From the Research
Introduction to Alternatives for Ciclopirox (Ciclopirox Olamine)
For patients unresponsive to Ciclopirox (ciclopirox olamine), several alternative treatments are available. These alternatives can be categorized into topical and systemic antifungal therapies.
Topical Antifungal Therapies
Topical treatments are suitable for mild to moderate onychomycosis, especially when the disease involvement is less than 50-65% of the nail [ 1 ]. Options include:
- Amorolfine
- Ciclopirox (though the patient is unresponsive, it's listed for completeness)
- Tavaborole
- Efinaconazole
These treatments are applied daily for 24-48 weeks, with longer treatment and follow-up showing better outcomes [ 1 ].
Systemic Antifungal Therapies
For more severe cases or when topical treatments are not effective, systemic antifungal therapies can be considered. These include:
- Terbinafine, which is effective against a wide variety of dermatophytes [ 2 ]
- Itraconazole, which is used for severe yeast infections and certain dermatophyte infections [ 3 ]
- Fluconazole, used for severe yeast infections and as an alternative for certain dermatophyte infections [ 3 ]
Combination Therapies
Combination of topical and systemic treatments can also be an option. For example, combining oral terbinafine with topical ciclopirox olamine 8% or topical amorolfine hydrochloride 5% [ 4, 5 ]. These combinations may offer alternative regimens for the treatment of moderate to severe dermatophyte toenail onychomycosis.
Considerations and Caveats
When choosing an alternative treatment, it's essential to consider the causative organism, the severity of the infection, and potential drug interactions. Resistance to certain antifungals, such as terbinafine resistance in T. rubrum, may also guide the choice of therapy [ 3 ]. Additionally, therapy monitoring should be carried out culturally and, if possible, using molecular methods [ 3 ].
Dosing Information
- Oral terbinafine: 250 mg/day [ 2, 4, 5 ]
- Topical terbinafine 1% formulations: applied once or twice daily for up to 2 weeks [ 2 ]
- Ciclopirox nail lacquer topical solution, 8%: applied once daily for 48 weeks [ 4 ]
- Topical amorolfine hydrochloride 5%: applied once weekly at night on all the affected nails [ 5 ]