Efinaconazole (Topical)

Efinaconazole, known in the US as Jublia, is applied daily for 48 weeks to treat fungal nail infections.

Overview

Efinaconazole is a topical treatment for infections of the toenails caused by fungus or yeast. The medicine works by killing the fungus or yeast which is to blame for the infection, but only if it is applied daily for a long period of time, typically 48 weeks.

It is a safer alternative to oral antifungals which can cause liver problems. Since efinaconazole is administered topically, very little of the drug reaches the bloodstream in order to have an impact on the liver. Instead, the medicine is applied exactly where it is needed in order that it can act on the fungus or yeast in question.

Efinaconazole is only available with a doctor's prescription. In the US, it is known under the brand name Jublia.

Conditions Treated?

  • Fungal toenail infection
  • Yeast toenail infection

Type Of Medicine?

  • Antifungal

Side Effects

Sometimes efinaconazole can cause unwanted side effects alongside its needed effects. Check with your doctor if you notice any of the following unwanted symptoms:

  • Ingrown toenail
  • Redness, itching or swelling on the skin around the affected toenail(s)
  • Pain, burning or stinging sensation on the area surrounding the affected toenail(s)
  • Blisters on the area surrounding the affected toenail(s)

If you notice any other side effects not listed here, consult your doctor as soon as possible. You could also report new side effects to the FDA.

Dosage

In adults, doctors usually recommend applying efinaconazole directly to the affected toenail(s) once every day for at least 48 weeks. For children, the use and dose should be determined by a doctor because it is not known how safe or effective the medicine is. Some doctors may still decide to prescribe the drug to children if they believe it to be suitable treatment.

How to use efinaconazole

Try to apply efinaconazole at the same time each day so that it becomes a habit and you are less likely to miss a dose. For example, you could apply it as soon as you get up in the morning, before you go to bed at night, or after you shower or bathe. Make sure that if you do apply it after showing or bathing, you wait at least 10 minutes to ensure toenails are fully dry.

Toenails should be clean and dry before you apply efinaconazole, and hands should also be freshly washed before you touch your feet or toenails. The solution is provided in a bottle with a built-in brush applicator. Remove the cap from the bottle of efinaconazole and hold the bottle upside down over the infected toe. The brush should become moistened with the solution with no need to squeeze the bottle. Then, simply wipe the brush across the affected nail, its cuticle, on the folds of skin around the nail, and underneath the nail. Repeat on all affected nails.

Replace the cap on the efinaconazole bottle and allow the toenails to completely dry. Wash your hands with warm, soapy water afterwards to remove traces of the solution.

Keep using efinaconazole even after symptoms begin to clear up because yeast and fungus infections take a very long time to treat. If you stop efinaconazole treatment sooner than the recommended 48 weeks, the infection will not completely clear and symptoms could return.

Missed doses

If you miss a dose of efinaconazole, apply it as soon as you remember unless it is almost time for the next dose, in which case simply skip the dose and continue with your normal dosing schedule. Never apply extra solution to make up for a missed dose as this could increase the risk of side effects. Applying efinaconazole consistently every day is vital for effective treatment, so try to incorporate application into your daily routine to minimize the risk of missing a dose.

Interactions

It is highly unlikely that other drugs will interact with efinaconazole since it is applied topically and very little enters the bloodstream. However, you should still make sure your doctor knows about all the medicines you currently take, just in case of a potential interaction. Keep a list of all prescribed and over-the-counter (OTC) medicines you use, including multivitamins and herbal supplements. You can then present this list to all doctors, pharmacists and other healthcare professionals to ensure no harmful interactions occur.

Warnings

Avoid pedicures and nail polish

Many nail products, such as nail polish, gel nail polishes, and acrylic nails, can worsen fungal nail infections or stop efinaconazole from reaching the nail and working correctly. Avoid these products throughout efinaconazole treatment. You should also avoid having pedicures as this could risk you transmitting the nail infection to others, or it could worsen the infection or lead to other complications.

Flammable

Efinaconazole solution is flammable. Stay away from heat and open flames while you are applying the medicine and until it has dried. Do not smoke while applying efinaconazole.

Pregnancy and breastfeeding

Efinaconazole is a pregnancy category C drug, which means that it shouldn't be used during pregnancy unless the benefits of the drug far outweigh potential risks to the fetus. Animal studies have shown that efinaconazole could be harmful to both the fetus and the mother and there have not been adequate human studies to determine the safety of the medicine. If you become pregnant while using efinaconazole, tell your doctor straight away.

It is not known whether topical efinaconazole is excreted in human breast milk. Animal studies have proven that the drug is excreted in milk after being administered subcutaneously. Since the risks aren't fully understood, it is recommended to avoid breastfeeding where possible.

Apply only to affected areas

Efinaconazole is designed only for toenail infections. Avoid contact with eyes, mouth and genitals. If the medicine does come into contact with these areas, cleanse the area thoroughly with clean water and consult your doctor as soon as possible. If someone has ingested a large amount of efinaconazole, contact your local poison control center or call 911 if they have collapsed or are not breathing.

Progress appointments

Your doctor will probably want you to have regular appointments in order that they can examine your affected toenails and assess your progress. This is an opportunity for you to report problems with the treatment or discuss side effects. If the infection does not appear to clear or gets worse, tell your doctor at these appointments.

Storage

Store efinaconazole in the container it is provided in with the cap securely closed at all times. Keep it at room temperature and away from heat, direct light or moisture, and do not allow it to freeze. The bathroom is not the best place to store efinaconazole due to the humid conditions.

Do not share efinaconazole solution with anyone else. If someone else in your family develops a toenail infection, they should visit their doctor to be prescribed a suitable treatment.

Keep efinaconazole away from children and pets. Store it up and away from the ground so that it is not within easy reach.

Do not keep outdated or unused efinaconazole. Instead, ask your healthcare provider how to safely dispose of it. There may be a medicine take-back program in your local area which will ensure the medicine is disposed of in such a way that it will not harm other people or the environment.

Summary

Efinaconazole is an antifungal treatment most commonly used to treat fungal toenail infections, though sometimes it is used to treat yeast toenail infections. It is a topical treatment and can only be purchased with a doctor's prescription. In the US, it is known under the brand name Jublia.

Since efinaconazole is a topical treatment, which means it is applied directly to the affected toenail(s) and immediate surrounding area, very little of the medicine reaches the blood stream. This means that the drug is unlikely to interact with other medicines. It also means that there are few side effects associated with the medicine. Some people may experience blistering, burning, itching, reddening or pain on the treated area; if so, it should be reported to a doctor immediately. You should also tell your doctor if you develop an ingrown toenail while using efinaconazole.

Efinaconazole is approved for use in adults but the safety and efficacy of the medicine in children is unknown. It should be applied to the affected toenail(s) once every day for 48 weeks. The long treatment time is important because fungal and yeast nail infections take time to clear up. Do not stop applying efinaconazole any sooner as doing so could cause symptoms to return.

Apply efinaconazole to clean, dry nails. Be sure to wait at least 10 minutes after showering or bathing to apply the solution. Spread a small amount across the affected nail and on the cuticle, the folds of skin surrounding the nail, and underneath the nail. Allow to completely dry before putting on socks or shoes.