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)