antifungals (topical)

Butenafine

(Generic available)

Cream: 1%^{Rx, OTC}

Ciclopirox

(Generic available)

Cream: 0.77%
Gel: 0.77%
Lotion: 1%
Nail lacquer: 8%
Shampoo: 1%
Suspension: 0.77%

Clotrimazole

(Generic available)

Cream: 1%^OTC
Ointment: 1%^OTC
Solution: 1%^OTC
In combination with:
betamethasone.

Econazole

(Generic available)

Cream: 1%
Foam: 1%

Efinaconazole

(Generic available)

Solution: 10%

Ketoconazole

(Generic available)

Cream: 2%
Foam: 2%
Shampoo: 2%

Luliconazole

(Generic available)

Cream: 1%

Miconazole

(Generic available)

Cream: 2%^{Rx, OTC}
Ointment: 2%^OTC
Powder: 2%^OTC
Solution: 2%^OTC
Spray powder: 2%^OTC
In combination with:
zinc oxide (Vusion). See Combination Drugs.

Naftifine

Cream: 1%; 2%
Gel: 2%

Nystatin

(Generic available)

Cream: 100,000 units/g^{Rx, OTC}
Ointment: 100,000 units/g^{Rx, OTC}
Powder: 100,000 units/g^{Rx, OTC}
In combination with:
triamcinolone.

Oxiconazole

(Generic available)

Cream: 1%

Sertaconazole

Cream: 2%

Sulconazole

(Generic available)

Cream: 1%

Tavaborole

(Generic available)

Solution: 5%

Terbinafine

(Generic available)

Cream: 1%^OTC

Tolnaftate

(Generic available)

Cream: 1%^OTC
Powder: 1%^OTC
Solution: 1%^OTC
Spray powder: 1%^OTC

Route/Dosage ⬆ ⬇

Butenafine

(Adults and Children >12 yr): Apply once daily for 2 wk for tinea corporis, tinea cruris, or tinea versicolor. Apply once daily for 4 wk or once daily for 7 days for tinea pedis.

Ciclopirox

(Adults and Children >10 yr): Cream/lotion: Apply twice daily for 2–4 wk; Topical solution (nail lacquer): Apply to nails at bedtime or 8 hr prior to bathing for up to 48 wk. Each daily application should be made over the previous coat and then removed with alcohol every 7 days; Gel: Apply twice daily for 4 wk; Shampoo: 5–10 mL applied to scalp; lather and leave on for 3 min; rinse; repeat twice weekly for 4 wk (≥3 days between applications).

Clotrimazole

(Adults and Children >3 yr): Apply twice daily for 1–4 wk.

Econazole

(Adults and Children ): Apply once daily for tinea pedis (for 4 wk), tinea cruris (for 2 wk), tinea corporis (for 2 wk), or tinea versicolor (for 2 wk). Apply twice daily for cutaneous candidiasis (for 2 wk).

Efinaconazole

(Adults and Children ≥6 yr): Apply to affected toenails once daily for 48 wk.

Ketoconazole

(Adults ): Apply cream once daily for cutaneous candidiasis (for 2 wk), tinea corporis (for 2 wk), tinea cruris (for 2 wk), tinea pedis (for 6 wk), or tinea versicolor (for 2 wk). Apply cream twice daily for seborrheic dermatitis (for 4 wk). For dandruff, use shampoo twice weekly (wait 3–4 days between treatments) for 4 wk and then intermittently.

Luliconazole

(Adults and Children ≥12 yr): Interdigital tinea pedis: Apply to affected and surrounding areas once daily for 2 wk; Tinea cruris: Apply to affected and surrounding areas once daily for 1 wk.
(Adults and Children ≥2 yr): Tinea corporis: Apply to affected and surrounding areas once daily for 1 wk.
(Adults ): Interdigital tinea pedis: Apply to affected and surrounding areas once daily for 2 wk; Tinea cruris and tinea corporis: Apply to affected and surrounding areas once daily for 1 wk.

Miconazole

(Adults and Children >2 yr): Apply twice daily. Treat tinea cruris for 2 wk and tinea pedis or tinea corporis for 4 wk.

Naftifine

(Adults ): Interdigital tinea pedis: Apply cream or gel once daily for 2 wk; Tinea cruris or tinea corporis: apply cream once daily for 2 wk.
(Children ≥12 yr): Interdigital tinea pedis: Apply cream or gel once daily for 2 wk.
(Children ≥2 yr): Tinea corporis: Apply cream once daily for 2 wk.

Nystatin

(Adults and Children ): Apply 2–3 times daily until healing is complete.

Oxiconazole

(Adults and Children ): Apply 1–2 times daily for tinea pedis (for 4 wk), tinea corporis (for 2 wk), or tinea cruris (for 2 wk). Apply once daily for tinea versicolor (for 2 wk).

Sertaconazole

(Adults and Children >12 yr): Apply twice daily for 4 wk.

Sulconazole

(Adults ): Apply 1–2 times daily (twice daily for tinea pedis). Treat tinea corporis, tinea cruris, or tinea versicolor for 3 wk, and tinea pedis for 4 wk.

Tavaborole

(Adults and Children ≥6 yr): Apply to affected nail once daily for 48 wk.

Terbinafine

(Adults ): Apply twice daily for tinea pedis (for 1 wk) or daily for tinea cruris or tinea corporis for 1 wk.

Tolnaftate

(Adults ): Apply twice daily for tinea cruris (for 2 wk), tinea pedis (for 4 wk), or tinea corporis (for 4 wk).

US Brand Names ⬆ ⬇

butenafine: Lotrimin Ultra,

ciclopirox: Ciclodan,

clotrimazole: Alevazol,

econazole: Ecoza,

efinaconazole: Jublia,

ketoconazole: Ketodan,

luliconazole: Luzu,

miconazole: Fungoid, Lotrimin AF, Micatin, Zeasorb-AF,

naftifine: Naftin,

nystatin: Klayesta, ~~Mycostatin,~~ Nyamyc, Nystop,

oxiconazole: Oxistat,

sertaconazole: Ertaczo,

sulconazole: Exelderm,

tavaborole: ~~Kerydin,~~

terbinafine: Lamisil AT,

tolnaftate: Tinactin

Action ⬆ ⬇

Butenafine, nystatin, clotrimazole, econazole, efinaconazole, ketoconazole, luliconazole, miconazole, naftifine, oxiconazole, sertaconazole, sulconazole, and terbinafine affect the synthesis of the fungal cell wall, allowing leakage of cellular contents. Tolnaftate distorts the hyphae and stunts mycelial growth in fungi. Ciclopirox inhibits the transport of essential elements in the fungal cell, disrupting the synthesis of DNA, RNA, and protein. Tavaborole inhibits fungal protein synthesis via inhibition of aminoacyl-transfer ribonucleic acid (tRNA) synthetase.

Therapeutic effects:

Decrease in symptoms of fungal infection.

Classifications ⬆ ⬇

Therapeutic Classification: antifungals (topical)

Pharmacokinetics ⬆ ⬇

Absorption: Absorption through intact skin is minimal.

Distribution: Distribution after topical administration is primarily local.

Metabolism/Excretion: Metabolism and excretion not known following local application.

Half-Life: Butenafine: 35 hr; Ciclopirox: 5.5 hr (gel); Efinaconazole: 29.9 hr; Terbinafine: 21 hr.

Canadian Brand Names ⬆ ⬇

ciclopirox: Loprox,

clotrimazole: Canesten, Clotrimaderm,

ketoconazole: Ketoderm,

miconazole: Micozole,

nystatin: Nyaderm,

terbinafine: Lamisil

Time/Action Profile ⬆ ⬇

( resolution of symptoms/lesions‡)

ROUTE	ONSET	PEAK	DURATION
Butenafine	unknown	up to 4 wk	unknown
Luliconazole	unknown	3–4 wk	unknown
Tolnaftate	24–72 hr	unknown	unknown

‡Only the drugs with known information included in this table.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Instruct patient to apply medication as directed for full course of therapy, even if feeling better. Emphasize the importance of avoiding the eyes.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Advise patient that some products may stain fabric, skin, or hair. Check label information. Fabrics stained from cream or lotion can usually be cleaned by handwashing with soap and warm water; stains from ointments can usually be removed with standard cleaning fluids.
Patients with athlete’s foot should be taught to wear well-fitting, ventilated shoes; to wash affected areas thoroughly; and to change shoes and socks at least once a day.
Advise patient to report ↑ skin irritation or lack of response to therapy to health care provider.
Nail lacquer: File away loose nail and trim nails every 7 days after solution is removed with alcohol. Do not use nail polish on treated nails. Inform health care provider if patient has diabetes mellitus before using.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or breastfeeding.

Pronunciation ⬆

butenafine: byoo-TEN-a-feen

ciclopirox: sye-kloe-PEER-ox

clotrimazole: kloe-TRYE-ma-zole

econazole: ee-KON-a-zole

efinaconazole: eff-in-a-KON-a-zole

ketoconazole: kee-toe-KOE-na-zole

luliconazole: loo-li-KON-a-zole

miconazole: mye-KON-a-zole

naftifine: NAFF-ti-feen

nystatin: nye-STAT-in

oxiconazole: ox-i-KON-a-zole

sertaconazole: ser-ta-KON-a-zole

sulconazole: sul-KON-a-zole

tavaborole: ta-va-BOR-ole

terbinafine: ter-BIN-a-feen

tolnaftate: tol-NAFF-tate

section name header

Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Classifications ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆