Summary: 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)
