Onychomycosis

Management of Onychomycosis in Canada in 2014 http://www.ncbi.nlm.nih.gov/pubmed/25775640

Drug name:

Brand:

SA

SA Criteria

SA Approval period

Direction

SE

Monitoring

Ciclopirox 8%

Penlac (nail lacquer)

No

Not covered

N/A

Nail lacquer: Apply bid to adjacent skin and affected nails daily. Remove with alcohol every 7 days (treat 4 weeks)

dermatitis, dry skin, local burning sensation

Efinaconazole

Jublia (nail lacquer)

Not covered

Not covered

N/A

Apply to affected toenails once daily for 48 weeks

Ingorwn nail (2%), dermatitis

Terbinafine tablets

Lamisil tablets

Yes

Severe onychomycosis

PLUS

functional disability

PLUS

positive KOH or dermatophyte culture of nail from a licensed lab.

First approval: Three months

Renewals: If required, up to three months.

250mg once daily for 6 weeks (fingernail); 250mg once daily for 12 weeks (toenails)

Headache (13%), diarrhea (6%), nausea, liver enzyme disorder (3%)

Monitor AST/ALT prior to initiation, repeat if used >6 weeks

Itraconazole

Sporanox

Yes

1. Immunocompromised pts/ Or 2. Pulse treatment for severe onychomycosis with functional disability

PLUS

confirmed lab results for candida or dermatophyte infection.

1. Immunocompromised pts approval is indefinite 2. 3 months approval for 2nd group of pts (No need for SA approval if prescribed by HIV/AIDS Dr)

Fingernail involvement: 200mg capsule twice daily for 1 week. repeat 1 week course after 3 week off time Toenails due to Trichophyton rubrum or T mentagrophytes: 200mg once daily for 12 consecutive weeks With or without fingernaikl involvement: 200mg once daily for 12 consecutive weeks Canadian labelling "Pulse dosing": 200mg twice daily for 1 week, then repeat 1 week course twice with 3 week off time between each course

Diarrhea, nausea, headache, skin rash

Liver function in patients with pre-existing hepatic dysfunction, and in all patients being treated for longer than 1 month

fluconazole

Diflucan

Yes

1. Immunocompromised patients.

OR2. Exceptions on an individual basis for fungal infections resistant to first-line medications.

1 day to indefinite (no need for HIV and AIDS Dr to apply for SA)