Possible drug interactions in oral treatment of onychomycosis

Abstract

A variety of medications may interact with oral antifungal agents used to treat onychomycosis. This article summarizes some possible consequences of concurrent administration of various therapeutic agents with the oral antifungals fluconazole, griseofulvin, itraconazole, ketoconazole, and terbinafine.

Hydroxypropyl-β-cyclodextrin: A Novel Transungual Permeation Enhancer for Development of Topical Drug Delivery System for Onychomycosis

“…In general, the oral antifungal therapy is associated with severe systemic and gastrointestinal side effects. Terbinafine hydrochloride has been particularly reported to cause hepatotoxicity [2–4]; thus, a routine liver function test is recommended for patients taking continuous treatment of terbinafine hydrochloride for more than one month [1]. To eliminate its systemic toxicity, topical route of drug administration could be used in place of oral route.…”

Trans-Ungual Iontophoretic Delivery of Terbinafine

“…Unfortunately, oral therapy is associated with severe systemic and GI side effects 4. In particular, oral therapy with terbinafine hydrochloride (Lamisil) is associated with several limitations which include drug interactions, severe side effects, toxicity and a high rate of recurrence 5–7. Moreover, hepatic function tests are also recommended for this drug when administered continuously for more than 1 month due to concerns about potential hepatotoxicity 8…”

Preventing Complications in the Diabetic Patient with Toenail Onychomycosis

“…These agents lack the toxicity and equivocal results associated with earlier antifungals such as ketoconazole and griseofulvin and so may represent a cure for onychomycosis in contrast to the merely palliative therapy of traditional nail debridement. 10 In choosing an oral antifungal agent to treat onychomycosis, the physician must consider the patient's current regimen of pharmacotherapy as well as issues regarding efficacy, toxicity, and ease of treatment. Total avulsions should be augmented with antifungal treatment so that recurrence is less likely.…”

“…Education of diabetic patients plays a central role in the long-term management of the disease. 10 In patients requiring medications that may interact with oral antifungal agents, terbinafine would be the oral antifungal agent of choice. The use of orthoses should be recommended as an additional preventative measure against the pedal manifestations of diabetes.…”