toenail fungus

Two new topical prescription drugs have been approved by the FDA for the treatment of nail fungus. Last month, the agency gave the green light to a drug called Jublia (efinaconazole). This month, the FDA approved Kerydin (tavaborole) which is also applied directly to affected nails.

It is estimated that over 30 million Americans suffer from toenail fungus, which leads to thickening, yellowing and discomfort. Oral antifungal drugs are available by prescription but have worrisome side effects and frequently interact with other medications.

The new topical agents were applied daily for 48 weeks and evaluated after one full year. Jublia resulted in a complete cure of nail fungus in 15 to 18 percent of study subjects. Daily use of Kerydin resulted in cure for 6.5 to 9 percent of study subjects. Both products have potential side effects such as redness, itching, swelling or irritation of the toes, but because they are applied to the nails and nail beds, they are not expected to affect the liver or interact with other drugs. One possible complication of Jublia is ingrown toenails. According to the prescribing information, that occurred in 2.3% of those applying the drug.


Are you impressed with these cure rates? We aren’t, either. A complete cure rate of 15 to 18 percent after almost a year is hardly something to write home about. And wait till you hear the price. We checked with one of the largestĀ  drugstore chains in the country. In our area, a 4 ml bottle of Jublia would cost $539. You read that right! Mind boggling, eh? That works out to $135 per ml. It is not clear that insurance will cover the cost.

You are supposed to apply one drop per affected toenail. If the big toe is affected, you will need two drops. So, if you have two toenails plus a big toe infected with fungus, you will need 4 drops per day. There are roughly 20 drops in a milliliter or 80 drops in a 4 ml bottle. That means you will go through one 4 ml bottle in about three weeks. But wait, the treatment is supposed to continue for 48 weeks. That means you would need 16 bottles. If you multiply 16 x $539 you end up with a total cost of $8,624. Without insurance, this would be prohibitive. And remember, the complete cure rate is at best 18% after 48 weeks.

There are advantages of a topical liquid antifungal agent over an oral medicine. There are far less serious side effects, for one thing. But if you are interested in topical treatments, you may want to consider a home remedy first. We can assure you that the cost will be infinitesimal compared to a prescription product like Jublia.

To learn more about home remedies and some older, less expensive ways of treating nail fungus, you may be interested in our Guide to Hair and Nail Care. Read other comments below or add your own.

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  1. David
    Reply

    The Jublia dispensers can be faulty. I turn the bottle upside down to put on my toe and it comes gushing out. I have no control over a drop here or there. This stuff isn’t cheap and I will be contacting shoppers drug mart to see what they can do as I would like some form of compensation.

  2. JC
    Canada
    Reply

    Yup, I’m a pharmacist and I can confirm that drug pricing between countries is crazy. For this drug, it’s about $80 in Canada and over $400 (usually) in the US. The price of many drugs is vastly different in different countries. To make it worse (i.e. more confusing), it’s not consistent – drugs in Canada aren’t always cheaper than in the US.

    • Janet M.
      Montreal
      Reply

      I agree Jublia bottles faulty. I lost half of the product. Bought 3 so far and all defective

  3. toejam
    Reply

    Jublia works but it takes forever to see any results. I started with all my toes heavily infected with very thick nails. After a year and 2 months, all but two little toes are completely cured. The other two are growing out normally, but still infected at the tip. One big toe is the same and is growing out normally and may be 6 months or more before grows out completely. The other big toe is still infected. So I think success with it means using it at least one year and probably two. Cost has been ~$210 for every 3 months. No insurance and I don’t buy it in the US.

  4. Lani
    NY
    Reply

    I have been on Terbinafine for about sixty days and I can see improvement but the rash I had on my torso was terrible. The itching was non-stop and the rash didn’t start until I had been on it for about 50-55 days. It took 3 days to work out of my system. The doctor has given me a prescription for Jublia. I hope for good results. The first fill is free but after that I was told each refill will be $40.00. Good as long as it works and without the rash or the chance of liver damage.

  5. Natalie
    Canada
    Reply

    My dermatologist just prescribed Jublia. She started me off with 2 bottles with four repeats and told me to come see her in August. Seems like she’s expecting it to clear up in 6 months and I hope it does. I just came off of Lamisil in July and it did a good job. it just wasn’t that strong enough. I really hope a Jublia clears it up completely. Oh and by the way my first 2 bottles cost a total of $36 with insurance. The prices on here seen outrageous. I mean $700 for a bottle? Meanwhile I’m getting 2 at a time. I consider myself lucky.

  6. Mike
    Reply

    This stuff works very well! I had about 8 nails that were affected and it cleared all of them up, but the only thing is time. It took about 3 months to notice anything. I’m on month 7 and I only have one nail with a small discolouration. Very expensive if you’re not covered though!

  7. Bruce
    Michigan
    Reply

    I had a really bad case of toenail fungus on six toes, and Jublia substantially cleared it up over about six months. The keyword in this article is “completely”; one toenail remains slightly discolored, so the cure wasn’t complete. But I certainly was happy with the result, particularly as compared with other remedies I’d tried (nothing oral, however). I can’t justify the price, but thus far my insurance plan has paid for everything. With the agreement of my podiatrist, I am now going off Jublia to see what happens.

  8. Martin
    Or
    Reply

    I got a prescription for this. It says to use it for 48 weeks once a day. The bottle I got was about 1/4 fluid ounces at the most and lasted less than 2 weeks. I called the pharmacy and was told the bottle cost $700. Only in America.

  9. Atekam
    Reply

    All the people going through Philidor and saying that they didn’t have to pay, please explain. I contacted them and was charged $75.00 when I shouldn’t have a co-pay at all.

  10. Prescriber
    New York, NY
    Reply

    Looks the comment section was bombed by the manufacturer. Discounts all around. Mail/Internet based pharmacy. Happy people.

    Where does the money really flow from and to. This isn’t free.

    And just wait for that high failure rate.

  11. Eugenia
    Montreal, Canada
    Reply

    I just bought a 6ml bottle and cost me 16 CAD after insurance, but the actual cost without insurance is 81 CAD. Today I started the treatment so I can’t say that much, I just wanted to say that the prices that the article gives is wrong.

  12. Shannon
    Florida
    Reply

    This stuff doesn’t work! The Jubila cost $400 for that tiny bottle. The other stuff costs $1,000 ridiculous!!!!!

  13. bob
    pa
    Reply

    Jublia is the most WORTHLESS treatment for foot fungus that I have ever purchased First of all the price for the TEENY TINY bottle of this rip-off product costs almost $600.00 Luckily, I found a coupon online and got it for FREE!! I used it faithfully for 3 months without any positive results.

  14. Marky
    Manitoba, Canada
    Reply

    Costs me 16 cdn dollars and this is the only thing that works. Thanks whoever makes Jublia!

  15. John
    New York
    Reply

    I’ve been using Jublia for 4 months and have seen some results. I have to use on ever nail since ever one was affected to some degree. Really hard to use 1 drop as the applicator really sucks and instead saturates the nail. I typically cover the entire nail, the skin around the nail and under the nail. I find also sanding the nail surface with the roughest side of a nail buffing tool makes it more porous and allows the Jublia to really soak in and dry much quicker. I apply pretty liberally, but fortunately, I have good insurance a bottle costs me $.44. My doctor tells me I’m the only patient he has on this medication because of the outrageous cost. Lucky for me as I can’t stomach the oral medication. Jury is still out on how effective it is, but appears to be more so than laser treatments. I’ve not had any sever side effects except for some areas where the toenail seems to be ingrown, but no pain, at least not yet. Hard to believe there isn’t a safe and more aggressive method to handle toenail fungus. So much for advanced medical technology. Such a joke.

  16. Jim
    Lumberton, nc
    Reply

    Went to a foot Dr. and was prescribed Jublia for toenail infection. Due to age and income he gave me a prescription for 8ml X 12 for $75.00 per order through Philidor. Got the first bottle and, because all ten toes are being treated, it did not last a full month. Called Phillidor to refill and was told that there has been a price increase on the 8ml size of $50.00 and it will now cost me $125.00 per refill.

    I told them not to refill it as I could not spend that much. I feel like this was a bait and switch scheme and a real rip-off. Called Valeant to see if they had increased their cost and was told “we don’t have any price information at our disposal, however, we do change our special offers from time to time”. Talk about customer satisfaction…

    I’m 73 years old and not looking for a foot modeling job so I think I’ll pass on this junk. 18% success is not what I would expect for that kind of price. I will spread the word of my experience as best I can. ( Now where did I put my wire cutters).

  17. Liz
    canada
    Reply

    I have had nail fungus on my big toe and two little toes for 10 years. The big toe Nail fell off 4 years ago and I was told by a doctor that it likely won’t grow back at all. The nail did grow back but ugly, crooked and still with the fungus. I used all sort of remedies, oil of aregano, tea tree oil, vinegar, mouth wash, nail lacquer and nothing worked. Jublia cleared my Nail entirely in approximately 8 months (I forgot to use it/didnt have prescription here and there). You have to use it daily and apply to nail and surrounding area. My nail is clear and smooth now, I can’t believe it! I thought I’d have to deal with it forever. Where I’m at (ontario,canada) it’s only 40$ after insurance coverage..no na compared to other I’ve tried :).

  18. Tracey
    Texas
    Reply

    Jublia has completely cleared up my toe and cost me next to nothing. I have one big toe infected and I do not go through a bottle even close to as quickly as this article claims. The person who wrote this seems determined to make this medication look as terrible as possible. It may not work for everyone, but it is a godsend for those of us who do respond well to it.

  19. Krista
    Indiana
    Reply

    I was just prescribed this as well , you don’t need to apply 2 drops to the big toe 1 does just fine. Using more at one time won’t make it work any faster. And let me remind you Rome wasn’t built over night. But needless to say I’m still in the early stages only a week in, so no results yet to report. However my podiatrist also recommended philidor, and mine was free as well! With no shipping cost either!

  20. DeeDee
    United States
    Reply

    I’ve had more than one bout of fingernail fungus over about 15 years. I’m a gardener and my Dermatologist thinks I get it in the soil I try to wear gloves and that helps. My very smart Dermatologist prescribed Sulfacetamide Sodium Sulfur lotion, costs me a $10 copay. This is normally used for acne. He told me to put it on my nail with something small, like a toothpick, twice a day. I put it all around the nail bed and under the fingernail at the top (it seeps down under the nail). I swab it generously morning and night and try not to wash it off for at least an hour. It takes a very long time (but not 42 weeks like Jublia!), but more like maybe 6 months. The nail has to entirely grow out clean for the fungus to go away. When I first did this, I had fungus under about 5 nails. At first I didn’t see much results, but he told me to stick with it and I did. IT WORKS. You must do this religiously, however, and try to get it under the nail bed as best you can without hurting yourself. I have had to do this at least 3 times (with years in between), but it has always worked. I can’t believe more people don’t know about this.

  21. Anita
    Philadelphia
    Reply

    I currently use Jublia and love it! I got it from my podiatrist and they recommended I have my script filled through Philidor, a mail order pharmacy. I called as soon as I got home from my appointment and it took maybe 2 minutes to set up my account with them. I had my script the NEXT day! It also was $0! I know that my CVS pharmacy wouldn’t put the rebate card through I got from my doctor so that’s why I used Philidor and it was a great experience! Anyone who is having issues with expense, ask your doctor to put it through the Philidor pharmacy so that way it guarantees if you have insurance besides medicare, you’ll get it for free! After using it for 6 months already I see a HUGE difference and haven’t paid a single cent on any of my refills as well!

    • Atekam
      Reply

      Well, when I placed an order through Philidor, the cost was $75.00, so I’m not understanding how you said it was free through them. I have a federal insurance plan through a branch of the government, so not sure why the co-pay was that much or even a cost to begin with.

      • Kath
        Reply

        If you look at the coupon, it says Medicare and Fed plans are not included in the ‘free copay’ program. You have to watch out though, I’m not sure if Philidor will still be there to dispense this product since the company (and the pharmaceutical company) are in trouble in the media. Just look up news about Valeant.

  22. C squared
    Canada
    Reply

    The prices quoted in this article are completely out of line from what I have paid. I pay $90 for a 6ml bottle. So far it has lasted me 3 months (although I am only using on 2 nails) and so far is working fabulous! Nails are growing out looking normal, and I have had no side effects. Huge difference from when I used lamasil tablets! So far no complaints, hope it works in the long term.

    • Ken
      Plainfield, IL
      Reply

      People who live in Canada can get it cheap, but not Americans we pay the most and think we are so cool.

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