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Intermittent Terbinafine for Toenail Fungus Treatment

Terbinafine (Lamisil ®) and itraconazole (Sporanox ®) are drugs in the oral history for the treatment of fungal nail. These drugs are expensive and the treatment regimen usually includes three months of treatment. Itraconazole has proven effective with a pulse dosing regimen, which means that the medication is taken daily for a week and not taken for three weeks, repeating the pulse on three occasions. This scheme reduces the cost of the drug, compared with a daily dose of 12 weeks. Terbinifine traditionally been established as a continuous dose, the treatment regimen is 250 mg daily for 12 weeks. In a recent study, the authors compared the results of trials of intermittent and continuous terbinafine and intermittent itraconazole. The three schemes treatment were as follows. intermittent terbinafine 250 mg / day for 4 weeks followed by 4 weeks of terbinafine and not after 4 weeks of terbinafine 250 mg / day. Itraconazole pulse: the pulse of 200 mg twice daily for 7 days, 21 days off, 7 days, 21 days off, 7 days (a total of three pulses). Terbinafine Continuous: 250 mg / day for 12 weeks.

Participants were followed for 72 weeks, mycological cure rates found that 83% for the pulse terbinafine group, 78% cure rate for continuous terbinafine group and 56% for the itraconazole pulse. Adverse events were minimal and did not require discontinuation of drug regimen. Adverse events did not differ significantly from one group to another. The authors concluded that the regime of intermittent terbinafine was as safe and effective as the regiment of continuous terbinafine and both were more effective than itraconazole therapy. (J Eur Acad Dermatol Venereol. 2009 Mar; 23 (3) :256-62).

Sporanox is contraindicated in patients with congestive heart failure. Sporanox ® should not be administered for the treatment of onychomycosis in pregnant patients or women contemplating pregnancy. Side effects may include nausea, vomiting, diarrhea, abdominal pain, fatigue, rash, headache, liver abnormalities. Rare cases of serious hepatotoxicity, including liver failure and death have occurred.

Lamisil is contraindicated in patients with Active liver. Side effects associated with Lamisil include headache, diarrhea, abdominal pain, naursea, flatulence, rash, taste disorders and visual and liver enzyme abnormalities. Some people taking Lamisil have developed severe liver damage leading to liver transplant or death.

Tips Treatment and prevention of toenail fungus

1. Place an antifungal powder or spray in your shoes a day or after use.
2. Turn your shoes often. Do not use the same shoes every day.
3. Keep shoes in a cool, dry place. Fungus grows in warm, humid, and will grow into the shoes if the shoes have not dried and stored in a cool place.
4. Change templates frequently. Amid use templates partially pull out of the shoe they can dry completely.
5. Use an antiperspirant spray if your feet sweat excessively. Antiperspirant aerosols decrease the amount of moisture and help prevent the growth the fungus.
6. Wash your shower mat regularly in hot water. The shower mat that gets on after a shower tends to retain moisture due to humidity, warm bathroom. Wash the carpet with hot water and dried completely on a weekly basis will reduce the growth of fungi.
7. Bleach out the shower on a weekly basis. cleaning products anti-microbial will not be as useful as a diluted chlorine once a week.
8. Avoid shoes that fit well, since may lead to interference in the toes. When the toe is jammed in the toebox, micro-trauma occurs in the nails, causing small breaks in the skin under and around the nail. This increases the probability of fungal infection.
9. Wear sandals in the locker room, if you belong to a gym or health club. One of the most usual to pick up a fungal infection of the feet is in the shower or gym clothing. Even if the gyms are cleaned regularly, wet, hot zone is a perfect environment for fungus to grow.
10. Wash your feet with anti-fungal soap to prevent reinfection and spread.

About the Author

Christine Dobrowolski, DPM is a podiatrist and owner of Northcoast footcare, Inc an online resource for foot health information and foot care products. More information on treatment of toenail fungus.

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