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
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
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)|