Toenail fungus. Just the words can make you cringe! But if you’re like a lot of people, you may be dealing with this very common condition. Medically known as onychomycosis, toenail fungus is a fungal infection that’s more than a cosmetic issue. It can affect your ability to walk comfortably and even worsen other health conditions.
Onychomycosis is incredibly common, accounting for a full third of all fungal skin infections and half of all nail diseases. Studies suggest that between 2 and 14 percent of people have it, but because many people don’t seek treatment, the real numbers might be even higher.
One of the medications used to treat toenail fungus is fluconazole, an oral antifungal. One of the benefits of fluconazole is that you only need to take it once a week.
But what’s the right diflucan toenail fungus dosage? How well does it work? Are there things you should consider before taking it? This article will give you a complete overview of using fluconazole to treat toenail fungus.
What is onychomycosis?
Onychomycosis is the medical term for toenail fungus. It’s typically not pretty, but it’s also usually not serious. Here’s what you need to know about the different types, what causes them, and how doctors diagnose them.
Types of onychomycosis
- Distal Subungual Onychomycosis (DSO): This is the most common type of toenail fungus, and it affects the end of the nail.
- White Superficial Onychomycosis (WSO): This type shows up as white spots on the surface of the nail. About 10% of toenail fungus cases are WSO.
- Proximal Subungual Onychomycosis (PSO): This is a less common type that starts near the cuticle.
- Candidal Onychomycosis: This type is caused by Candida, and it’s often seen in people who have immune system problems. It’s often linked to chronic paronychia, a skin infection around the nails.
What causes onychomycosis?
Most of the time, onychomycosis is caused by dermatophytes, especially Trichophyton rubrum. But other fungi, including yeasts and molds, can also cause it.
How is onychomycosis diagnosed?
It’s important to get a lab test to confirm onychomycosis because other nail problems can look similar. Common tests include KOH preparation and fungal culture. To get a sample for testing, your doctor will take nail clippings or scrapings from the affected area.
Fluconazole: How it Works
Fluconazole is an antifungal medication that belongs to a class of drugs called azoles. It works by blocking an enzyme called lanosterol 14-alpha-demethylase, which fungi need to create ergosterol.
What’s ergosterol? It’s a crucial part of the fungus’s cell membrane. If the fungus can’t make ergosterol, its cell membranes get messed up, and the fungus can’t grow or survive.
Fluconazole is great because you can take it by mouth, and it gets absorbed into your body really well. It also travels to different parts of your body, including the nail bed, which is where the fungus lives when you have a toenail infection. Your body gets rid of the drug through your kidneys.
The fact that fluconazole can be taken orally and reaches the nail bed makes it a convenient and effective treatment option for toenail fungus.
Diflucan dosage for toenail fungus: Evidence and recommendations
If your doctor prescribes Diflucan for toenail fungus, you’ll want to know how much to take and for how long.
Here’s what the science says.
Standard dosage regimen
One common approach to taking Diflucan is to take it once a week. The typical dose ranges from 150 mg to 450 mg each week.
Dosage comparison studies
One study looked at three different weekly doses: 150 mg, 300 mg, and 450 mg. Interestingly, the study found that all three doses were about equally effective.
In that study, researchers found that people who took Diflucan had far better outcomes than those who took a placebo (an inactive pill). The clinical success rates were 86 to 89 percent with Diflucan, compared with only 8 percent for the placebo.
The researchers also looked at “cure rates,” meaning how many people were completely free of the toenail fungus after treatment. The cure rates ranged from 28 to 36 percent with Diflucan, compared to 3 percent with the placebo.
Finally, they looked at how many people had the fungus completely eliminated from their toenails. The mycological eradication rates were 47 to 62 percent with Diflucan, versus 14 percent with the placebo.
How long will I need to take Diflucan?
The duration of treatment can range from 6 to 12 months, depending on how bad the infection is. In the studies, the mean time to clinical success was 6 to 7 months.
Considerations for dosage adjustment
If you have kidney problems, your doctor may need to adjust your Diflucan dosage. Also, it’s important to consider potential interactions with other medications you may be taking.
Be sure to tell your doctor about all the medications, vitamins, and supplements you take.
Diflucan compared to other antifungal treatments for toenail fungus
If you’re dealing with toenail fungus, you should know there are several treatments available.
Terbinafine
Terbinafine is often the first choice for treating toenail fungus caused by dermatophytes. Some studies show that terbinafine is more effective than some other antifungals at getting rid of the fungus and clearing up the infection.
In studies, terbinafine had a mycological cure rate (meaning the fungus was gone) of 71 to 82 percent and a clinical cure rate (meaning the nail looked normal again) of 60 to 70 percent for toenail infections.
Itraconazole
Itraconazole can fight a wider range of fungi, but it also has a higher chance of interacting with other medications you might be taking. You also need to be careful about taking it with food.
Studies have shown mycological cure rates of 45 to 70 percent and clinical cure rates of 35 to 80 percent for toenail infections when using continuous therapy.
Griseofulvin
Griseofulvin is mainly used for children.
However, newer medications are becoming available that may offer better results.
Topical antifungals
Antifungal creams and polishes don’t usually work well on their own for toenail fungus, but they can be helpful when used along with other treatments, such as red light therapy.
Is fluconazole safe? Side effects and drug interactions
Like any medication, fluconazole can have side effects and interact with other drugs.
Common side effects
The most common side effects of fluconazole are:
- Gastrointestinal problems, such as nausea and abdominal pain
- Headache
- Elevated liver enzymes (Your doctor may want to monitor your liver function during treatment.)
Rare but serious side effects
In rare cases, fluconazole can cause more serious side effects, such as:
- Hepatotoxicity (liver damage)
- QT prolongation (an issue with your heart’s electrical activity)
- Severe skin reactions, such as Stevens-Johnson syndrome
Drug interactions
Fluconazole can affect how your body processes other medications. It inhibits cytochrome P450 enzymes, which can lead to increased levels of other drugs in your system. Some important interactions can occur between fluconazole and drugs like warfarin, phenytoin, and certain statins.
Make sure your doctor reviews all the medications you’re taking before you start taking fluconazole.
Contraindications
You should not take fluconazole if you:
- Are hypersensitive to fluconazole or other azole antifungals
- Are taking other drugs that prolong the QT interval
What else can help?
In addition to taking antifungal medication, there are other steps you can take to get rid of your toenail fungus and keep it from coming back.
Adjuvant treatments
Your doctor might recommend these therapies to help your antifungal medicine work better:
- Nail avulsion. This is a procedure to surgically remove the infected nail. It can help antifungal medicines penetrate more deeply.
- Topical antifungal agents. You can use these creams and ointments along with oral medications to fight the fungus from the surface of the nail.
Preventive measures
Here are some things you can do on your own to keep toenail fungus from returning, including understanding at what temperature nail fungus dies.
- Practice good foot hygiene. Wear breathable shoes and socks made of cotton. Keep your feet dry.
- Treat athlete’s foot. Athlete’s foot is a fungal infection of the skin on your feet, and it can easily spread to your toenails.
- Don’t share nail clippers and files. If someone in your family has toenail fungus, don’t share nail grooming tools.
In Summary
Fluconazole (Diflucan) is one option your doctor might prescribe if you have toenail fungus. It’s an antifungal medication that can help to get rid of the infection, but it’s not the only way to treat toenail fungus.
Before you start taking any medication, it’s important to be sure you actually have a fungal infection. Your doctor might want to consider other possible conditions or other treatment options. If you and your doctor decide that fluconazole is the best option for you, be sure to ask about how long you’ll need to take it, any potential side effects, and ways to prevent future infections.