Toenail Fungus OTC Treatments

Does Lamisil Cream Cure Toenail Fungus?

Lamisil is the brand name for the drug, terbinafine, an over-the-counter treatment for toenail fungal infections and athlete’s foot (ringworm of the feet). Lamisil is available in the form of topical, as well as oral medications.

It has been approved by the Food and Drug Administration (FDA), alongside itraconazole, for treating toenail fungus infections. Antifungal treatment is recommended for alleviating symptoms, limiting the spread of infection to other regions of the body, and reducing the risk of secondary bacterial infection.

They work by stopping the growth of fungi. Antifungals for toenail fungus are available in oral and topical forms. Topical antifungal treatment, using drugs such as Lamisil cream, is one of the recommended creams for people with mild toenail infections. Systemic antifungal agents are commonly used if the condition doesn’t improve with topical treatment.

Does Lamisil Cream Remove Treating Toenail Fungus?

Most doctors recommend treating toenail fungus using topical treatments, such as Lamisil cream, if:

  • The fungal infection has affected only half of the nail or less
  • The base of the nail is not affected
  • Just a few nails are affected

Topical treatment is also commonly recommended for children, because oral medications may not be suitable for them. Another reason is that children’s nails are often thinner and grow more quickly, so it is likely that antifungal creams work better in children than adults. White superficial toenail fungus can also be treated with Lamisil cream.

If several nails are affected or if the infection has affected several nails, your doctor may recommend taking oral medication. Also, if the infection starts at the base of the nail, taking oral medications may be more beneficial in treating toenail fungus.

Is It Difficult to Treat Toenail Fungus Topically?

The effectiveness of antifungal creams for toenail fungus is not well-studied due to several factors that lead to failure in the treatment.

According to the Journal of Clinical and Aesthetic Dermatology, some of these limitations include:

  • Slow nail growth
  • The presence of the nail plate that impedes antifungal agents from reaching the infection when applied topically
  • Difficulty finding compounds with the pharmacologic profile to allow proper nail penetration, so that an antifungal can eradicate a nail fungus when applied
  • Challenges in developing optimal carriers for topical use that ensure the delivery of efficient drug levels to the infection
  • The anatomy of the nail unit, as well as its vascular pathways, which allow higher drug concentrations in the nail bed centrally – compared to the lateral nature of oral antifungal therapy
  • The high rates of relapse following topical therapy

Lamisil Cream vs. Lamisil Oral Medication

If topical Lamisil is ineffective, you may benefit from taking Lamisil tablets. Tablets for treating toenail fungus have been tested extensively in many studies. Overall, study results show that oral administration of Lamisil may work better than creams or nail polishes.

Although current guidelines endorse terbinafine or itraconazole as primary treatment methods, a study published in the Cochrane Database for Systematic Reviews suggests that oral Lamisil may be more effective than “azole” drugs.

The study showed that 58% of people showed a normal nail appearance following treatment with Lamisil, compared with 47% who took azoles. However, both drugs were categorized as more effective than the placebo. The medicine is also used to treat athlete’s foot, ringworm, scalp infections, jock itch, and other fungal infections.

According to the study, a 3-month treatment with terbinafine (Lamisil), lead to the following:

  • 76 out of 100 people who took terbinafine were completely cured of their fungal nail infection.
  • And only 17 out of 100 people in the study who didn’t take terbinafine, or took an alternative, showed no detectable nail infection.

Are There Medical Studies That Support Terbinafine Use?

Studies have also analyzed longer-term antifungal and clinical relapse rates using terbinafine. A 5-year blinded study published in the Archives of Dermatology, found a long-term treatment of 46% for terbinafine, compared to 13% from itraconazole.  The study also showed a lower clinical relapse for terbinafine; 21%, compared to 48% from itraconazole.

Another cost-efficacy analysis published in the American Journal of Managed Care that compared terbinafine, itraconazole, as well as griseofulvin, found that terbinafine was also the most cost-effective out of the three.

A randomized, double-blind, controlled study published in the Journal of the American Academy of Dermatology, that compared pulse-dose terbinafine with daily terbinafine found that daily intake of terbinafine (250 mg for 3 months) showed a 70.9% success rate, while pulse dose (500 mg daily for 1 week per month, for 3 months) showed a 58.7% success rate in treating fungal infections.

Terbinafine is also well-tolerated by most individuals. According to a 2017 survey published in Skin Appendage Disorders, patients who were treated with terbinafine reported greater ease and overall satisfaction with the drug, compared to other medicines.

Another study in the British Journal of Dermatology conducted with diabetic patients with fungal nail infections found that terbinafine proved to be relatively effective in treating fungal infections and did not cause any hypoglycemic reactions among patients treated with oral hypoglycemics or insulin.

If you have active or chronic liver disease, be sure to see your doctor before choosing any oral treatment.

What Are the Side Effects of Lamisil?

In the past, some people who took Lamisil, have developed severe liver damage that resulted in liver transplant and even death. In most of these cases, the patient has had a critical medical condition before administering the drug.

Therefore, it is crucial that you let your doctor know if you experience any of these symptoms that indicate liver issues:

  • Upper abdominal pain
  • Nausea
  • Loss of appetite
  • Itching
  • Clay-colored stools
  • Dark urine
  • Yellowing of the skin or eyes

It’s also important to note that skipping Lamisil doses may increase your risk of further infection and antibiotic resistance. Therefore, always be sure to follow your doctor’s instructions carefully while taking Lamisil.

Also, be sure to let your doctor know if you have or have had any of the following:

  • Liver disease
  • Kidney disease
  • Depression
  • Human Immunodeficiency Virus (HIV)
  • Acquired Immunodeficiency Syndrome (AIDS)
  • An autoimmune disorder, such as psoriasis or lupus

Keep in mind that if you are taking Lamisil to treat your toenail fungus, it may take a few months after you finish your treatment for the fungus to be removed entirely. Moreover, it will take some time for a healthy nail to grow back.

You should also let your doctor know if you are allergic to terbinafine or have any other allergies. Your doctor may want to perform frequent blood tests during your treatment to monitor your liver health. Keep all appointments with your doctor and lab while taking this drug.

Lamisil and Pregnancy

Lamisil is classified as an FDA Pregnancy Category B drug. This means that it is not expected to affect an unborn baby. However, it is ideal that you wait until you have your baby and have finished breastfeeding them to begin treatment for your toenail infection using Lamisil.

If you are pregnant or plan to become pregnant, let your doctor know. Lamisil is NOT recommended while breastfeeding, as the drug can pass into breast milk and harm a baby.

how can you tell if Lamisil is working

What Are the Side Effects of Lamisil?

Let your doctor know if any of the following side effects are persistent or become severe:

  • Stomach upset
  • Stomach pain
  • Diarrhea
  • Itching, rashes, hives
  • Loss of taste or changes in taste

Call your doctor immediately if you experience any of the following serious side effects during Lamisil treatment:

  • Mood swings
  • Depression
  • Extreme fatigue
  • Persistent stomach upset
  • Vomiting
  • Worsening skin rash
  • Irregular heartbeat or chest pain
  • A sore throat, fever or other signs of an infection

Interactions with Other Substances and Medications

Let your doctor know if you are taking any prescription, non-prescription, nutritional, herbal, dietary, recreational or illegal drugs while taking Lamisil.

These include the following:

  • Blood thinners
  • Antidepressants
  • Beta-blockers
  • Immune-suppressing medication
  • Cimetidine
  • Selegiline
  • Rifampin

You should also stop consuming alcohol while taking Lamisil. Regular consumption of alcohol can increase the likelihood of severe side effects. If you do consume alcohol, be sure to let your doctor know. It’s also recommended that you avoid cola, tea, energy drinks, coffee and other beverages that contain caffeine while using Lamisil.

Lamisil may also make your skin sensitive to sunlight. Therefore, avoid excess sun exposure and tanning beds, and wear sunscreen and protective clothing when you are outdoors.

Onychomycosis, or nail fungus, is notoriously difficult to cure and therapeutic options are limited. Oral treatment has been the standard of care for toenail fungus among most patients, mainly because of the lack of effectiveness seen using topical treatments, such as Lamisil cream, in the past. Although the availability of well-tolerated topical treatments will be beneficial, not many options are emerging because of formulation challenges that make it difficult to reach the infection.