Fungal nail infections
The regional formulary will not cover all eventualities for infections medicines choices. As with any condition; patient specific factors and sensitivities need to be considered. Please consider this regional formulary advice alongside any relevant local Board guidelines.
NICE CKS: Fungal nail infection
Treatment of fungal nail infections
Treatment for cosmetic reasons is not justified.
Terbinafine
Terbinafine 250mg tablets
250mg daily (6 weeks for fingernails or 3 months for toenails).
Itraconazole
Itraconazole 100mg capsules
200mg every 12 hours for 7 days repeated after 21 days: fingernails, 2 courses; toenails, 3 courses.
Prescribing Notes:
- In view of the long duration of treatment, possible significant side-effects and high costs, cosmetic treatment is not justified.
- Itraconazole and terbinafine have been associated with liver damage.
- Topical agents should be reserved for cases where the infection is confined to the distal edge of the nail in the very early stages of distal and lateral subungual onychomycosis or in superficial white onychomycosis. As superficial infections may not require treatment and topical agents are relatively expensive, it is difficult to justify their use.
History Notes
30/07/2026
Regional formulary chapter launched.