Nail infection: Should I take antifungal pills?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Take oral antifungal medicine (antifungal pills) to treat a fungal nail infection.
Try other treatment, such as antifungal creams, or do nothing.

Key points to remember

Antifungal pills give you the best chance of curing a severe fungal nail infection.
If you have liver or heart problems, you should not take antifungal pills. They can cause rare but dangerous side effects, including heart and liver failure.¹
You may need testing every 4 to 6 weeks to check for liver, kidney, or heart damage, depending on the antifungal pills you use.
Even if your treatment works, the infection may return. Of people whose infection goes away with antifungal pills, 15% to 20% start to get another infection in the next year.² This means that out of 100 people who take the pills, 15 to 20 will get another infection in the next year and 80 to 85 will not.
Having your nail removed, either nonsurgically or surgically, is another treatment choice for a nail that is badly infected or thickened.

FAQs

What is a fungal nail infection?

A fungal nail infection occurs when a fungus attacks a fingernail, a toenail, or the skin under the nail, called the nail bed. Fungi (plural of fungus) can attack your nails through small cuts in the skin around your nail or through the opening between your nail and nail bed.

See a picture of a fungal nail infection .

Fungal nail infections are more common in toenails than fingernails. In toenails they grow very slowly, giving the fungi more time to develop and get worse. It also takes more time to treat toenails than fingernails.

Yeasts, molds, and different kinds of fungi can cause fungal nail infections. Most are caused by the same type of fungus that causes athlete's foot. Fungi grow best in warm, moist places, and they can spread from person to person. You can get a fungal nail infection from walking barefoot in public showers or pools or from sharing personal items, such as towels and nail clippers. If you have athlete's foot, the fungus can spread from your skin to your nails.

Why would you use antifungal pills to treat a nail infection?

A fungal nail infection doesn't go away on its own, and it slowly gets worse over time. An infection may spread into the nail root, where new nail growth begins, and may spread to other nails. The longer you have an infection and the worse it gets, the harder it is to treat.

Severe infections, especially in older people who have had the condition for many years, can cause very thick nails that are hard to trim. They may cause pain or discomfort when you walk. If this happens, it is hard to cure a fungal infection, even with antifungal pills.

Why wouldn't you use antifungal pills to treat a nail infection?

Not all fungal nail infections need treatment with pills. Some people decide not to treat a fungal infection until it is uncomfortable or painful.

Nail infections are hard to treat, and antifungal pills can be costly. There is no guarantee that the pills will work or that the infection won't come back. Of people whose infection goes away with antifungal pills, 15% to 20% start to get another infection in the next year.² This means that out of 100 people who use antifungal pills, 15 to 20 will get another infection in the next year and 80 to 85 will not.

The pills used to treat fungal nail infections can cause serious side effects, including liver damage and heart failure.

You might think about trying other treatments, such as using an antifungal cream or removing the nail, either surgically or nonsurgically.

How well do antifungal pills work?

If you are older than 60, your chances of curing the infection with pills decreases. Out of 100 people over age 60 who use antifungal pills, 65 are cured while 35 are not.³

Pills to treat fungal nail infections include:

Terbinafine (Lamisil). This is the first-line medicine for fungal nail infections caused by dermatophytes. In people with an infection caused by dermatophytes, it: ⁴
- Killed fungi in 40 to 90 of 100 people who used it. This means it didn't kill the fungi in 10 to 60 of 100 people who used it.
- Killed fungi and produced a normal-looking nail in 35 to 50 of 100 people who used it. This means that 50 to 65 of 100 people who used it didn't end up with a normal-looking nail.
- Was more effective than itraconazole, griseofulvin, or fluconazole.
Itraconazole. This medicine is used for infections caused by yeast (Candida) and mold. It killed fungi in 45 to 70 of 100 people who used it. This means that it did not kill the fungi in 30 to 55 of 100 people who used it. The pills produced a normal-looking nail in 35 to 80 of 100 people who used it.⁴ This means that 20 to 65 of 100 people who used it did not end up with a normal-looking nail.
Fluconazole (Diflucan). This medicine is used as a first-line treatment for infections caused by Candida.⁴ When used for toenails, it greatly improved the appearance of the nail in 72 to 89 of 100 people who used it.⁴ This means that it didn't greatly improve the appearance of the nail in 11 to 28 of 100 people who used it. When high doses were taken for 3 months for fingernail infections, it produced a normal-looking fingernail in 90 of 100 people who used it. That means that 10 of 100 people who used it didn't end up with a normal-looking nail. The pills killed the fungi in nearly all the people who used them.⁴

Ketoconazole (Nizoral) and griseofulvin (Grifulvin V) are rarely used.⁵

What are the risks of not using pills to treat a nail infection?

If you are healthy, an ongoing fungal nail infection has no serious risks. But over time, the nail may get thick and look bad. It may be painful when you wear shoes or walk.

If you have diabetes or a weak immune system, a fungal infection can lead to a more serious bacterial infection.

Why might your doctor recommend antifungal pills for a fungal nail infection?

Your doctor may advise you to use pills if:

You have a painful nail infection.
You have another health problem, such as diabetes, that can cause problems from foot infection.

2. Compare Options

	Take antifungal pills	Don't take antifungal pills
What is usually involved?	You take pills every day for several months, or every day for 1 week a month for 2, 3, or 4 months. You may need to have blood tests to check that your kidneys and liver are working well.	Instead, you could: Try another treatment, such as an antifungal cream. Have the nail removed. Do nothing.
What are the benefits?	Antifungal pills give the best chance of curing a severe fungal nail infection.	You don't have the risks of taking pills. Using creams or removing the nail may clear up your infection, depending on how bad it is.
What are the risks and side effects?	The pills may not work well with other medicines you take, and they could cause problems such as liver damage and heart failure. If you have a history of blood or liver disease or plan to drink alcohol during treatment, these pills are not safe for you. Minor side effects include headache, stomach upset, diarrhea, rash, itch, and loss of taste. Antifungal pills can be expensive. Pills may not work, or the infection may come back. Your nail may still look bad after treatment.	Creams may take a long time to work. They will not work as well as pills for a severe infection. Your nail infection could get worse, and your nail may fall out.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Fungal Nail Infections.

Personal stories about taking oral antifungal medicine for fungal nail infection

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

" My toenails have always been a little thick and hard to trim, but lately they are starting to really make my feet hurt. I was never sure what the problem was, and now my doctor says it's some type of fungal infection. She says that the medication may help but that my nail is probably damaged and will never grow back in completely normal. She also mentioned that the medication is pretty expensive, and that's a concern for me. I'm going to try some other treatment that takes off part of the nail and see if that helps with the pain. "

— Tom, age 68

" I think this fungal toenail infection is the ugliest thing! It's so embarrassing. I always keep my nails trimmed and polished, and this one ugly toenail really bothers me. I asked my doctor about these new medications, and it sounds like they will work well for me, because the problem is just in one of my nails. I just can't believe how long it's going to take to work! "

— Tammy, age 35

" Taking medications for almost 3 months to treat something that really doesn't bother me? That doesn't make any sense to me. I have a hard enough time remembering everything I need to do at the office, much less remembering to take a pill every day. If the problem gets any worse, then I'll reconsider. For now, I'll just keep that toenail out of sight. "

— Bonita, age 40

" I will always remember my dad's feet. He had these thick, ugly yellow toenails, and he used to wince when he would walk, because they hurt his feet. My doctor says that I could wind up in the same situation. But since I just got this fungal toenail infection in the last year, if we treat it now, we have a good chance of curing it. I'm going to try this oral medication that takes several months to work. I'm also going to try all the other things he mentioned, like rotating my shoes so they dry, changing my socks more, and using antifungal foot drying powder. I don't care so much what my feet look like, but I sure don't want them to hurt when I'm older. "

— Bob, age 60

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take antifungal pills

Reasons not to take antifungal pills

I'm worried about my infection getting worse.

I'm not worried about my infection getting worse.

More important

Equally important

More important

I'm willing to have regular blood tests to check that my liver and kidneys are okay.

I don't want to be bothered with a lot of tests.

More important

Equally important

More important

I accept the risk of pills.

Taking these pills is too risky for me.

More important

Equally important

More important

I don't mind taking pills every day for several months.

I don't want to take pills every day.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking antifungal pills

NOT taking antifungal pills

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts

1. Do antifungal pills give you the best chance of curing severe fungal nail infections?

Yes
No
I'm not sure

You're right. Antifungal pills give you the best chance of curing a severe fungal nail infection.

2. Can antifungal pills cause serious side effects?

Yes
No
I'm not sure

That's right. Antifungal pills can cause rare but serious side effects, including liver damage and heart failure.

3. Is taking antifungal pills the only way to treat a fungal nail infection?

Yes
No
I'm not sure

You are right. Having your nail removed, either surgically or nonsurgically, is another treatment option for a severe nail infection.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

U.S. Food and Drug Administration (2001). FDA issues health advisory regarding the safety of Sporanox products and Lamisil tablets to treat fungal nail infections. FDA Talk Paper T01-22. Available online: http://www.fda.gov/bbs/topics/answers/2001/ans01083.html.
Habif TP, et al. (2005). Tinea of the nails (onychomycosis) section of Fungal infections. In Skin Disease: Diagnosis and Treatment, 2nd ed., pp. 234—237. Philadelphia: Elsevier Mosby.
Gupta AK, et al. (2001). Single-blind, randomized, prospective study on terbinafine and itraconazole for treatment of dermatophyte toenail onychomycosis in the elderly. Journal of the American Academy of Dermatology, 44(3): 479–484.
Rodgers P, Bassler M (2001). Treating onychomycosis. American Family Physician, 63(4): 663–672.
Verma S, Heffernan MP (2008). Superficial fungal infection: Dermatophytosis, onychomycosis, tinea nigra, piedra. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol 2, pp. 1807–1821. New York: McGraw Hill.