surface of the nail, and it shows up as white spots or patches on the nail plate.
- Proximal Subungual Onychomycosis (PSO): This type starts at the cuticle and spreads outward. It’s more common in people whose immune systems aren’t working at their best.
- Total Dystrophic Onychomycosis (TDO): This is the most severe form of nail fungus, and it can completely destroy the nail. It’s basically what happens when other types of onychomycosis reach their end stage.
What causes nail fungus?
Usually, nail fungus is caused by dermatophytes, but sometimes yeasts and molds can also be responsible.
Some things that make you more likely to get nail fungus are:
- Older age
- Diabetes
- Poor circulation
- Nail trauma
- Wearing tight shoes
- Sweaty feet
Diagnosis of nail fungus
It’s important to get an accurate diagnosis of nail fungus before starting any treatment. Onychomycosis (the medical term for nail fungus) can look like other nail conditions, so it’s important to be sure you’re treating the right problem.
Your doctor will start with a clinical examination, visually inspecting the nail. But laboratory testing is necessary for a definitive diagnosis.
The lab may perform these tests:
- Microscopic examination: Involves direct examination of nail clippings under a microscope.
- Fungal culture: The lab grows the fungus to identify the specific organism.
- PCR testing: Detects fungal DNA for a rapid and accurate identification.
Oral Antifungal Medications: A Detailed Overview
When topical treatments don’t work, doctors may prescribe oral antifungal medications to treat nail fungus. Here’s a closer look at these medications:
Types of Oral Antifungal Medications
- Terbinafine (Lamisil): Terbinafine is often prescribed for fungal infections. It works by stopping the fungus from making a key substance for its cell membranes. For toenail infections, the treatment usually lasts 12 weeks.
- Itraconazole (Sporanox): This is another common antifungal. It prevents the fungus from creating ergosterol, which is essential for fungal cell membranes. Itraconazole can be prescribed with pulse therapy (short, intense treatments) or continuous dosing.
- Fluconazole (Diflucan): Fluconazole isn’t used as much for nail fungus as terbinafine and itraconazole are. Like itraconazole, it also stops ergosterol production. It’s often used for yeast infections but can help with certain dermatophytes (a kind of fungus).
- Griseofulvin: This is an older antifungal drug. It interferes with fungal cell division by affecting microtubules. However, it’s not as effective as the newer antifungals and has more side effects.
How Oral Antifungals Work
Oral antifungals work through a systemic approach:
- The medications are absorbed into your bloodstream.
- The medication travels to the nail bed through the blood.
- The antifungal stops the fungus from growing and allows healthy nail to grow in.
Efficacy of Oral Antifungals
Research shows that oral antifungals work:
- Terbinafine vs. Placebo: A high-quality study showed that terbinafine works better than a placebo (sugar pill).
- Clinical cure: Risk Ratio 6.00 (95% CI 3.96 to 9.08).
- Mycological cure: Risk Ratio 4.53 (95% CI 2.47 to 8.33).
- Terbinafine vs. Azoles: Terbinafine is likely more effective than azole medications.
- Clinical cure: Risk Ratio 0.82 (95% CI 0.72 to 0.95).
- Mycological cure: Risk Ratio 0.77 (95% CI 0.68 to 0.88).
Potential side effects and risks
Like all medications, prescription antifungal pills for nail fungus can have side effects. Your doctor will weigh the benefits of these medications against their risks before prescribing them.
Common side effects
You might have any of the following:
- Gastrointestinal issues: Nausea, abdominal pain, and diarrhea are among the most common side effects.
- Liver problems: Elevated liver enzymes are also somewhat common. In rare cases, people experience liver damage. Your doctor will likely order regular liver function tests during your treatment.
- Skin reactions: Some people experience rash, itching, and hives.
- Headaches: Headaches are a common but usually mild side effect.
Serious side effects (rare)
Although rare, you should be aware of these side effects:
- Severe liver damage: This requires immediate medical attention.
- Allergic reactions: Anaphylaxis, though rare, is a medical emergency.
- Blood disorders: These include a decreased white blood cell count or platelet count.
Drug interactions
Antifungal medications can interact with other medications. Here are some examples:
- Terbinafine can interact with certain antidepressants, beta-blockers, and caffeine.
- Itraconazole interacts with many medications, including statins, proton pump inhibitors, and certain antibiotics.
- Fluconazole can interact with blood thinners and some diabetes medications.
Be sure to tell your doctor about all the medications and supplements you take.
Contraindications
There are some people who should not take oral antifungal medications. These include:
- People with active liver disease
- Pregnant people
- Breastfeeding people
If you have any concerns about the risks and benefits of oral antifungal medications, talk to your doctor.
Things to think about before taking a pill
Oral medications for nail fungus can be very effective, but they also have potential risks and side effects. Here are some things to think about before you and your doctor decide on this type of treatment:
How bad is the infection?
If the infection is mild, you may be able to clear it up with a topical treatment. But if the infection is severe or has spread to multiple nails, your doctor may recommend an oral medication.
What’s your health history?
Before you start taking oral antifungals, your doctor will want to know about your overall health, especially your liver function. They’ll also need to know about any other medical conditions you have, as well as other medications you take, to avoid potential drug interactions or contraindications.
What about drug interactions?
Be sure to tell your doctor about all the medications you’re taking, including over-the-counter drugs and supplements. Your doctor or pharmacist can check for any potential interactions with oral antifungals.
How much will it cost?
Oral antifungals can be expensive, so it’s a good idea to check with your insurance provider to see if they’re covered.
What do you think?
It’s important to weigh the benefits and risks of oral antifungal treatment with your doctor. Discuss any potential side effects, how long you’ll need to take the medication, and any other concerns you have. The goal is to work together to find the best treatment plan for you.
What to expect during treatment
If you and your doctor decide that prescription pills are the best way to deal with your nail fungus, here’s what you can expect.
First, an exam and consultation
Before you start taking medication, your doctor will want to confirm that you really have onychomycosis. There are other conditions that can look like nail fungus. Your doctor will also review your overall health, especially your liver function, since some antifungal medications can be hard on the liver.
Starting your medication
It’s important to take your medication exactly as prescribed and for the entire time your doctor recommends. Some antifungal medications are better absorbed when you take them with food.
Monitoring for side effects
You’ll need to schedule regular checkups with your doctor so they can watch for any side effects from the medication. You’ll also need periodic liver function tests. It’s important to tell your doctor right away if you notice anything unusual while you’re taking the medication.
How long will treatment last?
Toenail infections typically need about 12 weeks of treatment. Fingernail infections may need a shorter course of medication.
Follow-up and assessment
Once you’ve finished your medication, your doctor will want to see you again to assess how well the treatment worked. They’ll look for both clinical and mycological cures. A clinical cure means your nail looks better. A mycological cure means the fungus is gone.
Even after a successful treatment, nail fungus can come back. Your doctor can help you create a plan to minimize the risk of recurrence.
Alternative and complementary therapies
Some people prefer not to take a prescription pill for nail fungus, or they may want to add other therapies to their treatment plan. Here are some options to discuss with your doctor.
Topical treatments
Antifungal creams and lacquers can be helpful for mild infections, but they are generally less effective than oral medications when an infection is severe, though understanding the cost of Jublia with insurance is an important factor to consider.
Home remedies
Some people swear by home remedies such as tea tree oil (some research suggests it has antifungal properties) or vinegar soaks (which may help to prevent fungal growth), but topical treatments like Emoninail are also available.
But keep in mind that home remedies should not replace medical treatment from a doctor. If you’re interested in home remedies, be sure to discuss your plans with your doctor first.
Laser therapy
Laser therapy directs laser energy to the site of the infection to kill the fungus. Results are variable, and more research is needed.
Combination therapy
In some cases, combining oral and topical treatments may improve your overall outcome.
Talk with your doctor about your options and find out what’s best for you.
Frequently Asked Questions
What is the best pill for nail fungus?
There’s no single “best” pill for nail fungus, as effectiveness can vary depending on the specific fungus, the severity of the infection, and individual factors. Common prescription antifungals include terbinafine and itraconazole. Your doctor will determine the most suitable medication based on your health history and a lab test to identify the fungus.
Is there a pill for nail fungus?
Yes, several oral antifungal medications are available by prescription to treat nail fungus. These pills work by targeting the fungus from within the body, offering a higher success rate compared to topical treatments, especially for severe infections. Always consult with a doctor to determine if oral medication is right for you.
Should I cut my toenail off if it has fungus?
Generally, you should not cut off your toenail if it has fungus. Surgical removal is rarely needed unless the nail is causing severe pain or other complications. Instead, focus on treating the infection with prescribed medications and following your doctor’s instructions for nail care, such as trimming and filing.
Why can’t you drink coffee with terbinafine?
While you can drink coffee while taking terbinafine, it’s generally advised to limit caffeine intake. Terbinafine can sometimes cause insomnia or anxiety as a side effect, and caffeine can exacerbate these issues. Moderation is key; discuss any concerns with your doctor or pharmacist.
What worsens toenail fungus?
Several factors can worsen toenail fungus, including warm and moist environments (like sweaty shoes), poor foot hygiene, injuries to the nail, wearing tight-fitting shoes, and underlying health conditions like diabetes or a weakened immune system. Taking steps to keep your feet dry, clean, and well-ventilated can help prevent the fungus from thriving.
Conclusion
Oral antifungal medications are a common and effective way to treat nail fungus. Of these medications, terbinafine is often more effective than the azole medications. However, all oral medications can cause side effects and interact with other medications you might be taking.
It’s very important to talk with a healthcare professional if you think you have nail fungus. They can make sure you get the right diagnosis and talk with you about your treatment options. They can also monitor you to make sure the treatment is working and that you aren’t experiencing side effects. Regular monitoring and follow-up are essential for successful outcomes.
Researchers are constantly working to improve treatments for nail fungus and to minimize side effects. They are also investigating combination therapies and alternative treatments.
With the right diagnosis, treatment, and monitoring, nail fungus can be effectively managed. If you think you have nail fungus, talk with your doctor about the best way to treat it.