Nail fungus Drug: Fluconazole
Fluconazole is a drug which belongs to the group of triazole derivatives. Also this antimycotic ultimately blocks the synthesis of ergosterol. However, it first blocks the 14-alpha-demethylase of the cytochrome P450 system of the fungal cell.
This inhibition prevents the conversion of lanosterol into ergosterol, which results in membrane defects of the fungal cell. Fluconazole is effective against a broad spectrum of fungi, including Candida, Cryptococcus, epidermophytes, microspores and histoplasms. For this reason, it is used for most systemic or local fungal infections and also for nail fungal disease.
The most common side effects of Fluconazole are gastrointestinal symptoms such as nausea, vomiting and diarrhea. In some cases liver damage with elevation of transaminases may occur. For this reason, regular laboratory checks while taking Fluconazole are indicated.
Indication
If the attack of the nail fungus is very pronounced, for example if more than three nails are infected, in some cases treatment with a systemic therapy is necessary. The prerequisite for such a therapy is a healthy liver, since the antimycotics can impair liver function. In order to successfully complete the treatment, a very long therapy duration is often necessary, which should be adhered to urgently.
Usually the therapy lasts three to six months, in exceptional cases systemic therapy may be necessary for more than 12 months. With a purely systemic therapy the recurrence rate is often very high.Causes for this can be for example a very slow nail growth in the age, a bad defense situation of the body or also the lack of co-operation of the patient. In addition, more and more fungal species are becoming resistant to the antimycotics.
A fact which is not least caused by a lack of cooperation. Furthermore, severe side effects of the nail fungus drug such as gastrointestinal symptoms or a deterioration of liver function can lead to a discontinuation of the therapy. Even then no success can be achieved and the nail mycosis remains.
In order to control the liver function, regular laboratory controls with determination of the transaminases are necessary during the therapy. Basically, if a fungal infection of the nails is suspected, a suitable specialist should be consulted as soon as possible. As a rule, dermatologists are the right people to contact for infections of the fingernails and toenails.
Depending on the extent of the nail fungus, they can decide which medication is suitable and whether over-the-counter or prescription substances (medication on prescription) should be used. However, some people are so uncomfortable with the presence of a fungal infection, regardless of which part of the body is affected, that they shy away from choosing a specialist. For these patients, the attempt to treat the nail fungus with over-the-counter medication can be helpful.
Medicines against nail fungus are offered in the form of varnishes, ointments, gels, solutions and as tablets. In most cases, locally applicable drugs (especially varnishes and ointments) can be purchased over the counter. In this context, however, it should be noted that not all of these locally applicable drugs are freely available in drugstores.
Despite the fact that they are not subject to prescription, many nail fungus drugs are subject to a general pharmacy obligation. This means that they may only be sold in certified pharmacies. In case of slightly pronounced nail fungus which has not yet infiltrated the nail bed, the use of these over-the-counter drugs is usually sufficient to achieve a successful treatment.
However, if there is no visible improvement even after several days of treatment, a dermatologist must be consulted urgently. Pronounced nail mycosis with nail bed involvement, on the other hand, must in most cases be treated immediately with a combination of local and oral antifungal agents (antimycotics). Since most oral medications for the treatment of nail mycosis can cause a number of undesirable drug effects (side effects), they can only be purchased on prescription.
In addition, those antimycotics that are sold on prescription usually have a significantly higher effectiveness. A further justifiable reason for the distribution of oral nail fungus medicines on prescription is the fact that these substances must be strictly controlled in their intake. The success of treatment depends to a large extent on regular and proper use of the medication.
