Understanding Toenail
Fungal Infections

What causes it?

Onychomycosis is truly a fungus among us! Fungi are fond of warm, damp areas. So you can easily pick up toenail fungus by:

  • walking barefoot in a shower, in a locker room, or around a swimming pool
  • wearing shoes or socks that have become wet
  • wearing shoes that don’t fit properly or crunch your toes, such as high heels

Having athlete’s foot, another fungal infection, may increase your risk of toenail fungus.

Injuring your toe or having certain health conditions—such as diabetes, circulatory problems, or a weakened immune system—may also increase your risk of getting toenail fungus.

What happens if toenail fungus is untreated?

Having discolored or thickened toenails may be embarrassing. But toenail fungus is not just cosmetic. Without treatment, it won’t go away. It can actually spread and may get worse. Here are some problems that toenail fungus can cause:

  • Nails can become so thick that they are difficult to cut
  • Thickened nails may make wearing shoes uncomfortable
  • An infection can develop into a painful swelling under the nail
  • Nails may begin to crumble, eventually leading to an entire nail being lost

Think you may have toenail fungus? Talk with your doctor.

If your toenails are discolored, or if they have thickened, you may think it’s clear that you have toenail fungus. But just looking at your nails isn’t enough.

That’s because toenail fungus may be mistaken for something else, such as:

  • nail injury
  • a nail-bed tumor
  • peripheral vascular disease (a disease of the blood vessels)
  • psoriasis or other skin condition

Your podiatrist or dermatologist may take a nail scraping and send it to a lab to rule out nonfungal causes and to confirm that it is toenail fungus.

What should I know about treatment?

It may be easy to get toenail fungus, but it sure is tough to get rid of! Putting off treatment may even make things worse, giving the fungal infection more of a chance to grow. This may cause more damage to your toenails.

The earlier you seek professional medical help, the greater chance you have of clearing up your toenail fungus—and keeping it from spreading. Treatment options include topical treatments (such as antifungal cream, lotion, or polish), laser treatment, and oral treatments, such as ONMEL® (itraconazole).

What are treatment options?

Topical treatments

Topical treatments are applied to the nail surface over a period of time. That treatment period is typically 48 weeks.

Oral treatments

Antifungal pills attack the fungal infection from inside the body. The treatment period is typically 12 weeks. But be patient; it may take several months before you see a difference. That’s because it takes time (between 12 and 18 months) for the healthy nail to grow back completely.

Your healthcare provider may order blood tests to check your liver function before prescribing an oral antifungal medication.

Everyday foot care

Keeping your feet and toes clean and dry is your best defense against nail fungus. Here are 10 tips to keep fungus from coming back.

Keep your feet dry.

After your bath or shower, dry your feet well— especially between your toes.

Don’t wear the same shoes every day.

Switch footwear so your shoes dry and air out before you wear them again.

Choose good shoes.

Go for lighter, “breathable” materials that keep your feet well ventilated. Footwear made of vinyl, rubber, or other synthetic material can trap moisture (and fungus).

Wash your hands.

After touching infected nails, wash up to avoid spreading nail fungus.

Use antifungal powder.

Make it a part of your daily routine.

Practice good nail care.

Clip toenails straight across and file down thickened areas. Be sure to disinfect toenail clippers or home pedicure tools.

Carry a spare pair of socks.

Change into a fresh pair whenever you’re active and your feet sweat a lot.

Take care at nail salons.

If you go for a manicure or pedicure, make sure the nail salon sterilizes its instruments—or bring your own.

Protect your feet.

By the pool, in the shower room, at the gym, or in other public areas, wear waterproof sandals or shoes.

Don’t cover up your nails.

Avoid wearing nail polish and artificial nails, which can worsen an infection.


Effective toenail fungus treatment delivered in a single, once-daily tablet

ONMEL® (itraconazole)

200-mg tablets


How does ONMEL work?

ONMEL is an FDA-approved antifungal treatment; it stops the growth of toenail fungus. Clinical studies showed that many more patients who received ONMEL had a complete cure of their toenail fungus than those patients who received placebo—a treatment without the active medicine.


How is ONMEL different?

ONMEL works inside the body to attack and fight the toenail fungal infection. ONMEL uses Meltrex® Technology to allow the controlled release of medicine in just one 200-mg tablet.

ONMEL offers easy dosing.

Set up your medicine routine with ONMEL.

How do I take ONMEL?

Tips for staying on track with ONMEL:

ONMEL works best when taken with a full meal at the same time of day.

If you forget to take or miss doses of ONMEL, skip that dose and take the next dose at your regular time. Do not make up missed doses.

Remember, treatment with ONMEL takes 12 weeks. Be sure to finish all of your ONMEL as prescribed by your healthcare provider.

Your healthcare provider should do blood tests before you start and while you take ONMEL, especially if you have liver problems.

What to expect when taking ONMEL.

For best results, it is important to take your medicine for the full 12-week treatment period.

Good to know:

You may see some change in the base of your toenail during that time. But be patient because it may take longer for your toenail to grow out.

Always make sure you keep your healthcare provider informed about your treatment progress. Treating toenail fungus may vary from person to person. Your healthcare provider may also suggest other treatments while you are using ONMEL to help your toenails improve.

Save money on your prescription

ONMEL® (itraconazole)

200-mg tablets

ONMEL Co-Pay Savings Program

Eligible patients can receive great savings on their ONMEL prescriptions at participating pharmacies. Download and print the savings offer and take it with you when you fill your prescription. Please see full terms and conditions on the savings offer printout.

Click to Expand Click to Collapse
Indications and Usage

ONMEL is a prescription medicine used to treat fungal infections of the toenails.
It is not known if ONMEL is safe and effective in children under the age of 18.

Important Safety Information for ONMEL

ONMEL can cause serious life-threatening side effects, including:

1. Heart Failure. Do not take ONMEL if you have had heart failure, including congestive heart failure. Stop taking ONMEL and call your doctor right away if you have any of these symptoms of congestive heart failure:

  • shortness of breath
  • swelling of your feet, ankles, or legs
  • sudden weight gain
  • increased tiredness
  • coughing up white or pink phlegm
  • fast heartbeat
  • waking up at night more than normal for you

2. Serious cardiovascular effects. Do not take ONMEL if you also take the following medicines:

  • cisapride (Propulsid®)
  • felodipine, nisoldipine (Lexxel®, Plendil®, Sular®)
  • pimozide (Orap®)
  • triazolam (Halcion®)
  • quinidine (Quinidine Gluconate, Quinidine Sulfate)
  • lovastatin (Mevacor®, Advicor®, Altoprev®)
  • dofetilide (Tikosyn®)
  • simvastatin (Zocor®, Simcor®, Vytorin®)
  • levomethadyl (Oralaam®)
  • methadone (Dolophine®)
  • midazolam (Versed®)
  • ergot alkaloids (Migranal®, Ergonovine®, Cafergot®, Methergine®, Dihydroergotamine Mesylate, Methylergonovine)
  • This is not a complete list of medicines that can interact with ONMEL.
  • The product names used herein are for identification purposes only. All product names, trademarks and registered trademarks are the property of their respective owners.
  • Before taking ONMEL, tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
  • Talk to your doctor or pharmacist before you start any new medicine. They can tell you if it is safe to take ONMEL with your other medicines.
    • Know the medicines you take. Keep a list of your medicines and show it to your doctor and pharmacist when you get a new medicine.

Who should not take ONMEL?

Do not take ONMEL if you:

  • have or had heart failure, including congestive heart failure.
  • take certain medicines.
  • are taking fentanyl. Taking fentanyl, a strong opioid narcotic pain medicine with ONMEL could cause serious breathing problems that can lead to death.
  • are pregnant or plan to become pregnant. ONMEL can harm your unborn baby. Talk to your doctor if you are pregnant or plan to become pregnant.
  • are breast-feeding or plan to breast-feed. ONMEL can pass into your breastmilk and may harm your baby.
  • have ever had an allergic reaction to itraconazole or any of the other ingredients in ONMEL. Ask your doctor or pharmacist for a list of these ingredients.

What are the possible side effects of ONMEL?

ONMEL can cause serious side effects, including:

  • liver failure and death. Stop taking ONMEL and call your doctor right away if you have symptoms of liver failure including:
    • unusually tired
    • lose your appetite
    • nausea
    • abdominal pain
    • vomiting
    • yellow change in the color of your skin or eyes
    • dark colored urine
    • pale stools (bowel movements)
  • nerve damage (neuropathy). Call your doctor right away if you have tingling or numbness in your hands or feet. You may need to stop taking ONMEL if this happens.
  • hearing loss. Hearing loss can happen for a short time or permanently in some people who take ONMEL with other medications. Stop taking ONMEL and call your doctor right away if you have any changes in your hearing.

Common side effects of ONMEL include:

  • increased liver enzyme in blood test results
  • upper respiratory infection or cold
    (runny nose, cough, and sneeze)
  • urinary tract infection (burning and painful urination)
  • stomach pain
  • diarrhea
  • nausea
  • headache
  • tiredness
  • throat pain
  • back pain

These are not all of the possible side effects of ONMEL. Tell your doctor if you have any side effect that bothers you or that does not go away. For more information, ask your doctor.

About Merz North America

Merz North America is a part of the Merz Group of companies and was established to develop and commercialize products for the Merz Group. Areas of therapeutic focus include neurology, psychiatry, dermatology, and podiatry.

With over a century of heritage, the Merz Group is known worldwide for its development of original compounds and formulations for medical professionals and consumers in 90 countries. Globally, Merz is a leader in the development of pharmaceuticals for the treatment of neurological and psychological disorders as well as for aesthetic medicine. Global research is concentrated in fields that have a strong need for therapeutic innovation such as Alzheimer disease, Parkinson disease, tinnitus, chronic pain conditions, addictions, and neuromuscular disturbances.

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Please report any violations of these Terms of Use to us at the contact listed above.

18. Procedure for Making Claims of Copyright Infringement

We expect users of the Site to respect the intellectual property rights of others. If you believe in good faith that any of the Site Content infringes your copyright, please provide Merz’s copyright agent the written information specified below.

  • (a) An electronic or physical signature of the person authorized to act on behalf of the owner of the copyright interest;
  • (b) A description of the copyrighted work that you claim has been infringed;
  • c) A description of where the material that you claim is infringing is located on the Site;
  • (d) Your address, telephone number, and e-mail address;
  • (e) A statement by you that you have a good faith belief that the disputed use is not authorized by the copyright owner, its agent, or the law; and
  • (f) A statement by you, made under penalty of perjury, that the information in the notice is accurate and that you are the copyright owner, or are authorized to act on behalf of the owner, of an exclusive right that is allegedly infringe

Merz’s copyright agent for notice of claims of copyright infringement can be reached as follows:

General Counsel
Merz Pharmaceuticals, LLC
6501 Six Forks Rd.
Raleigh, NC 27615
(919) 582-8000

Privacy Policy

This Privacy Policy describes the types of information that Merz, Inc., including its wholly-owned subsidiaries and successors (together referred to as “Merz,” “we,” “us,” or “our”) collects through www.MerzUSA.com (the “Site”). Merz respects the individual privacy of visitors to the Site, and we want you to know how we collect, use, and disclose personal information through the Site. We also want you to know how you can control and update personal information about you collected through the Site. This Privacy Policy does not govern how we collect and use personal information collected through any other Merz-controlled website or offline through other means.

By using the Site, you explicitly accept, without limitation or qualification, our practices surrounding the collection, use, and disclosure of personal information provided by you in the manner described in this Privacy Policy. If you do not agree with the terms of this Privacy Policy, please do not access, browse, or use the Site.

Personal Information We Collect and How We Use It

Merz collects information through the Site in two ways:

Information You Give Us

You do not have to give us any personal information to browse the Site. However, you may be asked to provide personal information to register as a user of the Site, to submit information or request information from us, or to use the services offered through this Site. For example, you may submit your name, email address, postal address, telephone number, and other information in order to receive information about various subjects, to contact Merz, or to apply for employment with Merz. Once you provide us with personal information about you, you are no longer anonymous to us. If you decide to purchase any services or products from this Site, we may need to collect your credit/debit card number, credit/debit card expiration date, credit/debit card type (Visa, MasterCard, Discover, or American Express), and billing name and address in order to qualify and bill you for these services or products.

Cookies and Anonymous Information We Get From Your Use of Our Site

Like many websites, the Site uses a technology called “cookies.” Cookies are small pieces of information stored by web browsers on a computer’s hard drive and are used in website system administration to keep track of movement of an individual from one screen to another. When you visit or access the Site, we send one or more cookies or anonymous identifiers to your computer or device that uniquely identify your browser. Information collected by these technologies cannot be used to identify you unless it is added to identifiable information, and Merz will not match additional identifiable information with any information we collect through the use of such passive technologies.

Most web browsers automatically accept cookies, but you can usually change your browser settings to block all cookies, including cookies associated with this Site. Please note, though, that if you disable cookies, some features of the Site may not function properly. If you experience any problems, please contact us at info@merzusa.com.

As is common among Internet website operators, we maintain web server logs. Our web server automatically collects information from your computer and navigation patterns when you visit the Site, including your Internet Protocol (IP) address, your computer’s operating system, the type of browser you use, and the specific web pages visited during your connection.

How We Use Information We Collect

Merz and its affiliates may use personal information to: (a) administer the Site; (b) process your account and orders; (c) provide the products and services you select through the Site; (d) respond to your emails or other inquiries or requests; (e) help improve the Site, our products, and our services; (f) customize your experience at the Site; (g) request your feedback in confidential consumer surveys; (h) contact you, whether by newsletter, email or postal mail, with information about the Site or our products, services, and promotions; and (i) for such purposes as you may authorize at the time you submit the information. We may also combine personal information we collect through the Site with other generally or publicly available information to help us identify Site visitors’ preferences or interests.

We use cookies and automatically collected information to provide you a richer and more personalized consumer experience. We may use this information: (a) to remember your information so that you will not have to re-enter it during your visit or the next time you visit the Site; (b) to track data such as the total number of visits to the Site and the number of visitors to each page of the Site; (c) to compile statistics and analyze trends of visitors to the Site; (d) to detect and resolve problems with the Site; (e) to assist with customer support concerns;
(f) for system maintenance; and (g) to better understand how our visitors use the Site and services so that we can make them better.

How We Disclose Personal Information

We do not sell, rent, or trade your personal information collected through the Site. We may, however, share personal information with companies or individuals or groups outside of Merz as described below:

  • Consent. We may share personal information outside of Merz when we have your consent to do so.
  • Subsidiaries and Affiliates. We may share personal information with our subsidiaries and affiliates for the purposes for which you provided the information, or as reasonably necessary for our internal administrative and business purposes.
  • Service Providers. We work with third parties that provide services on our behalf. Such services may include shipping, billing and refund, processing debit or credit card payment, fulfilling and delivering orders, website hosting, marketing, and website usage analytics.We also work with authorized distributors who may receive, fulfill and deliver orders made through the Site. We may share personal information and non-personal information with these third parties for the purpose of enabling them to provide these services. Your personal information may be stored and processed by our service providers in the United States or other locations where the service providers maintain facilities. Merz is not responsible for the conduct of these third parties, and we expressly disclaim all liability for damages of any kind arising out of the action or inaction of such third parties.
  • Certain Transactions. We may disclose or transfer personal information or any information collected through this Site to third parties who acquire all or a portion of Merz’s business, whether such acquisition is by way of merger, consolidation, or purchase of all or a portion of our stock or assets, or in connection with any bankruptcy or reorganization proceeding brought by or against us.
  • Legal Reasons. We may disclose personal information if we are required to do so by law or pursuant to a legal process, in response to a request from government officials or law enforcement authorities, or if we have a good-faith belief that access, use, or disclosure of the information is necessary or appropriate in connection with an investigation of illegal activity, including to detect, prevent, or otherwise address fraud, or to protect against harm to the rights, property, or safety of Merz, our users, or the public.

How We Use and Disclose Aggregate Information

We may compile and share personal information and other non-personally identifiable information collected through the Site on an aggregate basis. This information may include, without limitation, demographic information about users of the Site. Such aggregate information does not identify you individually. We may use aggregate information and share aggregate information with third parties for any of the purposes specified in this Privacy Policy, for marketing and research purposes, to assist third parties in understanding the usage, viewing, and demographic patterns for certain programs, content, services, advertisements, promotions, and/or functionality on the Site, or for any other lawful purpose.

Information That Is Publicly Available

Note that any information which you post to a public message board or chat area becomes public information. You are solely responsible for any such information you choose to post on this Site, and you may always choose not to divulge any personal information to the public when posting to a message board or chat area.

Our Commitment to Children’s Privacy

Protecting the privacy of young children is important to us. The Site is neither designed nor intended to attract children under the age of 18, and we do not knowingly collect personal information from any individual who is under the age of 18. We ask that children under the age of 18 not submit any personal information to us. If you are a parent and become aware that your child has provided us with personal information, please contact Merz and we will work with you to address this issue.

Data Integrity and Security

Merz uses reasonable physical, managerial, and technical safeguards to preserve the integrity and security of personal information collected through the Site, and to help prevent the accidental loss and unauthorized access, use, or disclosure of such information. These safeguards include Secure Socket Layer (SSL) technology data transmission. However, no method of transmitting or storing data is completely secure. As a result, although we strive to protect personal information about you, we cannot guarantee that personal information collected through the Site may not be accessed, disclosed, altered, or destroyed by a breach of any of our physical, technical, or managerial safeguards. If Merz learns of a security systems breach, we may attempt to notify you electronically so that you can take appropriate protective steps. We may also post a notice on the Site if a security breach occurs. If you have reason to believe that personal information about you is no longer secure, please notify us immediately by contacting us in accordance with the last section below.

External Links

As a convenience to our visitors, the Site may contain links to a number of websites that we believe may offer useful information or services. This Privacy Policy does not apply to those websites, and Merz does not make any representations or guarantees regarding those websites. When you click on one of these links, you will no longer be transacting business through the Site, and we will display a warning whenever you link to a website that is not controlled by Merz. Third party websites maintain their own privacy policies, and we do not exercise any control over any of the third party websites that may be linked to the Site. Other websites you visit may have their own privacy policies or no policy at all, and might use personal information differently than our policy permits. If you visit a website that is linked to the Site, we strongly encourage you to consult that website’s privacy policy before providing any personal information. Please be aware that we are not responsible for the privacy practices of such other websites, and we are not liable for their misuse of personal information about you.

United States Only

The owner of the Site is based in the State of North Carolina in the United States. We provide the Site for use only by persons located in the United States. We make no claims that the Site or any of its content is accessible or appropriate outside of the United States. Access to the Site may not be legal by certain persons or in certain countries. If you access the Site from outside the United States, you do so on your own initiative and are responsible for compliance with local laws. If you are located outside the United States and you contact us, please be advised that any information you provide to us will be transferred to the United States, and that by submitting information, you explicitly authorize such transfer.

Changes and Updates to this Privacy Policy

Merz may revise this Privacy Policy periodically without prior notice and this will be reflected by a “last modified” date below. We will post a notice on this Site to advise you of any significant changes to this Privacy Policy and indicate at the top of this statement when it was most recently updated. Your continued use of this website constitutes your continued assent to the terms of this Privacy Policy, as updated or amended at that time.

Effective Date, Date Last Modified

This Privacy Policy is effective as of May 10, 2013.

How You Can Control and Update Personal Information About You

You can always choose whether or not to provide information on this Site. However, if you choose not to disclose certain information, you may not be able to register as a user of this Site, which may limit your access certain portions of this Site. We want to be sure that we keep only the most accurate and up to date information about you in our records. Therefore, whenever you believe that information you have given to us needs to be updated, you can email us at info@merzusa.com to correct or update your contact information. You may choose at any time to remove your name, telephone numbers, and postal and email addresses or any other personal information from any lists we might use to send notices or updates and elect not to receive correspondence from us. Please notify Merz of your wishes by contacting Merz by email at info@merzusa.com, or by sending a letter to:

Merz, Inc.
Attn: Webmaster
6501 Six Forks Rd.
Raleigh, North Carolina 27615
Merz will endeavor to respond to all reasonable requests in a timely manner upon receipt of a request.

Thank you for visiting ONMEL.com

Merz is committed to advancing treatment in antifungal therapy.
For other information, please contact:

Merz North America, Inc.
6501 Six Forks Road
Raleigh, NC 27615

Phone: (877) 485-5002 or (919) 582-8000
Fax: (877) 883-6381
Email us at: info@merzusa.com

You can also view our Privacy Policy and Terms of Use for this website.


References: 1. ONMEL [package insert]. Greensboro, NC: Merz Pharmaceuticals, LLC; 2012. 2. Data on file. Raleigh, NC. Merz Pharmaceuticals, LLC. 3. Rodgers P, Bassler M. Treating onychomycosis. Am Fam Physician. 2001;63:663-672. 4. Breitenbach J. Melt extrusion: from process to drug delivery technology. Eur J Pharm Biopharm. 2002;54(2):107-117. 5. Maddin S, Quiring J, Bulger L. Randomized, placebo-controlled, phase 3 study of itraconazole for the treatment of oncyhomycosis. J Drugs Dermatol. 2013;12(7):758-763.