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Is Sporanox a Versatile Cure or a Dangerous Drug?

The anti-fungal drug itraconazole (Sporanox) should be reserved for use against serious systemic fungus infections, not used off label for minor problems.
Is Sporanox a Versatile Cure or a Dangerous Drug?
Capsule and pills medicines in hand with pink background

Sometimes health care professionals develop biases toward certain drugs that may keep them from seeing the downsides. We’ve seen this with respect to cardiovascular drugs such as statins. A podiatrist recently sang the praises of an anti-fungal medicine with little appreciation of its risks.

How Risky Is Sporanox?

Q. As a podiatrist, I have had the opportunity to prescribe the oral anti-fungal drug itraconazole (Sporanox). I have noticed that a six-month course of this medicine is not only good against nail fungus. It can also help clear up eczema, acne and sometimes even psoriasis. I know the drug can cause liver problems, but you can test for that.

How Is This Drug Used?

A. The FDA originally approved oral itraconazole in 1992 for serious systemic fungal infections. Doctors still prescribe it to treat frightening infections such as pulmonary histoplasmosis (Clinics and Practice, Aug. 9, 2019). The agency added toenail fungus as “indication” in 1995. It has NOT approved Sporanox for acne, eczema or any other skin condition.

There is a black-box warning that cautions physicians not to prescribe Sporanox to people with heart failure. Doctors have reported cases in which heart failure first occurred during treatment with itraconazole (Medicina Clinica, Jan. 20, 2017).

Itraconazole can interact dangerously with dozens of other medications, including the anti-anxiety drug alprazolam, the gout drug colchicine and the heart rhythm medicine dronedarone. Many other medications are contraindicated or should be avoided in combination with itraconazole.

Liver damage, although rare, can come on suddenly and can be life threatening. Nerve damage and hearing loss are other serious complications of this medication.

Other Ways of Treating Nail Fungus:

Given the potentially serious side effects of Sporanox, we’d like to see it reserved for life-threatening infections. Nail fungus is not life-threatening. Wouldn’t it be better to use a less toxic drug or even home remedies to manage this cosmetic problem?

Many people have reported success treating their toenail fungus with such drugstore staples as Listerinecastor oil or Vicks VapoRub. Others have found vinegar soaks or topical vitamin E oil can clear it. One of the most unusual remedies we have encountered is soaking the affected foot in cornmeal. No matter what approach you may choose, you will need a lot of patience. Overcoming toenail fungus means having the nails grow out completely, and that can take many months. 

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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  • Neupane R et al, "An unusual infection in an immunocompetent male from a non-endemic area: Lessons from a vacation." Clinics and Practice, Aug. 9, 2019. DOI: 10.4081/cp.2019.1141
  • Rodrigo-Troyano A et al, "Heart failure induced by itraconazole." Medicina Clinica, Jan. 20, 2017. DOI: 10.1016/j.medcli.2016.09.040
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