Contents
Mochalov Pavel Alexandrovich
MD therapist
Nail fungus is an infectious disease that is easily transmitted from person to person. Having struck one finger, she will not stop and will gradually capture new healthy areas. The fungus is diagnosed in adults and children. Infection often occurs in rooms with high temperature and humidity. High-risk areas are swimming pools and locker rooms in gyms, baths and saunas. If one of the family members suffers from nail fungus and walks barefoot on the floor, then it is enough to follow in his footsteps to become infected.
It contributes to the infection and reproduction of nail fungus, their long-term moisturizing, for example, with daily wear of shoes that do not have time to dry out. Additional risk factors are injuries and other damage to the nail.
It will be possible to cope with the infection only with the passage of a full-fledged treatment course. Complex therapy is especially important if a person is at risk, for example, suffering from diabetes. It is necessary to consult a doctor at the first signs of illness. Treatment of nail fungus is the responsibility of a dermatologist or mycologist. The doctor will be able to accurately determine the cause of changes in the nail plate, which can be triggered not only by a fungus, but also by other diseases.
If the infection is detected at an early stage, then it will not be difficult to cope with it. Often it is possible to get by with local therapy, for which the patient is prescribed varnishes, creams, ointments. If the remedy is chosen correctly, then it will be possible to forget about the fungus after the nail plate is completely renewed.
Treatment is necessary not only to prevent the fungus from spreading to healthy nails and skin, but also to avoid becoming a source of infection for other people, including family members.
If the disease progresses for a long time, then it will not be possible to cope with it only with the help of local drugs. You need to take pills.
Despite active advertising, it will not be possible to cure nail fungus solely with the help of varnish, even medical one. In advanced cases, monotherapy with solutions does not work. The fungus must be destroyed from the inside, since it is localized not only in the nail plate.
Tablets for the treatment of nail fungus are based on substances that have fungicidal activity. They are aimed at suppressing their growth, affecting the body as a whole. The selection of drugs should be handled by a specialist who will take into account not only the indications for the start of therapy, but also the possible harm, as well as contraindications.
Terbinafine
Analogues: Lamisil, Exifin, Terbizil, Binafin, Tebikur, Terbifin [1]
In the pharmacy, the drug can be found not only in the form of tablets, but also in the form of a cream. You don’t need a prescription to buy the topical form, but you will need one to buy the tablets.
The active ingredient is terbinafine hydrochloride. This is a substance from the group of allylamines with a wide spectrum of antifungal activity. It is equally effective against fungi that affect the nail plate, skin and internal organs. By acting on the shell of the fungus, the drug simply destroys it, thereby causing the death of the organism. In this case, the production of ergosterol of the fungus is suppressed, which it needs to strengthen its own walls.
Indications:
Fungal infections provoked by various reasons.
Treatment of trichophytosis (ringworm).
Dermatophytic.
Stop fungus.
Fungus of the internal organs.
Therapy should take place under medical supervision. When treating with Terbinafine, control of the blood picture is required, since the active ingredient can affect the level of platelets and neutrophils.
Side effects most often occur when taking high doses, they are expressed in allergic reactions, dizziness, taste distortion, disorders in the liver and kidneys. The transition of chronic arthritis to the acute phase is possible.
Do not prescribe the drug to pregnant and lactating women, children and patients with severe disorders of the liver and kidneys.
The dosage is selected individually, depending on the severity of the disease. The course can last up to six months, or until the nail is completely renewed and negative test results are obtained.
Lamisil
Price: 540 rubles
Tablets based on terbin afin hydrochloride. They are active against most fungi that can infect nails – these are dermatophytes, molds and dimorphic fungi. The drug penetrates into the plate during the first weeks from the start of treatment. Lamisil is prescribed both for nail fungus and for mixed infections, involving other parts of the body. In most cases, patients tolerate therapy well. [2].
Pros:
When ingested, a high concentration of the active ingredient is created in the nails, which provides a high-quality fungicidal effect.
Biological availability is high, exceeds 70%.
There is no dependence on food, food intake does not require dose adjustment.
Onychomycosis is a direct indication for the beginning of treatment.
The minimum number of contraindications.
It is made in Switzerland.
Cons:
A hepatotoxic effect is not excluded both in patients with liver diseases and without.
The course of treatment is long, for complete recovery it may take up to 12 weeks of therapy and even more.
Common side effects include: headache, taste disturbances, loss of appetite, increased gas production, skin rashes, hives, diarrhea, mild abdominal pain.
Exifine
Price: 950 rubles
Tablets are indicated for use in nail fungus caused by various mycotic microorganisms, since their main component, terbinafine hydrochloride, has a wide spectrum of activity. The drug is prescribed for fungus of nails, skin, feet, mucous membranes [3].
Pros:
High bioavailability, which is 80%.
The age of the patient does not affect the pharmacokinetics of the drug.
Exifin is effective against advanced fungal infection.
Can be used in the treatment of aging patients. Dose adjustment is not required.
During treatment, you do not have to remove the affected nail plate.
Cons:
Do not prescribe for the treatment of children under 2 years of age, pregnant and lactating women.
The drug can provoke an exacerbation of psoriasis.
Do not prescribe pills to patients suffering from alcoholism.
Treatment is long, can reach 6 months or more.
Side effects are most often observed from the digestive system and are manifested by nausea, loss of appetite, flatulence. Allergic reactions, as well as pain in muscles and joints, are not excluded.
When taking the drug together with oral contraceptives, menstrual irregularities are possible.
Terbizyl
Price: 300 rubles
Antifungal drug based on terbinafine at an affordable price. Possessing a wide spectrum of activity, the drug destroys the membrane of the fungus, leading to its death. Tablets are active against most mycoses that can affect the nail plate [4].
Pros:
Bioavailability is high, about 70%.
The drug can be prescribed to elderly patients without prior dose adjustment.
The tablets are effective against severe onychomycosis.
The price is not high (compared to a number of other drugs for the treatment of nail fungus).
The list of absolute contraindications is insignificant.
Made in Hungary.
Cons:
The ban on therapy is pregnancy, age under 2 years and breastfeeding.
It is recommended to take the drug after meals.
Side effects from the digestive system are possible, dizziness and headaches, allergic reactions, pain in muscles and joints are not excluded.
When taken together with alcohol, the risk of liver damage increases.
Fluconazole
Analogues: Vertex, Diflazon, Diflucan, Medoflucon, Mikomax, Mikosist, Prokanazol, Fangiflu, Flucoside, Fluconorm, Forkan, Ciskan [5].
In addition to tablets, Fluconazole is available in the form of capsules, sprays, gels, ointments and suppositories for vaginal use. When purchasing drugs for oral administration, a prescription from a doctor is required. The active ingredient of the drug is fluconazole, which is detrimental to most fungal microorganisms.
Indications:
Fungus of the nail plate and feet.
Prevention of fungal infection with a decrease in immunity.
Cryptococcosis of the nervous system, digestive organs and skin.
Prevention of fungal infection during immunosuppressive therapy, as well as during donation.
Therapy of candidiasis and pink lichen.
The doctor will help determine the dose, its selection depends on the severity of the course of the disease. Among the undesirable effects: allergic reactions, itchy skin, abdominal pain, changes in blood counts. In this regard, therapy should be carried out under the supervision of a specialist.
It is forbidden to prescribe Fluconazole and preparations based on it to patients suffering from serious liver diseases, in particular, from cirrhosis and hepatitis. It is not used in the treatment of pregnant and lactating women, patients with impaired renal function. A strict dose calculation is required when used in pediatric practice.
To achieve the optimal effect, oral administration of the drug and the use of local forms are recommended. The course lasts 2 months.
Vertex
Price: 650 rubles
Fluconazole-Vertex is a drug with antifungal activity. He is a representative of a new class of triazole antimycotics. Due to the wide spectrum of action, it can be used in the treatment of various forms of nail fungus. [6].
Pros:
When taken orally, bioavailability exceeds 90%.
Nail dermatophytosis is a direct indication for therapy.
Tablets can be used for prophylactic purposes, with a high risk of contracting a fungal infection.
Eating does not affect the absorption of active ingredients.
The release of the drug is carried out by the Vertex company, which has modern production and its own research center.
Cons:
The drug is not prescribed for children under 3 years of age, pregnant and lactating women, persons with lactose intolerance.
Common side effects include headache, abdominal pain, nausea, vomiting, diarrhea, elevated ALT and AST, and rash.
The drug interacts with a number of other drugs, which must be considered when starting treatment. Among them: Terfenadine, Astemizol, Pimozide, Quinidine, Erythromycin and not only.
When taken by patients with severe liver damage, a lethal outcome is not ruled out.
Diflucan
Price: 400 rubles
Diflucan is a fluconazole-based drug that is active against various fungal infections. It prevents the production of sterols in the cell of fungi, thereby causing their death. The drug is prescribed for fungal infections of the nails, if taking other medicines is not possible [7].
Pros:
When taken orally, the bioavailability is high, equating to 90%.
The treatment regimen is convenient, with nail fungus it is enough to take one capsule per week.
In most cases, Diflucan is well tolerated by patients.
The drug was developed and manufactured in France. It has been produced in Russia for over 25 years.
Cons:
The drug is not recommended for the treatment of children under 3 years of age, as well as pregnant and lactating women.
Long-term therapy is required, which can be 6-12 months.
Among the most common side effects: headache, abdominal pain, vomiting, diarrhea, skin reactions.
Patients with HIV and cancer should be careful when undergoing therapy.
ECG changes are possible, including an increase in the QT interval, ventricular fibrillation, which is most often observed in patients with severe heart disease.
Mycosist
Price: 500 rubles
The drug is used in the treatment of nail fungus, as it has fungistatic activity. It is well tolerated by patients and rarely causes side effects. This makes it possible to use tablets and capsules for long-term therapy, which, with nail fungus, can last from six months or more. [8].
Pros:
A wide spectrum of action, which allows the use of tablets in the treatment of various fungal infections of the nail.
When taken orally, the drug is well absorbed in the gastrointestinal tract, its biological activity reaches 90%, which makes it possible to increase the effectiveness of therapy.
Side effects occur rarely, most often when the dose is exceeded.
Mikosist is produced in Hungary, undergoes strict quality control.
Cons:
During therapy, regular monitoring of the blood picture is required.
It is possible to have a toxic effect on the liver, therefore, if nausea, vomiting, rashes and other symptoms of organ damage appear, you should immediately consult a doctor.
Self-administration of the drug is unacceptable, as it interacts with other drugs, including anticoagulants, phenytoin, rifampicin and others.
Among the most common adverse reactions: headaches, disorders in the digestive tract, skin rashes.
Ketoconazole
Analogues: Mycozoral, Funginok [9]
Ketoconazole can be found in different forms of release. Tablets can only be purchased with a doctor’s prescription. Shampoos, suppositories, creams and other topical products are available for sale. The active ingredient ketoconazole is active against most representatives of the fungal flora. Tablets are prescribed for severe disease, or in the absence of the effect of local therapy. The destruction of the fungus occurs due to the destruction of the protein component of its membrane.
Indications:
Fungal infection of the nail plates of the fingers and toes.
Candidiasis of various localization.
Thrush (in the absence of the effect of fluconazole therapy).
Ketoconazole therapy is associated with a number of side effects, including: hair loss, disorders of the digestive system, deterioration of potency, sleep problems, conjunctivitis, irritability.
The drug is not used in the treatment of children under 12 years of age, with severe liver and kidney diseases. It is contraindicated in pregnancy and individual intolerance.
The minimum therapeutic course is 4 weeks.
Mycosoral
Price: 300 rubles
The drug is used in the treatment of fungal infections, as it has a fungicidal and fungistatic effect on most pathogenic flora that causes damage to the nail plates. Ketoconazole was first introduced into the practice of systemic treatment of onychomycosis back in 1984. Since then, more effective drugs have appeared, with a high safety profile, so it is used only when they are intolerant. [10].
Pros:
The drug has been used systemically for more than 30 years, so its effects are well studied and expected.
The active ingredient is well absorbed when taken orally.
Cons:
Numerous side effects with a high risk of their occurrence.
Low efficacy in ketoconazole compared to other antifungal drugs.
Bioavailability is reduced when taken with antacids, anticholinergics, proton pump inhibitors, didanosine.
It is necessary to take the drug during meals.
Ketoconazole has a hepatotoxic effect, the likelihood of which increases with a course of longer than 2 weeks.
Itraconazole
Analogues: Irunin, Itrazol, Candshitral, Myconichol, Orungal, Orungamine, Orunit, Rumicoz, Teknazol [11].
A prescription drug that comes in the form of a solution and capsules. The active ingredient is itraconazole, which has a wide spectrum of antifungal activity. Its action is aimed at destroying the wall of the fungus. This is due to the suppression of estradiol production. Resistance to the drug develops extremely rarely, so it is used in the treatment of severe fungal infections.
Indications:
Onychomycosis (nail fungus), regardless of the cause that provoked the disease.
Fungal infection of the mucous membranes.
Fungal diseases caused by a decrease in immunity.
Fungal infection of internal organs.
When taking the drug, side effects may occur, in particular, loss of appetite, abdominal pain, headache. Long-term therapy requires monitoring of the state of the liver.
Do not use the drug in the treatment of patients with liver disease, with severe kidney damage. It is not prescribed to pregnant and lactating women.
The minimum course duration is 3 months.
Irunin
Price: 400 rubles
Irunin is a broad-spectrum drug that is active against dermatophytes and other fungi that cause infection of the nail plate. It can be used to combat mold mycoses, which are difficult to treat. [12].
Pros:
Biological availability is more than 80%, which determines the high efficiency of the drug.
The active component is found in the nail plate within a week after the start of therapy and remains in it for at least six months, subject to a course intake of 3 months.
The drug is well distributed in the tissues, which allows it to be used in the treatment of advanced forms of nail fungus.
The list of contraindications is minimal.
Perhaps the use of the drug in a continuous treatment regimen or pulse therapy, short courses.
Cons:
Relationship with food.
The drug is prescribed with caution to children, pregnant women and patients with serious diseases of the liver and kidneys.
Possible side effects in the form of dyspeptic disorders, abdominal pain, nausea. Some patients report headache, dizziness, allergic reactions. Women experience menstrual irregularities.
Itrazol
Price: 400 rubles
The drug is effective in the treatment of onychomycosis, as it destroys the membrane of fungi, causing their death. It is active against most representatives of the fungal flora that cause damage to the nail, including against dermatophytes and mold microorganisms. [13].
Pros:
The drug is well absorbed in the gastrointestinal tract, joint intake with food increases bioavailability.
The concentration in the tissues of the nail plates is high, more than in plasma by 4 times.
The drug is effective against complex forms of nail fungus. It can be used for combined infections.
The concentration of the drug in the nail, necessary for the destruction of the fungus, is observed already a week after ingestion and lasts up to 6 months.
Cons:
The drug is contraindicated in pregnant and lactating women, children under 3 years of age.
Relationship with food.
Side effects in the form of flatulence, nausea, constipation, hepatitis, loss of appetite, headache, increased fatigue. Allergic reactions are not excluded.
There is a risk of liver damage and heart failure.
Orungal
Price: 3000 rubles
Capsules Orungal have a wide spectrum of activity against fungal flora. By destroying the cell membrane, the drug contributes to its death, thereby preventing the spread of infection. With the right course, a complete recovery occurs. [14].
Pros:
Drug resistance rarely develops.
The therapy is effective in the treatment of onychomycosis caused by dermatophytes, yeasts and molds.
In the nail plates, a high concentration of the active substance is observed,
It can be used according to the pulse therapy scheme or as a continuous course.
The drug is made in Italy.
Cons:
The drug is prohibited for patients with heart failure, pregnant and lactating women, children under 3 years of age.
Relationship with food.
Among the side effects that are more common than others: headache, nausea, abdominal pain, menstrual irregularities.
High price.
Voriconazole
Analogues: Varicose veins, Vifend, Biflurin [15].
A broad-spectrum antifungal drug from the triazole group. It affects the synthesis of ergosterol, which is necessary for the membranes of fungal cells. As a result, their destruction and death of the body occur. The drug is dispensed by prescription.
Indications:
Severe nail fungus.
Aspergillosis is invasive.
candidal infections.
Prevention of fungal infection in immunocompromised patients.
When taking the drug, side effects may occur in the form of decreased vision, allergic reactions, abdominal pain and respiratory depression. Voriconazole is contraindicated in pregnant and lactating women with hypersensitivity to the components that make up the tablets. They are not prescribed for children under 3 years of age.
Wifend
Price: 2000 rubles
Vofend tablets based on voriconazole with a wide spectrum of antifungal activity. The drug is used in the treatment of severe infections that are not amenable to therapy with other antifungal agents. [16].
Pros:
Bioavailability is 96%.
The effectiveness is high, the drug can be taken with an advanced form of nail fungus.
The tablets are made in Germany.
Cons:
The drug is not prescribed in the treatment of patients under 3 years of age, pregnant and lactating women, as well as people with lactose intolerance.
Tablets should be taken one hour before meals or after meals.
The most common side effects are visual disturbances, fever, vomiting, nausea, abdominal pain, and respiratory depression.
When taking the drug, caution is required when driving.
High price.
How to choose pills for nail fungus?
To cope with nail fungus requires an integrated approach. With the help of topical agents (varnishes, ointments, solutions, creams, sprays), it will be possible to quickly destroy the fungus, or remove the affected plate. Tablets enhance the therapeutic effect, as they penetrate into the deep structures of the nail, where ointments and creams cannot get.
Therapy course, it can last from 3 months to six months. Not all patients can withstand such a long period. They stop treatment, because of which the disease again reminds of itself after a short period of time. Modern antifungal tablets can be taken less frequently, up to 1 time per week.
Answers to popular questions
Why does nail fungus occur?
Anyone can get nail fungus, but some people are at higher risk.
Factors that increase the chance of a fungal infection:
Elderly age. In people over 65, nail fungus is especially common. In children under 6 years of age, the disease is practically not diagnosed.
Climate. High temperature and humidity contribute to the rapid spread of infection.
Health status. Nail fungus is more often diagnosed in patients with cancer (against the background of chemotherapy), with previously diagnosed onychomycosis, with weak immunity, psoriasis, poor nutrition of the foot. What matters is the violation of the integrity of the nail plate and the presence of an infected person in the family circle.
Образ жизни. Additional risk factors: smoking, hands and feet in a humid environment, walking barefoot in public places, wearing narrow closed shoes.
What to do if a fungus is found?
The accession of a fungal infection is indicated by white spots, crumbling of the nail, its thickening or discoloration. The plate may turn brown, green, yellow. As the disease progresses, the nail rises from the bed, becomes thicker or thinner. In this case, a person does not experience pain, especially in the early stages. Pain may join later. In this situation, it is important to consult a doctor in time and start treatment, which will allow you to get by with only local preparations.
When to call a doctor at home?
Nail fungus does not require a specialist to visit the house. Appointments must be made on a scheduled basis.
Can fungus be cured on its own?
Self-medication should not be done, since at home it is impossible to determine the type of fungus and find effective drugs. Only a doctor can prescribe the correct therapy.
Author: Mochalov Pavel Aleksandrovich | MD therapist