| AGENT | APPLICATION | AVAILABILITY | COMMENTS |
| Over-the-counter |
| Terbinafine 1% (Lamisil) | 1-4 wks, twice daily | Cream, solution, spray | Tinea (not indicated for Candida) |
| Clotrimazole 1% (Lotrimin) | Twice daily | Cream, lotion, solution | Tinea, Candida, tinea versicolor |
| Miconazole 2% (Micatin) | Twice daily | Cream, lotion, spray | Tinea, Candida, tinea versicolor |
| Tolnaftate 1% (Tinactin) | Twice daily | Cream | Tinea |
| Selenium sulfide 1% (Selsun Blue) | Apply daily to wide area for 10 min, followed by a shower | Shampoo | Tinea versicolor |
| Miconazole 2% (Zeasorb) | As needed | Powder | Tinea, Candida, tinea versicolor; antifungal, antifriction/drying agent |
| Prescription |
| Ketoconazole 2% (Nizoral) | Once daily | Cream | Tinea, Candida, tinea versicolor |
| Econazole 1% (Spectazole) | 4 wks, once daily | Cream | Tinea, Candida, tinea versicolor, Gram-positive bacteria |
| Ciclopirox 0.77% (Loprox) | 4 wks, as needed | Cream, lotion, shampoo | Lotion preferred for nail penetration |
| Naftifine 1% (Naftin) | Once daily | Cream, gel | Tinea; has anti-inflammatory activity |
| Sulconazole (Exelderm) | 4 wks, twice daily | Cream, solution | Tinea, Candida, tinea versicolor |
| Miconazole (Monistat-Derm) | 4 wks, twice daily | Cream | Tinea, Candida, tinea versicolor |
| Oxiconazole 1% (Oxistat) | 4 wks, twice daily | Cream, lotion | Tinea, Candida, tinea versicolor |
| Griseofulvin (Fulvicin, Grisactin, Gris-PEG) | | Microsized: 250-, 500-mg tablets; ultramicrosized: 125-, 250-, 333-mg tablets. Pediatric: Microsized: 125-mg/tsp pediatric suspension | Effective only against dermatophytes
Contraindicated in pregnancy
Fungistatic
Take with fatty meals
Alcohol should be avoided
Occasional headache
Gastrointestinal upset
Photosensitivity
Elevation of liver function tests
Significant drug interactions (phenobarbital, warfarin, other drugs metabolized in liver) |
| Terbinafine (Lamisil) | | 250-mg tablets 125-mg oral granules 187.5-mg oral granules | Side effects minimal; include rare hepatotoxicity, reversible taste loss |
| | | Fewer drug interactions than itraconazole |
| | | Severe hepatotoxicity including liver failure reported in patients with no pre-existing liver disease. A baseline hepatic profile (alanine and aspartate aminotransferase) levels is recommended and monitored in patients receiving continuous treatment >1 mo or those who develop evidence suggestive of liver disease. |
| Itraconazole (Sporanox) | | 100-mg capsules | Side effects minimal; rare hepatotoxicity |
| | Oral solution (10 mg/mL) | Significant drug interactions and contraindications: drugs not to be taken with itraconazole include astemizole, cisapride, terfenadine, triazolam, midazolam, lovastatin, and simvastatin |
| | | Potential risk for developing congestive heart failure (CHF). Should not be used in the treatment of onychomycosis in patients with ventricular dysfunction such as CHF or a history of CHF. |
| Fluconazole (Diflucan) | | 50-, 100-, 150-, 200-mg tablets; oral solution 10 mg/mL, 40 mg/mL | Side effects minimal; rare hepatotoxicity
Liver toxicity must be monitored if used long term
Not to be taken with cisapride |