Once-weekly fluconazole (150, 300, or 450 mg) in the treatment of distal subungual onychomycosis of the toenail

Efinaconazole 10% and Tavaborole 5% Penetrate Across Poly-ureaurethane 16%: Results of In Vitro Release Testing and Clinical Implications of Onychodystrophy in Onychomycosis

“…The newer topical products efinaconazole 10% and tavabarole 5%, were approved for the treatment of onychomycosis of toenails due to Trichophyton rubrum or Trichophton mentagrophytes. 7,8 The efficacy in the phase III trials was better than previously available topical antifungals, but remains below that of oral agents such as terbinafine and itraconazole, [9][10][11][12][13][14][15][16][17][18] Even with oral therapy in onychomycosis, recurrence rates…”

Is This the Right Drug or the Dose for the Management of Onychomycosis?

“…Pilot study 11 Toenail of fingernail [ [10][11][12][13][14][15][16]. The diffusion of the drug into the distal part of the nail occurs via nail bed that is further confirmed due to the presence of two foldhigher drug concentration in subungual nail material than in distal nail clippings of a patient treated for one month.…”

Confirmatory Testing for Onychomycosis—Reply

“…However, additional clinically significant adverse effects of terbinafine, including severe neutropenia and toxic epidermal necrolysis, 4 should also be included. To be complete, the other oral treatment option approved by the US Food and Drug Administration, itraconazole, with potential adverse effects such as liver failure, peripheral neuropathy and cardiovascular events, 5 should be analyzed. Both of these oral medications may also interact with the patients' existing drugs through the CYP450 system, causing other adverse effects.…”

“…Furthermore, recent metaanalyses for the prevalence of onychomycosis in Europe and North America estimate it to be only 4%, with previous reports of 7% to 14% in North America. [3][4][5] Mikailov et al 1 also discuss the cost savings for liver function test monitoring during terbinafine therapy. While the incidence of apparent liver injury from terbinafine is low, one needs to consider quality of life issues and financial repercussions of other adverse effects such as dysgeusia, gastrointestinal upset, and more serious systemic manifestations including DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), Stevens-Johnson syndrome, and toxic epidermal necrolysis.…”

“…Future studies could include other treatment options such as weekly fluconazole pulsing, which is cheap, effective, and obviates much of the monitoring tests and interaction risks of terbinafine and itraconazole. 5 We would like to directly address the major concerns of Wang et al, which arise from a misinterpretation of our methods and a different standard for how one defines the "art" of medicine. To clarify, our study focuses on the cost-effectiveness of confirmatory testing, not diagnostic testing.…”