Is Sporanox a Versatile Cure or a Dangerous Drug?

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 Listerine,  castor 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.