SKIN - Onychomycosis Toenails, Fingernails (Tinea unguium) Long-term efficacy of terbinafine may be superior to itraconazole.
Fluconazole Diflucan^® Pregnancy: C; Lactation: Likely Safe Tabs: 50 mg, 100 mg, 150 mg, 200 mg	Fingernails Children: N/A Adult: 150-300 mg once per week for 3-6 months. Toenails Children: N/A Adult: 150-300 mg once per week for 6-12 months.	Food: May take with or without meals. Important side effects: Nausea, vomiting, diarrhea, dizziness. Advise patient to report any prodromal signs of liver failure. Drug interactions may be significant. Consult a pharmacist.
Itraconazole (Sporanox^®) Pregnancy: C; Lactation: Unsafe Caps: 65 mg, 100 mg    Tablet: 200 mg	Fingernails Children: Not approved. Adult: 200 mg PO once daily for 6-12 weeks OR Pulse dosing: 200 mg twice daily one week then off for three weeks. Repeat two times for fingernails. Toenails Children: Not approved. Adult: 200 mg PO once daily for 3 months OR Pulse dosing: 200 mg twice daily one week then off for 3 weeks. Repeat three to four times for toenails.	Food: Avoid grapefruit products while taking. Take capsules with food. Take oral solution on an empty stomach. Not well absorbed with acid-suppressing drugs. Important side effects: Advise patient to report any prodromal signs of liver failure. Caution: May cause hepatitis. Use with caution in persons with history of liver disease. Consider periodic liver function tests. May cause or contribute to congestive heart failure or cardiac dysrhythmias. Use with caution in persons with history of cardiac disease. Use for onychomycosis is contraindicated in patients with history of ventricular dysfunction or CHF. Use is contraindicated in any patient taking cisapride, dofetilide, quinidine, midazolam, triazolam, pimozide, lovastatin, or simvastatin. Not well absorbed with acid-suppressing drug. Has caused bone defects and changes in tooth appearance in rats; implications for humans are not established.
Terbinafine (Lamisil^®) Pregnancy: B; Lactation: Unsafe Tabs: 250 mg	Fingernails Children (>2 years) <20 kg: 62.5 mg Q24H for 6 weeks. 20-40 kg: 125 mg Q24H for 6 weeks. ≥40 kg and Adult: 250 mg Q24H for 6 weeks. Toenails Children (>2 years) <20 kg: 62.5 mg Q24H for 12 weeks. 20-40 kg: 125 mg Q24H for 12 weeks. ≥ 40 kg and Adult: 250 mg PO once daily for 12 weeks.	Food: May take with or without meals. Important side effects: Ocular changes, rash, neutropenia, hepatobiliary dysfunction, nausea. Advise patient to report any prodromal signs of liver failure. Liver failure and death have occurred. Baseline LFTs should be obtained and patient should be advised to contact provider if any side effects occur.