From the Guidelines
Terbinafine is the most effective treatment for tinea unguium, with a higher efficacy rate compared to itraconazole, and should be considered as the first choice of treatment. When treating tinea unguium, the following treatment options are available:
- Oral terbinafine, which is licensed at a dose of 250 mg per day for 6 weeks in fingernail and 12–16 weeks in toenail infection 1
- Oral itraconazole, which is licensed at a dose of 200 mg per day for 12 weeks continuously, or alternatively as pulse therapy at a dose of 400 mg per day for 1 week per month 1 Several large studies demonstrate higher efficacy rates for terbinafine in comparison with itraconazole, with a multicentre, randomized trial involving 508 subjects demonstrating complete cure in 55% of patients receiving 16 weeks of continuous terbinafine, compared to 26% of patients receiving pulsed itraconazole 1. It is essential to monitor treatment success by visible nail improvement and ideally confirmed with mycological testing, and to re-evaluate patients 3–6 months after treatment initiation and further treatment should be given if the disease persists 1.
From the FDA Drug Label
Terbinafine tablets are an allylamine antifungal indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium) (1) Terbinafine tablets, USP are indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium). The best antifungal for tinea unguium is Terbinafine 2, 2, 2.
- Key points:
- Indication: Treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium)
- Drug name: Terbinafine
- Drug class: Allylamine antifungal
From the Research
Antifungal Treatment for Tinea Unguium
- The most commonly prescribed oral antifungal agents for the treatment of tinea unguium are itraconazole and terbinafine 3.
- Itraconazole and terbinafine are effective in treating fungal nail infections, but they have different mechanisms of action and metabolic pathways, resulting in differences in efficacy and drug-drug interaction potential 3.
- Terbinafine has a relatively low potential for drug-drug interactions, making it a useful agent for the treatment of tinea infections in immunocompromised patients 3.
- Topical antifungal therapy is not as efficacious as oral antifungal therapy for the treatment of tinea unguium, except for the topical antifungal agent ciclopirox 3.
- A study found that itraconazole-containing groups showed significantly higher cure rates than terbinafine-only groups in the treatment of tinea infection 4.
Comparison of Itraconazole and Terbinafine
- Itraconazole seems to be more effective than terbinafine in the treatment of tinea infection 4.
- There is no benefit in increasing the dose or using a combination regimen of itraconazole and terbinafine in the treatment of tinea 4.
- Prolonged duration of treatment is required for complete cure of tinea infection 4.
Treatment Options for Tinea Unguium
- Oral antifungal agents, such as itraconazole and terbinafine, are the primary treatments for tinea unguium 5, 6.
- Topical antifungal agents, such as amorolfine and ciclopirox, may be used for milder cases of onychomycosis 5.
- Pulse therapy and short-duration therapy with oral antifungal agents have been reported to be effective in the treatment of tinea unguium 7.