The standard antifungal for nails and skin — effective, slow for nails, and the tablets need bloods first.
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Terbinafine is an antifungal that kills dermatophytes — the fungi responsible for athlete's foot, ringworm, jock itch and fungal nail infection. It works by blocking an enzyme the fungus needs to build its cell membrane.
It comes as a cream, available over the counter, and as tablets, which are prescription-only.
The distinction matters enormously. Cream works well on skin and does essentially nothing for an infected nail — it cannot penetrate the nail plate. Nail infection needs oral treatment for months, and that is a genuinely different decision with genuinely different risks.
It does not treat Candida — thrush needs a different antifungal entirely.
The tablet does not clear the existing damaged nail — it stops the fungus so a healthy nail can grow out. Toenails grow roughly 1mm a month, so a full toenail takes twelve to eighteen months to replace.
That means the nail will still look abnormal when you finish the course, and it will keep improving for a year afterwards. Knowing this in advance prevents a great deal of unnecessary disappointment.
Local irritation, redness, itching or stinging. Generally well tolerated.
Only if you are allergic to it. It is otherwise very safe, and is available over the counter for good reason.
Is the nail actually fungal? Roughly half of abnormal-looking nails are not. Psoriasis, trauma, and lichen planus all mimic it, and treating those with six months of terbinafine achieves nothing while exposing someone to the risks.
That is why nail clippings for laboratory confirmation are recommended before starting oral treatment — not as a formality, but because the answer changes the plan half the time.
Liver function tests before starting, and again at four to six weeks for longer courses. This is standard practice and is not optional.
A full blood count is checked in longer courses or where there is any concern.
Nail clippings for mycology before starting — the most useful test of all, because it establishes whether the diagnosis is right.
Yes for both, and the useful part of the consultation differs completely between them.
Terbinafine cream is available over the counter and is cheap. For straightforward athlete's foot or ringworm, a pharmacy is faster and we would say so rather than charge a fee.
This is where a consultation genuinely earns its place, because the decision is more involved than it looks:
Where treatment matters more: diabetes, poor circulation, immunosuppression, or nails causing pain or recurrent skin infection.
This page is information, not an offer to supply.
Terbinafine cream is over the counter and inexpensive — own-brand versions cost a few pounds and are identical to Lamisil.
Tablets are prescription-only and cheap as a generic, though a three to six month course accumulates, and the blood tests are a separate cost on the private route. That total is worth knowing at the outset.
Drying between the toes, rotating footwear, treating the athlete's foot that reinfects the nail, and not sharing nail clippers. Recurrence rates are high, and this is what changes them.
Complete the course. Stopping early is the commonest reason nail treatment fails, and it usually happens because the nail still looks abnormal — which it will.
Twelve to eighteen months for a toenail, and the tablets finish long before that.
The medicine stops the fungus; the nail has to grow out. Your nail will still look abnormal on the last day of the course, and that is expected rather than failure.
No. Cream cannot penetrate the nail plate. Nail infection needs oral treatment, or accepting it.
Yes, for the tablets. Terbinafine can affect the liver, and baseline liver function — with a repeat at four to six weeks for longer courses — is standard practice rather than caution for its own sake.
Not necessarily, and this is worth saying plainly. A discoloured toenail causing no symptoms in a healthy person is a cosmetic issue, and three to six months of tablets with monitoring is a genuine intervention.
Treatment matters more if you have diabetes, poor circulation, a suppressed immune system, or the nail is painful or causing repeated skin infections.
Moderate drinking is generally acceptable, but heavy drinking is not advisable during a course, since both the drug and alcohol are handled by the liver.
A recognised side effect. It usually returns within weeks of stopping, though occasionally it takes longer. Worth reporting.
Usually reinfection from athlete's foot, shoes, or communal floors. Treat the skin alongside the nail, rotate footwear, dry between the toes, and do not share clippers.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
September 5, 2026
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Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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