![]() Never take Sporanox capsules if you are taking any of the following medications: ![]() 53 The manufacturer of itraconazole recommends obtaining liver function tests only in patients who have preexisting liver function abnormalities or who have had liver abnormalities while on other medications.A wide variety of drugs may interact with Sporanox capsules. 52 The manufacturer of terbinafine recommends obtaining pretreatment liver function tests in all patients and monitoring a complete blood count in immunosuppressed patients receiving terbinafine for > 6 weeks. 54 With both agents, the frequency of adverse events is comparable to placebo. Liver enzyme elevations caused discontinuation of therapy in 4%. 53 Common adverse reactions occurring while patients took itraconazole to treat onychomycosis of the toenails included headache (10%), rhinitis (9%), upper respiratory tract infection (8%), and sinusitis (7%). Liver enzyme abnormalities occurred in 3.3%. 52 Common adverse reactions occurring while patients took terbinafine included headache(12.9%), diarrhea (5.6%), rash (5.6%), and dyspepsia (4.3%). The newer antifungal agents, including terbinafine and itraconazole, rarely cause serious adverse reactions. After 5 years, 47% of the terbinafine group compared with 13% of the itraconazole group still had negative mycology. 50 A third study looked at long-term cure and relapse rates in continuous terbinafine compared with pulse itraconazole for 12 and 16 weeks. In groups who were treated for 16 weeks, 80.8% of the terbinafine group achieved a mycological cure compared with 49.1% in the itraconazole group. 49 A second study of 496 patients with onychomycosis comparing continuous terbinafine with pulse itraconazole found that after 72 weeks in groups who were treated for 12 weeks, 75.7% of the terbinafine group achieved a mycological cure compared with 38.3% in the itraconazole group. 48Another study comparing continuous terbinafine and pulse itraconazole in elderly patients for 12 weeks plus an additional 4 weeks, if needed, after 6 months found a mycological cure rate for continuous terbinafine of 64%compared with 62.7% for pulse itraconazole. One study found a 73% mycological cure rate for continuous terbinafine compared with 45.8% in continuous itraconazole for 12 weeks. Studies comparing continuous terbinafine and continuous itraconazole have shown mixed results. Although it has been shown that diabetic patients with onychomycosis have a higher rate of complications and infections than diabetic patients without onychomycosis, 10 to our knowledge, no study has compared treatment options with outcomes such as diabetic complications or secondary infections. Many studies have compared the mycological cure rates, recurrence rates, and cost-effectiveness of the various treatment options. In addition,patient education is vital to reduce the risk of recurrence. 15, 23Patients > 55 years of age may have a higher rate of relapse. 15 Several modalities can be used for the treatment of onychomycosis in diabetic patients: topical therapy, systemic therapy, combination therapy, and nail removal. 23 Elderly diabetic patients' nails may grow even slower and require a longer duration to treat. 13Toenails grow at one-third to one-half the rate of fingernails and thus need to be treated longer. ![]() The treatment of onychomycosis in diabetic patients is the same as in patients without diabetes. These may also provide a route for the entry of bacteria. 3, 4, 14, 15Extension of the fungal infection to surrounding skin causes tinea pedis,which may lead to fissures in the plantar and interdigital skin. When combined with peripheral neuropathy, blisters and erosions may progress to cellulitis or osteomyelitis of the underlying bone. 3, 4, 9, 14, 15Thickened nails can cause erosions of the nail bed and hyponychium because of pressure, just as tight shoes can cause friction blisters in these patients. Injury to adjacent skin from mycotic nails may occur without patients' awareness and can lead to secondary infections, both fungal and bacterial, including paronychia and cellulitis. Thickened,dystrophic nails can be very painful and make walking difficult. 13Because onychomycosis in diabetic patients can lead to many complications,most insurance companies cover treatment in documented cases. Thus, effective treatment in these patients is of paramount importance. 4, 10- 22The outcome from not treating onychomycosis in diabetic patients can be worse than in those without diabetes. Onychomycosis in people with diabetes is more than a cosmetic nuisance it increases the risk for other foot disorders and limb amputation. ![]()
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