Your guide to prescription medications for nail fungus

Nail fungus, also known as onychomycosis, is a common infection that can affect the nails on your fingers, toes, or both. It happens when fungus, most typically a kind called dermatophytes, overgrows on, under, or inside your nail.

Nail fungus might affect only part of your nail, an entire nail, or multiple nails. Its symptoms include:

• a brittle or thick nail
• a strong odor from the nail
• a misshapen nail that may lift from the nail bed
• discoloration of the nail

Treatment for fungal nail infections includes prescription antifungal medications, either a topical solution you apply directly to your nails or oral medications in more severe cases. While over-the-counter (OTC) treatments are available, doctors don’t usually recommend them.

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What is nail fungus?

Onchyomycosis, the medical term for nail fungus, happens due to an infection by a type of fungus. The most common is dermatophytes, which occur in 90% of toenail fungus infections and 50% of fingernail infections, but it can also happen due to yeast or mold.

Nail fungal infections can affect both your fingernails and toenails, but they’re more common in the toenails.

You can develop a fungal nail infection after being in a warm, wet place, like a public pool shower or locker room. They’re easily transmissible, so you can develop an infection if someone with a fungal infection walked barefoot in an area before you.

It’s also related to athlete’s foot, a fungal infection of the toes and other areas of the feet. Wearing sweaty shoes and socks for a prolonged time can worsen onychomycosis.

Prescription medications for nail fungus

Antifungal medications are the first-line treatment for fungal nail infections. These medications help stop more fungus growth, allowing your nail to grow out until you can eventually trim away the infected area. For fingernails, this can be around 4 to 6 months. For toenails, it may be up to 18 months.

Prescription antifungals might be in topical form, which you apply to your nails like a polish, or systemic form, which you take by mouth. Oral antifungals are generally more effective treatments, but doctors may reserve these for more severe cases.

Topical antifungals for the nails are better for mild cases. Examples include:

• ciclopirox nail lacquer (Ciclopirox)
• ketoconazole (Ketodan)
• clotrimazole (Canesten)

Like any medication, these drugs may have some side effects, although they’re likely to be mild. They might cause stinging or burning upon application, swelling, and ingrown toenails.

In more severe cases, doctors might prescribe oral antifungals. These include:

• fluconazole (Diflucan)
• griseofulvin (Grifulvin V)
• terbinafine (Lamisil)
• itraconazole (Sporanox)

These may also cause side effects, including stomach upsets, headaches, and heartburn. In severe cases, they may cause allergic reactions, although this is uncommon.

In some cases, doctors might recommend a combination treatment of oral and topical medications, which may produce better results.

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Are there any OTC options?

Doctors don’t usually recommend OTC treatments for fungal nail infections as there is little research into their effectiveness. While OTC antifungals are available, it’s better to seek prescription medications from a healthcare professional.

According to a 2018 paper, most OTC topical antifungals can soften the nails, which can make it easier to trim and remove affected areas of the nail. However, the medications rarely penetrate into the nail, meaning they won’t be very effective in treating the fungal infection.

A 2024 research review also mentions that some other OTC options may have some effectiveness in managing fungal nail infections. For example, topical tea tree oil and topical cough suppressants, such as Vicks VapoRub, have shown some mild benefits.

However, these treatments are not as effective as prescription medications, and the research into them is very limited.

Prevention strategies

You can implement some strategies to help prevent nail fungus — and stop it coming back after treatment. These include:

• washing your hands and feet regularly
• drying your hands and feet thoroughly after they get wet
• wearing clean socks every day
• wearing breathable shoes that fit well
• wearing flip-flops in public showers and locker rooms
• treating athlete’s foot as soon as you can

Online care for nail fungus

Nail fungus is a common condition, but it may greatly affect your quality of life. Some 2023 research suggests that nail fungus can have physical and psychological effects on your life.

Online care services, including Optum Perks Online Care, may make getting treatment easier. With these services, you can submit an online form answering a few questions about your symptoms, and a US-licensed healthcare professional will respond soon after to prescribe a treatment plan.

Summary

Fungal nail infections are very common, but they can have physical and psychological effects if you’re experiencing them. If you think you have this infection, consider speaking with a healthcare professional.

Treatment for nail fungus usually involves prescription antifungals. In mild cases, you can use topical antifungals you apply to the nail, and oral antifungals to treat moderate to severe cases. Doctors may even recommend using both.

OTC drugs are not usually recommended for nail fungus as there is limited evidence of their effectiveness. If you have a fungal nail infection, consider speaking with a doctor in person or via online care to get the right treatment straight away.

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