Patient Handouts : Onychomycosis Therapy Protocol

Onychomycosis Therapy Protocol

This is the usual treatment protocol for toenail fungus. Please read it carefully.

There are two medications we use for toenail fungus: itraconazole (Sporonox) and terbinafine (Lamisil). Terbinafine is the one used most of the time. Either of these medicines can rarely cause liver irritation: if the liver becomes irritated and treatment is continued, severe liver damage and even death can result. Therefore, a blood test is checked before treatment (baseline) and after 3-4 weeks. If the liver has not been irritated by that time, no further blood tests are required.

Make sure you have told PVD all the medications you are currently taking! Sometimes medications can interact adversely with each other. Also, make sure you tell any physician prescribing any new medication that you are taking an oral antifungal!

Do not take these medications if you are pregnant!

During therapy, if you notice an unusual rash or altered taste sensation you should let us know.

For a course of one of these medications you must do the following:

  1. Get blood drawn for baseline liver enzyme test.
  2. Once we have received the blood test results, we will notify you. If you have not heard from us within 3-4 days of getting the blood test done, call us.
  3. At that time, it is OK to start the medication.
    Your first prescription will only be for 4 weeks, no refills.
  4. When you start the pills, MAKE AN APPOINTMENT with PVD for 4 weeks later.
  5. After taking the medication for 3 weeks, you must get a second blood test.
  6. When you return for your appointment 4 weeks after starting the medication, we can discuss the blood test results and how you are tolerating the medication. If all is well you will be given a prescription at that time covering the remaining two months of the course. You will NOT be given any refill of the medication until you are seen in person. Sometimes patients run out of the medication before their appointment: for this medication this does not matter. It is OK to be out of the medication for even as long as 3 weeks, because of the way the medication works.

After 3 months of medication, your toenails may not look much better. They have to grow out! The medicine is accumulated in the toenails, and they should now grow out normally: full regeneration may take close to a year for some people. The chance of recurrence of the fungus is probably over 50% in the first three years after treatment; retreatment generally clears this up even better. Occasionally a 4 month treatment may be recommended.

NOTE: because of the $4/month program at Walmart and Target, no prior authorizations will be filled for this medication.