The People's Perspective on Medicine

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.
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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I had laser treatment on my toenail fungus about 5 years ago, and it worked very well. It completely went away. It was expensive and not covered by my insurance. I’ve not had any problems with it coming back, so it was well worth the money!

A combination of Myocide, tea tree oil, and Vicks Vapo Rub, used in alternating weekly treatments with each, was suggested to me by a conservative and experienced podiatrist who, at the time, did not even feel the need for a one year follow up. Patience works. It’s been less than a year, and my 2 fungal nails never looked better.

At my one and only visit a year ago, when I questioned coming back for a follow up, he said I could come in for a trimming if that is too difficult to do at home, but I never needed to go back for even a trim. I can even cut my own toenails now, in addition to the benefit of the much improved appearance, and after so many years of advice that failed to produce even the minutest improvement. (I followed the advise of a former podiatrist to use the urea brush-on treatment that was sold at his office, and even after finishing one bottle, nothing changed.)

Also, it doesn’t hurt to question a product sold at the office, or a compounded med thru a pharmacy of that doctor’s recommendation, which this doctor also recommended but was rejected by insurance and the cost was out of this world. It feels like something fishy going on because the same happened when a neurologist had, in the past steered me to the same compounding pharmacy for an over-the-top expensive med that was also rejected by the insurance.

I use a compounded prescription topical solution of Thymol 4% in alcohol for toenail fungus, and it has been helpful. It is the same thyme-based ingredient in Listerine’s original formula only more concentrated.

Tea tree oil has helped some people as well (2x/day, test a patch on your arm x24hrs to make sure not allergic 1st).

Last week my podiatrist started me on laser treatments for my toenail fungus. I had one treatment last week and will have 2 additional treatments over the next 4 weeks. Is laser treatment effective?

In one study, treatment with a specific laser (long-pulsed Nd:YAG 1064-nm laser) knocked out about two-thirds of the nail fungus, which is a pretty good figure. Nail fungus is hard to eliminate.

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