|RE: Life-long Maintenance Regimen for Onychomycosis (Carl Solomon, DPM)|
From: Bryan Markinson, DPM
Dr. Solomon laments the lack of studies for exactly how little terbinafine we can give and still achieve efficacy. This has been beautifully done and published in 2004 in a very well known study on onychomycosis in the dermatology world but little known in podiatric medicine. I say “little” because even though I have written about it in several different venues for several years, podiatrists still react incredulously. I encourage all to read the following: Nardo Zaias, MD; Gerbert Rebell, MS, The Successful Treatment of Trichophyton Rubrum Nail Bed (Distal Subungual) Onychomycosis With Intermittent Pulse-Dosed Terbinafine.ARCH DERMATOL/VOL 140, JUNE 2004.
The study concludes that one 250mg tablet daily for seven days, repeated at three months intervals,(total of 28 250mg doses annually), is virtually as effective as 90 day continuous dosing. That’s 70% less drug and a two month and three week holiday between pulses. I will e-mail a copy of the study to anyone requesting it.
Bryan C. Markinson, DPM, NY, NY, firstname.lastname@example.org
Dr Blake's comment:
So, if you are being offered oral daily Lamisil (terbinafine), consider going a safer route with this pulsed version. Lamisil has now replaced Sporonox for the treatment of severe toenail fungus in many circles. Remember that Lamisil is not benign and can cause serious side effects. Please have a long discussion with your prescribing doctor before taking, and I am presently recommending laser treatments (although expensive), first before any though on oral anti-fungals.