Q. I’ve had fungus in all my toenails since the summer I spent three weeks hiking through snow. Most of my toenails and the outer skin of my feet sloughed off then, about 44 years ago.
I asked my physician to prescribe Jublia despite its low cure rate. At the pharmacy, I was told it needed pre-approval. If I wanted to pay cash, though, a 4 ml bottle to be applied daily for 10 months would cost me $418.00 per bottle!
I laughed and said no thanks. I can live with this just as I have been for all these years.
A. Efinaconazole (Jublia) is a new topical anti-fungal medication that is being widely advertised on television.
Actual cure rates are not mentioned in the commercials. There were two clinical trials to get FDA approval.
In one, a “complete cure” was achieved in 17.8 percent of the subjects after 48 weeks of Jublia applications. In the other study, 15.2 percent of the volunteers achieved a cure after 48 weeks.
A Pricey Prescription
Chain pharmacies near us charge between $539 and $589 for a 4 milliliter (ml) bottle. You would need at least one drop per infected toenail each day.
If all your nails are infected, that could be 12 ml daily (the big toes get two drops). There are roughly 80 drops in a 4 ml bottle, so one bottle would last about a week. After 48 weeks you could be out over $20,000 if your insurance company won’t pay.
Home Remedies for Nail Fungus
A few days ago we received an interesting message from a retired physician:
“Joe & Terry,
“Thanks for your publication about the amazing cost of Jublia. No wonder they could justify ads on the Super Bowl!
“I’ve looked into the popular suggestions for my own long standing toenail fungus such as original Listerine and Vicks VapoRub. They’re acidic and share some fungicidal contents, at rather low concentrations.
“My thinking immediately came to two critical factors: 1) you’ll have to treat for the total growth time of toenails, about 12 months, and 2) you need to find a way of keeping the tissue wet with the “medication” for hours at a time to assure adequate “soak-in”.
“It appears to be working! For the past 3 or 4 months I’ve been treating for 2 to 3 hours several times a week. At this point the new growth of the nails appears pink and healthy.
“And the treatment; several cc’s of amber “original” Listerine in the toe of each of a pair of molded plastic gardening moccasins I found in the garden department of our local Lowes. No socks, just my foot in a small puddle of Listerine.
“A year is a long time to do anything, but so far I’m sticking with this, usually when I’m sitting around in the evening.
“It’s hard to believe drug companies can charge about $70.00 per drop to treat what amounts to a cosmetic problem!
“All the best to the two of you.” David M., M.D. (retired)
Many people would prefer to try home remedies, even though we don’t know their cure rates. At least they won’t cost you as much as Jublia. You can learn more about various approaches such as vitamin E oil, tea tree oil, Vicks VapoRub or Listerine and vinegar soaks in our Guide to Hair and Nail Care.