Nail fungus, also known as onychomycosis, is a common condition that can cause your nails to become discolored, thick, and even painful. It’s unsightly and uncomfortable, and it affects a surprisingly large portion of the population. Risk factors include age, diabetes, and anything that impairs circulation.
While there are topical treatments available, they are often not strong enough to tackle a serious infection. That’s why doctors often prescribe oral antifungal medications like terbinafine and fluconazole.
Both terbinafine and fluconazole are effective at treating nail fungus, but they have different side effects and drug interactions. This article will compare terbinafine and fluconazole, including how well they work, their safety profiles, and other things you need to consider when choosing between these two medications for nail fungus.
How do these antifungals work?
Terbinafine and fluconazole both attack the fungus by interfering with its ability to make ergosterol, a key ingredient for its cell membranes. But they do it in different ways.
Terbinafine
Terbinafine stops the fungus from making ergosterol by blocking an enzyme called squalene epoxidase. This causes a buildup of squalene, which is toxic to the fungus. It also prevents the fungus from making enough ergosterol. Without ergosterol, the fungal cell membranes can’t work right, and the fungus dies.
Fluconazole
Fluconazole, on the other hand, is an azole antifungal. It blocks a different enzyme, 14-alpha-demethylase, which is also needed to make ergosterol. By blocking this enzyme, fluconazole disrupts the fungal cell membrane and stops the fungus from growing.
Key Differences
Terbinafine and fluconazole target different enzymes in the ergosterol production line. Terbinafine works earlier in the process than fluconazole. This difference can affect how well each drug works against different types of fungi and how likely the fungus is to develop resistance to the medicine.
Terbinafine vs. fluconazole: Which is more effective for nail fungus?
Both terbinafine and fluconazole are effective treatments for onychomycosis, or nail fungus. But which one is more effective?
Terbinafine efficacy
In general, terbinafine has higher efficacy rates than fluconazole, meaning it’s more likely to completely clear the fungal infection, but it’s important to consider other options like bifonazole vs terbinafine. Clinical trials have repeatedly demonstrated that terbinafine boasts higher mycological cure rates.
In other words, studies show that in 70 to 80 percent of people who take terbinafine, the fungus disappears from their system. And terbinafine treatment courses are often shorter than fluconazole courses, meaning you’ll likely be on the medicine for less time.
Terbinafine is especially effective against dermatophytes, which are the most common cause of onychomycosis. Trichophyton species are a type of dermatophyte.
Fluconazole efficacy
Fluconazole also works to treat nail fungus, but its success rate is generally lower. The mycological cure rates for fluconazole typically range from 40 to 60 percent, according to research. It also typically requires longer treatment durations compared to terbinafine.
One advantage of fluconazole is that it has a broader spectrum of activity. It’s effective against a wider range of fungi, including Candida species, in addition to dermatophytes.
Comparative studies
Several studies have directly compared terbinafine and fluconazole for the treatment of onychomycosis. These head-to-head clinical trials have consistently shown that terbinafine has higher cure rates and shorter treatment durations compared to fluconazole.
When looking at these studies, it’s important to keep in mind that there may be biases in the study design or limitations that could influence the results. For example, the type of fungus causing the infection, the severity of the infection, and the health status of the participants can all affect the outcome.
Terbinafine and Fluconazole: What are the side effects?
All medicines have side effects, and antifungals are no exception. It’s important to balance the risks and benefits with your healthcare provider before starting any medication.
Terbinafine side effects
Common terbinafine side effects include:
- Nausea
- Abdominal pain
- Headache
- Rash
Rare but serious side effects include liver problems. Terbinafine can raise liver enzyme levels and, in rare cases, cause liver failure. Your doctor will likely monitor your liver function with blood tests during treatment.
Terbinafine can also interact with other medications you may be taking.
Fluconazole side effects
Common side effects of fluconazole include:
- Nausea
- Abdominal pain
- Headache
- Rash
Rare but serious side effects include liver problems and QT prolongation. Fluconazole can also raise liver enzyme levels and, rarely, cause liver failure. QT prolongation is a heart-related side effect that can lead to irregular heartbeats.
Fluconazole can also interact with many other medications, especially those broken down by CYP enzymes in the liver.
Contraindications
Certain conditions may make terbinafine or fluconazole unsafe for you. For example, if you have pre-existing liver disease, terbinafine may not be a good choice.
Fluconazole may not be right for you if you have certain heart conditions or are pregnant.
Be sure to share your complete medical history and a list of all medications you’re taking with your doctor before starting either of these drugs. It’s important to work with a knowledgeable professional to make the best decision for your individual situation.
Dosing and administration
When you and your doctor choose a medication for nail fungus, it’s important to follow the prescribed dosage and the entire treatment plan.
Terbinafine dosing
For terbinafine, the typical dosage for onychomycosis is 250 mg daily. Treatment lasts for six weeks if the infection is in your fingernails and 12 weeks if it’s in your toenails.
Factors like kidney function may influence the dosage your doctor recommends.
Fluconazole dosing
Fluconazole is typically taken once a week for several months. A common dosage is 150 to 300 mg per week, and understanding the nuances of fluconazole 150 vs 200mg can be important.
As with terbinafine, factors like kidney function may influence the dosage your doctor recommends.
Importance of adherence
With both medications, it’s critical to follow the treatment plan exactly as prescribed. Missing doses or stopping early can lead to treatment failure and recurrence of the infection. Set reminders or enlist a friend or family member to help you stay on track.
Cost and Availability
Let’s talk about money. The costs of these medications can vary, but generic terbinafine is usually cheaper than brand-name fluconazole. Of course, generic versions of fluconazole are also available, which will bring the price down.
Both medications are widely available, but access might vary depending on where you live. Your insurance coverage also plays a big role. Some plans might prefer one drug over the other, or have different copays for each. Always check with your insurance company to see what your out-of-pocket costs will be.
Frequently Asked Questions
What is the most effective oral treatment for toenail fungus?
While individual results can vary, terbinafine is generally considered the most effective oral treatment for toenail fungus due to its higher cure rates compared to other antifungals. However, the “best” treatment depends on the specific type of fungus, potential side effects, and your overall health.
What is the best antifungal for nail fungus?
There isn’t a single “best” antifungal for nail fungus. Terbinafine is often preferred orally. Topical treatments, while less effective on their own, can be helpful in mild cases or as an adjunct to oral medication. The best choice depends on the severity of the infection and individual factors.
What do podiatrists prescribe for toenail fungus?
Podiatrists often prescribe oral terbinafine or itraconazole for toenail fungus, depending on the patient’s medical history and the severity of the infection. For some, itraconazole cream might also be a viable option. They may also recommend topical treatments or, in some cases, nail avulsion (removal of the nail) combined with antifungal therapy.
Is fluconazole better than terbinafine for nail fungus?
Generally, terbinafine is considered more effective than fluconazole for treating nail fungus. Studies have shown that terbinafine typically has higher cure rates and shorter treatment durations. Fluconazole may be considered as an alternative when terbinafine is not suitable due to contraindications or potential drug interactions.
What is the success rate of fluconazole?
The success rate of fluconazole for treating toenail fungus is lower than that of terbinafine. Cure rates with fluconazole typically range from 30% to 40%, and it often requires a longer treatment duration. Due to its lower efficacy, it is not the first-line treatment for onychomycosis.
The Bottom Line
Terbinafine and fluconazole are both antifungals prescribed to treat nail fungus. Terbinafine is typically more effective and requires a shorter treatment period than fluconazole. But it also carries a greater risk of liver problems. Fluconazole has a lower success rate and can interact with other drugs you might be taking.
The best choice for you depends on several things. These include how bad your infection is, other health problems you have, other medicines you take, and what you can afford.
Be sure to talk with a doctor about your infection and your overall health. They can help you decide which medicine is best for you, and they can monitor you for side effects during treatment.