What are the most effective treatments for nail fungus. How do topical treatments compare to oral medications. What are the success rates of different nail fungus treatments. How long does it take to treat nail fungus effectively. What are the potential side effects of nail fungus medications.

Understanding Nail Fungus: Symptoms and Diagnosis

Nail fungus, medically known as onychomycosis, is a persistent condition that affects many individuals worldwide. The most common signs of nail fungus include:

• Brittle or crumbly nails
• Whitish-yellowish or brownish discoloration
• Thickening of the nail
• Changes in nail shape
• Separation of the nail from the nail bed

Recognizing these symptoms is crucial for early diagnosis and treatment. But how does one confirm a nail fungus infection? Typically, a healthcare professional will examine the affected nail and may take a sample for laboratory testing to identify the specific type of fungus causing the infection.

Topical Treatments: Nail Polishes and Creams

When it comes to treating nail fungus, many people opt for topical treatments as their first line of defense. These treatments are available over-the-counter and come in various forms, including nail polishes and creams.

Medicated Nail Polishes

Two primary active ingredients are found in antifungal nail polishes:

1. Amorolfine: Applied once or twice a week
2. Ciclopirox: Application frequency varies, starting more often and gradually decreasing

How effective are these nail polishes? Studies on ciclopirox polish showed that after one year of treatment, about 32 out of 100 people no longer had a detectable fungal nail infection, compared to 10 out of 100 who didn’t use the treatment. This suggests a 22% success rate attributable to the ciclopirox polish.

Urea and Bifonazole Cream Sets

Another topical treatment option involves a set containing two creams and a nail scraper:

• Urea cream: Softens the nail for removal
• Bifonazole cream: Provides antifungal action

A study comparing this combination treatment to urea cream alone found that after three months, 51 out of 100 people using both creams showed no visible or detectable fungus, compared to 41 out of 100 using only urea cream. However, the long-term effectiveness of this treatment remains questionable, as many participants experienced a recurrence of the fungal infection.

Oral Medications: A Systemic Approach to Nail Fungus

For more severe or persistent cases of nail fungus, oral medications may be prescribed. These systemic treatments work from inside the body to inhibit fungal growth or eliminate the infection entirely.

What are the advantages of oral medications over topical treatments? Oral antifungal medications are generally more effective and can treat the infection more quickly than topical options. They can reach the infection through the bloodstream, attacking the fungus at its source.

Some common oral antifungal medications include:

• Terbinafine
• Itraconazole
• Fluconazole

These medications typically require a prescription and may need to be taken for several weeks or months, depending on the severity of the infection and the specific drug prescribed.

Comparing Effectiveness: Topical vs. Oral Treatments

When considering treatment options for nail fungus, it’s natural to wonder about their relative effectiveness. How do topical treatments stack up against oral medications?

While topical treatments have shown some efficacy, particularly in mild to moderate cases, oral medications generally demonstrate superior results. Oral antifungals can treat the infection more comprehensively and often in a shorter time frame compared to topical options.

However, it’s important to note that oral medications may come with a higher risk of side effects. This is why they’re typically reserved for more severe cases or when topical treatments have failed to produce satisfactory results.

Treatment Duration and Patient Compliance

One of the challenges in treating nail fungus is the extended duration of therapy required. How long does it typically take to treat nail fungus effectively?

For topical treatments:

• Nail polishes may need to be applied for up to one year
• Cream treatments usually last for several weeks to months

For oral medications:

• Treatment duration typically ranges from 6 to 12 weeks
• In some cases, treatment may extend to several months

The prolonged treatment period can pose challenges for patient compliance. It’s crucial for individuals to understand the importance of completing the full course of treatment, even if improvements are noticed early on. Premature discontinuation of treatment can lead to recurrence of the infection.

Potential Side Effects and Considerations

As with any medical treatment, it’s essential to be aware of potential side effects and considerations when treating nail fungus. What are the risks associated with different treatment options?

Topical Treatments

Generally, topical treatments have fewer systemic side effects due to their localized application. However, some individuals may experience:

• Skin irritation or redness around the nail
• Temporary nail discoloration
• Allergic reactions (rare)

Oral Medications

Oral antifungal medications can have more significant side effects due to their systemic nature. These may include:

• Gastrointestinal disturbances (nausea, diarrhea)
• Headaches
• Skin rashes
• Liver function abnormalities (rare but serious)

It’s crucial for patients to discuss their medical history and any current medications with their healthcare provider before starting oral antifungal treatment. Regular monitoring may be necessary during the course of treatment to ensure safety.

Preventing Recurrence: Long-term Management of Nail Fungus

Successfully treating nail fungus is only part of the battle. How can individuals prevent the recurrence of fungal nail infections?

Here are some strategies for long-term management and prevention:

1. Maintain good foot hygiene, including regular washing and thorough drying
2. Wear breathable footwear and moisture-wicking socks
3. Avoid walking barefoot in public areas like locker rooms and swimming pools
4. Use antifungal powders or sprays in shoes
5. Trim nails regularly and keep them short
6. Disinfect nail clippers and other pedicure tools after each use
7. Consider using a topical antifungal product as a preventive measure

By incorporating these practices into daily routines, individuals can significantly reduce their risk of developing recurrent nail fungus infections.

Alternative and Complementary Treatments for Nail Fungus

While conventional medical treatments are the primary approach to treating nail fungus, some individuals may be interested in exploring alternative or complementary therapies. What options exist outside of traditional medications?

Natural Remedies

Several natural remedies have been suggested for treating nail fungus, although their efficacy is often not scientifically proven. These include:

• Tea tree oil
• Oregano oil
• Apple cider vinegar
• Garlic
• Coconut oil

While some people report success with these remedies, it’s important to note that they may not be as effective as conventional treatments and could potentially cause skin irritation or allergic reactions.

Laser Therapy

Laser treatment for nail fungus is a relatively new approach that has gained attention in recent years. How does laser therapy work for nail fungus?

The procedure involves using high-powered lasers to target and destroy the fungus without damaging the surrounding nail or skin tissue. While some studies have shown promising results, more research is needed to fully establish the long-term efficacy of this treatment.

Advantages of laser therapy include:

• Non-invasive procedure
• No systemic side effects
• Relatively quick treatment sessions

However, laser therapy can be expensive and may not be covered by insurance. Additionally, multiple sessions may be required for optimal results.

Photodynamic Therapy

Photodynamic therapy (PDT) is another emerging treatment for nail fungus. This approach involves applying a photosensitizing agent to the affected nail and then exposing it to a specific wavelength of light. The light activates the agent, which then produces reactive oxygen species that destroy the fungal cells.

While PDT shows promise, it is still considered an experimental treatment for nail fungus, and more research is needed to determine its effectiveness and optimal protocols.

As with any alternative or complementary treatment, it’s crucial to consult with a healthcare professional before trying these approaches, especially if you’re also using conventional treatments.

When to Seek Professional Help for Nail Fungus

While mild cases of nail fungus can often be managed with over-the-counter treatments, there are situations where professional medical advice is necessary. When should you consult a healthcare provider about nail fungus?

• If you have diabetes or a weakened immune system
• If the infection is causing pain or discomfort
• If over-the-counter treatments haven’t improved the condition after several weeks
• If the infection appears to be spreading to other nails or areas of the body
• If you notice signs of a bacterial infection, such as redness, swelling, or pus

A dermatologist or podiatrist can provide a definitive diagnosis and recommend the most appropriate treatment plan based on the severity of your condition and your overall health status.

The Impact of Nail Fungus on Quality of Life

While nail fungus is often considered a cosmetic issue, it can have significant impacts on an individual’s quality of life. How does nail fungus affect people beyond the physical symptoms?

Psychological and social effects of nail fungus may include:

• Embarrassment and self-consciousness about the appearance of affected nails
• Reluctance to engage in activities that expose the feet or hands
• Reduced self-esteem and confidence
• Anxiety about the potential spread of the infection
• Frustration with the long-term nature of treatment and potential for recurrence

These factors underscore the importance of effective treatment and management strategies for nail fungus. By addressing both the physical and emotional aspects of the condition, healthcare providers can help patients achieve better overall outcomes and improved quality of life.

Future Directions in Nail Fungus Treatment

As research in the field of dermatology and mycology continues, new treatments for nail fungus are being explored. What innovations might we see in the future for managing this persistent condition?

Nanotechnology-based Treatments

Researchers are investigating the use of nanoparticles to deliver antifungal agents more effectively. These tiny particles could potentially penetrate the nail better than traditional topical treatments, improving efficacy while minimizing side effects.

Combination Therapies

Future treatments may involve combining different approaches for synergistic effects. For example, using oral medications in conjunction with topical treatments or combining conventional antifungals with natural compounds to enhance effectiveness.

Gene Therapy

As our understanding of the genetic factors influencing fungal infections grows, gene therapy could become a potential treatment option. This approach might involve modifying genes to make nails more resistant to fungal invasion or altering the fungus itself to make it less harmful.

Immunotherapy

Developing treatments that boost the body’s own immune response to fungal infections could provide a more targeted and potentially more effective approach to managing nail fungus.

While these potential future treatments are exciting, it’s important to remember that they are still in the research and development phase. Current treatment options, including topical and oral medications, remain the gold standard for managing nail fungus.

As we continue to explore new frontiers in nail fungus treatment, the goal remains the same: to provide more effective, safer, and more convenient options for patients struggling with this persistent condition. By staying informed about emerging treatments and working closely with healthcare providers, individuals can ensure they’re receiving the most up-to-date and appropriate care for their nail fungus infections.

Nail fungus: Polish, cream or tablets? – InformedHealth.org

Created: January 14, 2015; Last Update: June 14, 2018; Next update: 2021.

Nail fungus can be very persistent. Topical treatment with nail polish may take up to one year. Tablets for treating fungal nail infections usually have to be taken for several weeks or months. They are much more effective than topical treatments, but they have more side effects.

Brittle (crumbly) nails and a whitish-yellowish or brownish discoloration are typical signs of nail fungus. The nails may also become thicker and change shape. The affected part of the nail sometimes detaches from the nail bed. The treatment options for nail fungus include nail polishes and creams as well as tablets. Nail polishes and creams are available in pharmacies without a prescription.

What topical (external) treatments are there?

Nail polishes

Lots of people first try to treat nail fungus with a colorless nail polish. Before applying the nail polish, the affected nail has to be cut and filed down as much as possible. The nail polishes contain the growth-inhibiting and antifungal ingredients amorolfine or ciclopirox. The products differ in how often they have to be used:

• Amorolfine is applied one to two times a week.

• Ciclopirox products are usually applied every other day in the first month, at least twice a week in the second month, and once a week starting from the third month.

With both treatments, the old layer of polish has to be removed using an alcohol swab before applying the new layer. Cosmetic nail polish can be applied on top of the medicated nail polish. Newer ciclopirox nail polishes are water-soluble. They are applied daily, and the remaining polish is removed using water before each new application.

Sets with creams and a nail scraper

Treatment sets that contain two creams and a nail scraper (spatula) can also be used for the topical treatment of nail fungus:

• One cream has urea in it, which softens the nail so it can be removed.

• The other cream contains bifonazole, which has an antifungal effect.

For this treatment, the affected toe or finger first has to be soaked in warm water for ten minutes and then dried. After that, the urea-based cream is applied to the nail, and the nail is covered with an adhesive bandage. After 24 hours, the bandage is removed and the toe or finger is held in warm water again. The softened layer of the nail is then scraped off using a spatula, the cream is applied again and the nail is covered with a new bandage. This treatment is carried out over 14 days. Once the infected part of the nail has been scraped away completely, the skin beneath is treated for another four weeks with a bifonazole cream.

How effective are topical treatments?

So far, only a few studies have looked into topical nail fungus treatments with nail polishes or creams. Because these studies had weaknesses, the results should be interpreted with caution. Amorolfine has not yet been well studied. Ciclopirox polish and treatment sets with urea and bifonazole cream were tested in a few studies.

Research on the effectiveness of nail polish containing ciclopirox showed that, after one year:

• About 10 out of 100 people who did not use ciclopirox no longer had a detectable fungal nail infection.

• About 32 out of 100 people who used ciclopirox no longer had a detectable fungal nail infection.

In other words, treatment with ciclopirox got rid of the fungal infection in about 22 out of 100 people. But even if the fungus had gone away, the cosmetic result wasn’t always satisfying. The nails only looked healthy after treatment in 7 out of 100 people.

Treatment with sets containing urea and bifonazole cream was tested in one study. It was compared with a treatment in which only urea cream was applied and the nail was removed, but without applying bifonazole cream afterwards. Three months after treatment was completed, it was found that:

• No fungus was visible or detectable in about 41 out of 100 people who only used urea cream.

• No fungus was visible or detectable in about 51 out of 100 people who used both urea and bifonazole cream.

In other words, the combination of urea and bifonazole got rid of nail fungus in an extra 10 participants. But there was no difference between the two groups six months after treatment. Also, the fungal infection returned in many participants, so it’s likely that neither of the two treatments can increase the chances of getting rid of the fungus in the long term.

People did not take part in the study if their fungal infection covered more than half of the affected nail area or if the infection started at the base of the nail.

What oral medications are available?

To treat fungal nail infections from inside the body, you can take tablets that inhibit the growth of fungi or kill them. They are all prescription-only. Terbinafine and itraconazole are typically used for this purpose.

• Terbinafine is preferred if the nail fungus is caused by a skin fungus (dermatophyte). This is usually the case.

• Itraconazole is generally used if the nail infection is caused by yeast or mold.

Itraconazole and terbinafine tablets can both be taken either continuously or with breaks between treatments. But they are used differently:

Terbinafine

In continuous treatment, the medication is usually taken once a day for three months (dose: 250 mg).

In treatment with breaks, the medication can be taken as follows:

• 500 mg terbinafine (2 tablets) daily for a week, then a three-week break

• Or: 250 mg terbinafine (1 tablet) daily for four weeks, then a four-week break

Even in this approach, the treatment typically doesn’t take any longer than three to four months.

Itraconazole

In continuous treatment, itraconazole is taken once daily for a maximum of three months. The dose is then 200 mg per day (two 100 mg tablets).

In treatment with pauses, 400 mg of itraconazole is taken daily for a week (two 100 mg tablets in the morning and two in the evening). That is followed by a three-week break in treatment. This treatment also lasts three months or less.

Fluconazole

Fluconazole is only used if other treatments didn’t work or aren’t an option for other reasons. It is taken once a week (dose: 150 mg). But fluconazole has to be taken for about 6 to 12 months to work properly.

How effective are tablets in treating nail fungus?

Tablets for the treatment of nail fungus have been tested in several studies. All participants had an infection on their toenails caused by a skin fungus. Overall, the study results showed that tablets are considerably more effective than nail polishes or creams.

One year after a three-month treatment with terbinafine:

• About 17 out of 100 people who didn’t have this treatment no longer had a detectable fungal nail infection.

• About 76 out of 100 people who had this treatment no longer had a detectable fungal nail infection.

In other words, the treatment with terbinafine got rid of the fungal infection in about 59 out of 100 people.

Itraconazole also proved to be effective. After one year,

• 7 out of 100 people who didn’t have this treatment no longer had a detectable fungal nail infection.

• About 43 out of 100 people who had this treatment no longer had a detectable fungal nail infection.

In other words, the treatment with itraconazole got rid of the fungal infection in about 36 out of 100 people.

Some studies directly compared itraconazole and terbinafine with each other. They confirm that terbinafine is somewhat more effective than itraconazole.

Treatment with breaks is thought to be about as effective as continuous treatment. But that has only been looked into in a few studies.

What side effects and drug-drug interactions do the tablets have?

The possible side effects of itraconazole include headaches, dizziness, stomach and bowel problems, and rashes. Itraconazole can also interact with a number of other drugs. These include cholesterol-reducing and blood-sugar-lowering medications, as well as certain sleeping pills. It is therefore important to let your doctor know about any medication you take. Itraconazole is not an option for people with heart failure (cardiac insufficiency). It also isn’t suitable for women who are pregnant or breastfeeding.

Terbinafine can cause gastrointestinal (stomach and bowel) problems and a temporary loss of taste and smell. It can also interact with certain antidepressants and heart medications. Overall, terbinafine has far fewer drug-drug interactions than itraconazole. Nevertheless, it’s still important to tell your doctor if you are taking any other medication. As a precaution, this medication should not be taken during pregnancy or if you are breastfeeding.

The studies only rarely reported on how often the different side effects occurred. But most people tolerate nail fungus medications well. Only a few people in the studies stopped treatment because of side effects.

But there is a very small risk of liver damage from taking itraconazole or terbinafine. For this reason, people with a liver disease are only given these medications if it’s absolutely necessary.

What can be expected of products such as tea tree oil?

Sometimes home remedies such as applying tea tree oil or vinegar are recommended for the treatment of nail fungus. But there aren’t any good quality studies on whether these or other products help to treat nail fungus.

When are the different treatments considered?

Most doctors recommend treating nail fungus with nail polish or cream if

• not much more than half of the nail is affected by the fungus,

• the base of the nail is not infected, and

• only some nails are affected.

Topical treatment is also usually recommended for children. One reason for this is that most oral medications aren’t suitable for children. Another reason is that children have thinner nails that grow more quickly, so it’s assumed that treatment with nail polish or creams is more likely to work in children than in adults. White superficial onychomycosis is also often treated with a nail polish or cream.

If several nails are infected by the fungus, or if the infection has spread out more on the affected nails, it’s usually necessary to take oral medication. And if the infection started at the base of the nail, it’s highly likely that only tablets will help.

Additional treatments

If the fungal nail infection is severe, tablets can be used in combination with nail polish or cream. For example, if the nail is very thick, urea cream can be used (in addition to taking tablets) to gradually remove or partially file off the affected nail. Combining these treatments may also be an option if there are large collections of fungi beneath the nail. Another option for severe fungal nail infections is professional medical footcare. If the nail is filed off, it’s important to ensure good hygiene and disinfect the area, because the removed nail tissue could contain infectious fungal spores.

Sometimes people with a fungal nail infection are offered laser treatment. This involves shining infrared or ultraviolet (UV) light on the nail in order to kill the fungi. Laser treatments haven’t been proven to work in good quality studies. Because statutory health insurers in Germany don’t cover the costs of this treatment, people have to pay for it themselves.

Which treatment is right for me?

Nail fungus is usually harmless. But many people find discolored or thickened nails unpleasant to look at and want to get rid of the fungus as soon as possible. Fungal nail infections can also spread, and may infect other people. Regardless of the treatment you choose, it will take a while until the nail looks normal again. It’s especially important to be patient where toenails are concerned. It can take a year for a healthy big toenail to grow back. Nail fungus can sometimes be very persistent despite treatment. It can also come back after successful treatment.

Topical treatment (polish or cream) isn’t likely to get rid of a fungal nail infection. Treatment with tablets is considerably more effective and takes less time. But some people can’t take tablets because of the very rare, yet serious risks. How you feel about the pros and cons of the different treatment options is a personal matter. You can also discuss the options with your doctor.

Sources

• Crawford F, Hollis S. Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database Syst Rev 2007; (3): CD001434. [PMC free article: PMC7073424] [PubMed: 17636672]

• De Berker D. Clinical practice. Fungal nail disease. N Engl J Med 2009; 360(20): 2108-2116. [PubMed: 19439745]

• Deutsche Dermatologische Gesellschaft (DDG), Deutschsprachige Mykologische Gesellschaft (DMykG). Tinea der freien Haut (S1-Leitlinie). AWMF-Registernr.: 013-002. October 2008.

• Eisman S, Sinclair R. Fungal nail infection: diagnosis and management. BMJ 2014; 348: g1800. [PubMed: 24661991]

• Gupta AK, Daigle D, Foley KA. Topical therapy for toenail onychomycosis: an evidence-based review. Am J Clin Dermatol 2014; 15(6): 489-502. [PubMed: 25257931]

• Kreijkamp-Kaspers S, Hawke K, Guo L, Kerin G, Bell-Syer SE, Magin P et al. Oral antifungal medication for toenail onychomycosis. Cochrane Database Syst Rev 2017; (7): CD010031. [PMC free article: PMC6483327] [PubMed: 28707751]

• Tietz HJ, Hay R, Querner S, Delcker A, Kurka P, Merk HF. Efficacy of 4 weeks topical bifonazole treatment for onychomycosis after nail ablation with 40% urea: a double-blind, randomized, placebo-controlled multicenter study. Mycoses 2013; 56(4): 414-421. [PubMed: 23586591]

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

How and when to take or use terbinafine

The treatment you use will depend on where the infection is on your body and how severe it is.

For large areas of skin, or if the area is hairy, it’s best to use the spray.

If you buy terbinafine in a pharmacy or shop, follow the instructions that come with your medicine.

Dosage

Your doctor or pharmacist will tell you how much terbinafine to use and how long you need to use it for, depending on your infection.

If you’re using the cream, gel or spray, you’ll usually need to use it once or twice a day.

If you’re using the solution, you only use it once.

If you’re taking the tablets, the usual dose is 1 tablet, taken once a day. You’ll usually take the tablets for 2 to 6 weeks. This depends on the type of infection you have and how serious it is.

How to use terbinafine cream or gel

Put the cream or gel on the infected area once or twice a day for 1 to 2 weeks.

1. Wash your hands before using the cream or gel.
2. Wash and dry the infected skin where the cream or gel will go. If you’re treating your feet, it’s also important to wash and dry between your toes first.
3. Unscrew the cap.
4. Squeeze out a small amount of the cream or gel onto your finger (enough to put a thin layer on your skin).
5. Gently rub it into the infected areas. Avoid putting it near your mouth, lips and eyes.
6. Replace the cap.
7. Wash your hands.

If you’re using the cream or gel on the area between your toes, or on your bottom or groin, you can cover the skin with a clean strip of gauze afterwards. This type of light dressing is available to buy at pharmacies and is especially helpful to use at night.

How to use terbinafine spray

Put the spray on the infected area once or twice a day for 1 to 2 weeks.

1. Wash your hands before using the spray.
2. Wash and dry the infected skin before using the spray. If you’re treating your feet, it’s also important to wash and dry between your toes first.
3. Take the cap off and prepare the spray by pressing the top of the spray down once or twice.
4. Hold the bottle about 10cm away from the infected area and spray until your skin is thoroughly wet. Avoid getting it near your mouth, lips and eyes.
5. Replace the cap.
6. Wash your hands.

If you’re using the spray on the area between your toes, or on your bottom or groin, you can cover the skin with a clean strip of gauze afterwards. This type of light dressing is available to buy at pharmacies and is especially helpful to use at night.

How to use terbinafine solution (Lamisil Once)

The solution for athlete’s foot comes in a tube with a nozzle. It’s a single treatment that you only use once.

Use the solution on both feet even if one of them looks fine. If one foot looks less infected than the other, put the solution on the less infected foot first.

1. Use the solution after a shower or bath. Before using the solution, make sure your feet are dry, including between your toes.
2. Remove the cap.
3. Put the solution all over your toes, including between each toe, and on the sole, top and sides of your foot. This should use about half the tube. Finish treating this foot before treating the other.
4. Do not rub or massage the solution in.
5. Leave the solution to dry on your feet for 1 to 2 minutes.
6. Replace the cap and throw the tube away.
7. Wash your hands.
8. Put on your normal shoes and socks.

Do not wash or splash your feet with any water for 24 hours after using the solution.

After 24 hours, wash your feet with warm, soapy water in the bath or shower and gently pat them dry.

How to take terbinafine tablets

Swallow the tablet whole with a drink of water.

You can take terbinafine tablets with or without food. It’s best to take your tablets at the same time each day.

If you have a fungal nail infection, you’ll probably need to take the tablets for several months. These infections take a while to clear.

How long to take or use it for

If you’re using the cream, gel or spray, you’ll usually need to use it for 1 to 2 weeks. Talk to your doctor if your symptoms do not get better within 2 weeks.

If you’re taking the tablets, you’ll usually take them for:

• 2 to 4 weeks if you have jock itch
• 2 to 6 weeks if you have athlete’s foot
• 4 weeks if you have ringworm
• 6 weeks to 3 months (sometimes longer) if you have a fungal nail infection

It’s important to keep taking or using terbinafine until you finish the course, even if your symptoms get better. Follow the instructions from your doctor or on the leaflet that comes with the medicine.

If you stop using your terbinafine too soon, or if you do not use it as recommended, the fungal infection could come back.

Talk to your doctor if you’re thinking of stopping your treatment for any reason.

If you forget to take it or use it

If you forget to use your terbinafine cream, gel or spray, just use it as soon as you remember and then keep following your usual routine.

If you forget to take a terbinafine tablet, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just skip the missed dose and take your next one at the usual time. Then carry on until you have finished the course.

Do not take 2 doses to make up for a missed dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember your medicines.

If you take or use too much

If you use too much terbinafine cream, gel or spray or use it more often than you need to, it may make your skin irritated or red. If this happens, use less of the cream, gel or spray the next time.

Taking 1 or 2 extra terbinafine tablets is unlikely to harm you.

If you take more than this, you may get side effects including stomach pain, feeling or being sick, diarrhoea, headache or feeling dizzy.

Urgent advice: Contact 111 for advice now if:

• you take a lot of terbinafine tablets at the same time (4 or more) even if you have no side effects
• you take 2 or more terbinafine tablets and have side effects

Call 111 or go to 111. nhs.uk. Call 111 if you need advice for a child under the age of 5 years.

If you need to go to A&E do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the terbinafine packet, or the leaflet that came with your medicine, and any remaining medicine with you.

Terbinafine from nail fungus in Engels: 93-products: free shipping, discount-30% [link]

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Terbinafine for nail fungus 9 0003

TERBINORM Spray: overcome fungus with ease

Increased the number of sunny days, the thermometer tends to rise, nature is actively changing, mood and, of course, our wardrobe is changing. More and more open things and contact with the outside world. With the onset of heat, the risk of trauma to the open skin of the feet and nails increases, the intense work of the body’s thermoregulation system leads to increased sweating, including the feet, and favorable conditions are formed for the development of a fungal infection. It is difficult to hide this not only a cosmetic problem, in addition, it becomes obvious to others. Therefore, it’s time to purchase a modern effective antifungal agent.

Among antifungal drugs, terbinafine has gained well-deserved popularity due to its pronounced fungicidal action against a wide range of dermatophytes, molds and dimorphic fungi, as well as its safety.

TERBINORM spray (manufactured in Romania) is a topical preparation of terbinafine for the treatment of fungal infections of the skin caused by dermatophytes of the genus Trichophyton , Microsporum canis and Epidermophyton floccosum . It is advisable to use the drug for such common mycoses as interdigital epidermophytosis of the feet (“athlete’s foot”), inguinal dermatophytosis (“jockey’s itch”), dermatophytosis of the body (ringworm), as well as for versicolor versicolor caused by Pityrosporum orbiculare ( Malassezia furfur ).

The mechanism of action of terbinafine is directed at the enzyme systems of the fungus, which have a low affinity for the human cytochrome system (Burbello A. T., 2007). That is why the drug does not affect the synthesis of human steroid structures (cholesterol, hormones) (Zaichenko A.V., 2013). Many drugs are metabolized by the cytochrome P450 system. Terbinafine has a significant metabolic neutrality and little enters into pharmacokinetic interactions with other drugs (Shtrygol S.Yu., 2006). Thus, terbinafine is the first choice antimycotic for patients receiving drug therapy for concomitant diseases (Vashchenko O.O. et al., 2009). In old age, it is necessary to take into account the severity of systemic action and, accordingly, possible systemic adverse reactions of the drugs used. TERBINORM Spray acts exclusively at the site of application, as less than 5% of the applied dose of terbinafine is absorbed.

The clinical course of mycosis is often complicated by the bacterial flora, so therapy should be complex and include drugs with antimicrobial and anti-inflammatory effects. In studies, a high activity of external forms of terbinafine against gram-positive and gram-negative bacteria was noted (Bolotnaya M. A., 2012). The spray shape allows you to evenly distribute the drug over the surface of the skin. TERBINORM spray is convenient and easy to use, provides quick treatment of fungal lesions, which is especially important in the presence of large lesions or their localization in skin folds, between the toes. It should be noted that in addition to the antifungal action, terbinafine has a high anti-inflammatory activity and pronounced antibacterial properties, and due to lipo- and keratophilicity, it is quickly absorbed into the skin, softening it (Klimova I.Ya. et al., 2007). The spray form has a refreshing, drying , anti-inflammatory and antipruritic effects. Another advantage of TERBINORM spray is that the drug is odorless, colorless and does not leave marks on clothes. The course treatment with TERBINORM spray is 7 days. The drug is used once a day, while creating therapeutic concentrations of terbinafine in the skin layers, which persist for up to 1 week, which determines the post-therapeutic effect of the drug.