Tinea Unguium Drug Summary

Last updated: 23 April 2026
Reviewed by

Antifungals (Oral)

Drug Dosage Remarks
Fluconazole 150 mg PO once weekly
Continue until infected nail is replaced		 Adverse Reactions
  • GI effects (abdominal pain, diarrhea, flatulence, nausea/vomiting, taste disturbance, elevated liver enzyme levels)
Special Instructions
  • Use with caution in patients with renal and hepatic impairment
  • Periodically monitor liver function tests (LFTs) and for risk of drug interactions
  • Treat until nail is normal or acceptably improved
Griseofulvin 500-1,000 mg PO 24 hourly or in divided doses (at least 4 months for fingernails or 6 months for toenails)
  • Only effective if dermatophytes are the etiologic agents
Adverse Reactions
  • GI effects (diarrhea, epigastric distress); CNS effects (headache, nausea/vomiting); Dermatologic effects (rash, urticaria)
Special Instructions
  • Should be taken immediately after meals
  • Long-term use is not advised due to possibility of adverse effects; monitor hepatic, renal and hematopoietic function if used long term
Itraconazole Continuous treatment:
200 mg PO 24 hourly x 3 months
Pulse treatment:
Fingernails only
200 mg PO 12 hourly x 1 week followed by a 3-week drug-free interval for 2 pulses
Toenails with or without fingernail involvement
200 mg PO 12 hourly x 1 week followed by a 3-week drug-free interval x 3 pulses		 Adverse Reactions
  • GI effects (dyspepsia, abdominal pain, nausea, constipation, diarrhea, pyrosis); CNS effects (headache, dizziness); Dermatologic effect (pruritus)
Special Instructions
  • Two pulse treatment are recommended for fingernail infections and 3 pulse treatments for toenail infections
  • Pulse treatments are always separated by a 3-week drug-free interval
  • Clinical response will become evident as the nail regrows, following discontinuation of treatment
  • Use with caution in patients at risk for heart failure, hepatic impairment and renal insufficiency
  • Monitor LFTs at baseline and regularly throughout therapy
  • Monitor for symptoms of drug interactions (eg Rifampicin, macrolides, oral anticoagulants, etc)
  • In patients with hypochlorhydia, absorption may be improved by administering the drug with an acidic drink (eg cola)
Ketoconazole 200-400 mg PO 24 hourly x 6-12 months Adverse Reactions
  • GI effects (nausea/vomiting, abdominal pain, serious hepatotoxicity); Dermatologic effects (urticaria, angioedema, pruritus, rash, alopecia); CNS effects (headache, dizziness, somnolence); Other effects (inhibition of testosterone and adrenal steroid synthesis [high dose], rarely gynecomastia)
Special Instructions
  • Use only to treat serious fungal infection when other therapies are not tolerated or unavailable
    • Carefully consider the benefits against the potential risk of therapy
  • Contraindicated in patients with acute or chronic liver disease
  • Monitor LFTs at baseline and weekly during treatment course
  • Use with caution in patients with adrenal insufficiency
Terbinafine Fingernail treatment:
250 mg PO 24 hourly x 6 weeks
Toenail treatment:
250 mg PO 24 hourly x 12 weeks		 Adverse Reactions
  • GI effects (anorexia, nausea/vomiting, diarrhea, abdominal pain, loss or disturbance of taste, liver dysfunction); CNS effect (headache); Dermatologic effects (rash, urticaria)
Special Instructions
  • Do not use in patients with hepatic and renal impairment
  • Monitor complete blood count (CBC) and LFTs at baseline and regularly throughout therapy
  • Use with caution in patients with psoriasis
  • Reduce doses in patients with renal impairment

Antifungals (Topical)

Drug Available Strength Dosage Remarks
Imidazoles
Clotrimazole1 1% lotion, cream Rub on affected areas 8-12 hourly x 2-4 weeks Adverse Reactions
  • Dermatologic effects (erythema, stinging or burning sensation, blister, skin peeling, edema, itching, urticaria, skin irritation)
Special Instructions
  • Contraindicated in patients with skin TB, measles, chickenpox, herpes simplex and syphilitic skin infection
  • Use with caution in pregnant and nursing women
  • May be used with or without occlusive dressing over large areas
Efinaconazole 10% solution Apply 24 hourly x 48 weeks Adverse Reactions
  • Dermatologic effects (ingrown toenail, dermatitis, vesicles, pain)
Special Instructions
  • Discontinue use if sensitization and irritation develops
  • Avoid contact with eyes
Luliconazole 1% cream; 5% solution Apply 24 hourly Adverse Reactions
  • Dermatologic effects (local site reaction, cellulitis, contact dermatitis)
Special Instructions
  • Avoid contact with eyes
Miconazole1 2% cream, tinct Apply 24 hourly Adverse Reactions
  • Dermatologic effects (burning sensation, irritation, allergic contact dermatitis)
Special Instructions
  • Discontinue use if sensitization and irritation develops
  • Avoid contact with eyes
  • Contraindicated in patients with cracked skin on hand or foot
Tioconazole 28% solution Apply thinly 12 hourly x 6-12 months Adverse Reactions
  • Dermatologic effects (mild local irritation, dermatitis, paresthesia, allergic reaction)
Special Instructions
  • Contraindicated in patients allergic to imidazoles, in pregnant and nursing women
Others
Amorolfine 5% nail lacquer Apply 1-2x weekly until nail is regenerated and areas are cured Adverse Reactions
  • Dermatologic effects (occasional local irritation, slight, transient peri-ungual burning sensation)
Ciclopirox
(Ciclopiroxolamine,
Ciclopirox olamine)		 8% nail lacquer Apply 48 hourly x 1 month, then twice weekly x 1 month, then once weekly for third month onwards until nail is regenerated and areas are cured
Remove coating with alcohol once weekly		 Adverse Reactions
  • Dermatologic effects (pruritus, redness, scaling, burning sensation, pain)
Naftifine 1% cream Apply 24 hourly to affected nail Adverse Reactions
  • Dermatologic effects (redness, burning sensation, dryness)
Tavaborole 5% solution Apply 24 hourly x 48 weeks Adverse Reactions
  • Dermatologic effects (ingrown nail, local site exfoliation, erythema, dermatitis)
Special Instructions
  • Avoid contact with eyes
Terbinafine 1% lotion, gel Apply 24 hourly x 1-2 weeks Adverse Reactions
  • Dermatologic effects (redness, itching)
Special Instructions
  • Avoid contact with eyes, nose, mouth
1Combination with a corticosteroid is available. Please see the latest MIMS for specific formulations and prescribing information.

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

Related MIMS Drugs