From the Guidelines
Ciclopirox is the least expensive topical medication for onychomycosis (nail fungus), available as an 8% lacquer applied once daily for up to 48 weeks. The cost of ciclopirox lacquer is generally lower compared to other topical treatments, such as amorolfine, with a price range of around $15-25 per bottle 1. For nail fungus treatment, apply the lacquer to the affected nail(s) once daily after thoroughly cleaning and drying the area. The medication should be applied to the nail and surrounding skin. Treatment typically needs to continue for several months (6-12 months for toenails, 3-6 months for fingernails) as nails grow slowly and the medication needs time to eliminate the fungus as the nail grows out.
- Key points to consider:
- Ciclopirox has broad-spectrum antifungal activity against T. rubrum, S. brevicaulis and Candida species 1
- It inhibits metal-dependent enzymatic processes including nutrient uptake, cellular energy production and degradation of toxic intracellular peroxide 1
- The recommended duration of treatment is up to 24 weeks on the fingernails and up to 48 weeks on the toenails 1
- Periungual and nail fold erythema are the most common side-effects 1 While topical treatments are less expensive than oral medications, they are also less effective, particularly for more severe infections or when the fungus affects the nail matrix (base of the nail) 1. Topical treatments work best for mild to moderate infections limited to the nail surface. Ciclopirox works by inhibiting metal-dependent enzymatic processes, which disrupts fungal cell membrane synthesis, ultimately killing the fungus. For better penetration, consider filing down the infected nail surface before application or using the medication in conjunction with urea-containing products that can soften the nail.
From the FDA Drug Label
INDICATIONS AND USAGE ... Ciclopirox Topical Solution, 8%, (Nail Lacquer), as a component of a comprehensive management program, is indicated as topical treatment in immunocompetent patients with mild to moderate onychomycosis of fingernails and toenails without lunula involvement, due to Trichophyton rubrum
The least expensive topical medication for onychomycosis (nail fungus) is ciclopirox (TOP), however the cost information is not provided in the drug label. 2
From the Research
Least Expensive Topical Medication for Nail Fungus
The least expensive topical medication for onychomycosis (nail fungus) is ciclopirox 8% nail lacquer.
- The cost of regimen for ciclopirox nail lacquer was $325.2 3
- In comparison, the cost of regimen for other treatments such as griseofulvin, itraconazole (continuous), itraconazole (pulse), terbinafine, and fluconazole were $1413.1, $1410.2, $811.7, $890.1, and $966.8 respectively 3
- Ciclopirox nail lacquer has been shown to be effective in treating mild-to-moderate onychomycosis, with a mycologic cure rate of 52.6% +/- 4.2% 3
- The medication has also been found to be safe, with mild, transient irritation at the site of application reported as the most common adverse event 4
Efficacy of Ciclopirox 8% Nail Lacquer
- Ciclopirox 8% nail lacquer has been shown to be effective in treating onychomycosis, with a mycologic cure rate of 29% to 36% in clinical trials 5, 4
- The medication has also been found to be effective in combination with oral terbinafine, with a mycologic cure rate of 66.7% to 70.4% 6
- Ciclopirox 8% nail lacquer has a broad spectrum of activity, with efficacy against Candida species and some non-dermatophytes 5