Medication	Dosing	Cure rates (%)		Organisms targeted	Potential adverse effects	Potential drug interactions*	FDA pregnancy category	Estimated monthly cost†	Comments
		Clinical	Mycotic
Ciclopirox 8% solution (nail lacquer)	Apply once daily to affected nails and to the underside of the nail	6 to 921	29 to 3621 (77 when used in combination with debridement)22	Candida species, dermatophytes	Periungual erythema, erythema of the proximal nail fold, burning sensation, nail shape changes, ingrown toenails, nail discoloration	—	B	$11 for 3.3-mL bottle	Indicated for use in immunocompetent patients with mild to moderate onychomycosis without lunular involvement; patients should not bathe for eight hours after applying nail lacquer; lacquer should be removed once per week, and as much of the damaged nail as possible should be removed using scissors, nail clippers, or a nail file
Fluconazole (Diflucan)	100 to 300 mg orally every week for three to six months (fingernails) or six to 12 months (toenails)	4123	4823	Candida species	Nausea, vomiting, abdominal pain, diarrhea, headache, rash	Benzodiazepines, calcium channel blockers, statins	C	$13 for 30 100-mg tablets ($492 brand)	Not FDA approved for treatment of onychomycosis in children or adults; prescribing guidelines recommend periodic monitoring of liver function, renal function, and potassium levels; use with caution in breastfeeding women and in patients with hepatic or renal disease or porphyria
Itraconazole (Sporanox)	Pulse dosing: 200 mg orally two times per day for one week per month, for two months (fingernails) or three months (toenails) Continuous dosing: 200 mg orally once per day for six weeks (fingernails) or 12 weeks (toenails)	7023	63 (pulse dosing) 69 (continu ous dosing)23	Candida species, dermatophytes, nondermatophyte molds, Aspergillus species	Nausea, vomiting, hypokalemia, elevated transaminase and triglyceride levels, rash	Benzodiazepines, calcium channel blockers, proton pump inhibitors, statins, warfarin (Coumadin), zolpidem (Ambien)	C	$195 for 30 100-mg capsules ($523 brand)	Liver function should be monitored in patients with preexisting hepatic dysfunction, and in all patients being treated for longer than one month; serum drug levels should be monitored because of erratic bioavailability with capsule formulation; renal function should be monitored; use with caution in breastfeeding women and in patients with hepatic or renal disease or porphyria; contraindicated in patients with ventricular dysfunction or congestive heart failure
Terbinafine (Lamisil)	250 mg orally once per day for six weeks (fingernails) or 12 weeks (toenails)	6623	7623	Some yeasts, dermatophytes, nondermatophyte molds	Gastrointestinal upset, rash, headache	Antiarrhythmic agents, beta blockers, selective serotonin reuptake inhibitors, tricyclic antidepressants, warfarin	C	$4 for 30 250-mg tablets ($607 brand)	Liver transaminase levels should be checked before therapy is started; if treatment continues beyond six weeks, complete blood count and liver function testing should be performed; use with caution in breastfeeding women and in patients with hepatic or renal disease, psoriasis, or porphyria