From the Guidelines
Fluconazole is effective for onychomycosis of the toes, but its efficacy is lower compared to other treatments like itraconazole or terbinafine.
Key Points
- The mycological cure rates for fluconazole in toenail infections range from 47% to 62% 1.
- Clinical cure rates are lower, ranging from 28% to 36% for toenail infections 1.
- Higher doses (450 mg per week) and longer treatment duration (9 and 12 months) are associated with higher cure rates 1.
- Fluconazole may be a useful alternative in patients unable to tolerate terbinafine or itraconazole, with a once-weekly dosing regimen that may improve compliance 1.
- Common adverse effects of fluconazole include headache, skin rash, gastrointestinal complaints, and insomnia 1.
Treatment Guidelines
- The recommended dosage for fluconazole in toenail infections is 150-450 mg per week for at least 6 months 1, 2.
- Baseline liver function tests and full blood count are recommended, with monitoring of liver function tests in high-dose or prolonged therapy 2.
From the Research
Efficacy of Fluconazole for Onychomycosis of the Toes
- Fluconazole has been shown to be effective in the treatment of onychomycosis of the toenail, with clinical and mycologic success rates significantly superior to placebo 3, 4.
- Studies have demonstrated that fluconazole penetrates healthy and diseased nails rapidly, yielding detectable concentrations after two weekly doses, and persists for up to 6 months or longer after therapy is stopped 5.
- The efficacy of fluconazole in the treatment of onychomycosis of the toenail has been evaluated in several studies, with results showing that fluconazole is effective in eradicating clinical and mycologic symptoms of onychomycosis, both at the end of active treatment and at 6 months after treatment 3, 4.
- Clinical success rates at the end of therapy have been reported to be 86% to 89% for fluconazole-treated patients, compared with 8% for placebo-treated patients, with mycologic eradication rates of 47% to 62% at the end of therapy compared with 14% for placebo 4.
Dosage and Treatment Duration
- Studies have evaluated the efficacy and safety of different doses of fluconazole (150, 300, and 450 mg) given orally once weekly for the treatment of onychomycosis of the toenail 3, 4.
- Results have shown that all three doses are effective and well tolerated, with no significant differences between the doses on efficacy measures 4.
- The mean time to clinical success in the fluconazole treatment groups has been reported to be 6 to 7 months, which may be used as a guideline for fluconazole treatment duration 4.
Combination Therapy
- A study has evaluated the efficacy and safety of a combination therapy of fluconazole 1% and urea 40% compared with fluconazole 1% alone in a nail lacquer for the treatment of onychomycosis, with results showing that the combination therapy was more effective (82.8%) than fluconazole 1% alone (62.8%) 6.