efinaconazole

Therapeutic Classification: antifungals

Pharmacologic Classification: triazoles

Indications ⬆ ⬇

REMS

Topical treatment of onychomycosis of the toenail.

Action ⬆ ⬇

Inhibits synthesis of ergosterol, a component of fungal cell membranes.

Therapeutic effects:

Resolution of toenail fungus.

Spectrum:

Active against Tricyhophyton rubrum and Trychophyton mentagrophytes.

Pharmacokinetics ⬆ ⬇

Absorption: Minimal systemic absorption follows application to toenails.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: 29.9 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
Topical‡	unknown	unknown	unknown

‡Prolonged treatment is necessary due to need for treatment throughout growth of new toenails.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

None noted.

Use Cautiously in:

OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Children <6 yr (safety and effectiveness not established);
Geri: Older adults may be more sensitive to drug effects.

Adv. Reactions/Side Effects ⬆ ⬇

Local: application site dermatitis, application site pain, application site vesicles, ingrown toenail

Interactions ⬆ ⬇

Drug-drug:

None reported.

Route/Dosage ⬆ ⬇

(Adults and Children ≥6 yr): Apply to affected toenails once daily for 48 wk.

Availability ⬆ ⬇

(Generic available)

Topical solution: 10%

Assessment ⬆ ⬇

Inspect involved areas of skin before and frequently during therapy. Increased skin irritation may indicate need to discontinue medication.

Implementation ⬆ ⬇

Topical Apply to affected clean, dry toenails once daily for 48 wks with integrated flow-through brush applicator. Ensure toenail, toenail folds, toenail bed, hyponychium, and undersurface of toenail plate are completely covered. Solution is clear, colorless to pale yellow.

Patient/Family Teaching ⬆ ⬇

Instruct patient to apply efinaconazole as directed for full course of therapy, even if feeling better. Emphasize the importance of topical use only, not for oral, ophthalmic or intravaginal use. Advise patient to wait at least 10 min after showering, bathing, or washing before applying. Efinaconazole is flammable; avoid use near heat or open flame.
Advise patient to report increased skin irritation (redness, itching, swelling) to health care professional.
Caution patient to avoid pedicures, nail polish, and cosmetic nail procedures during therapy.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇