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Treatments for toenail fungus:
Ciclopirox Nail Lacquer (Penlac)

Generic Name: Ciclopirox
Brand Name(s): Penlac
Treatment Form: topical solution

What is Ciclopirox?

Cicloprirox topical solution is a clear, colorless antifungal nail lacquer recommended for persons with mild to moderate toenail fungus (onychomycosis) due to the dermatophyte Trichophyton rubrum. Ciclopirox is applied to fungal nails daily as a part of regular program that includes weekly trimming of the nails by the patient and monthly trimming by a health care professional. It is marketed under the brand name Penlac® and is also available in generic form. In the U.S., ciclopirox is available only by prescription. It is supplied in 6.6 mL glass bottles with screw caps which are fitted with brushes.

Cicloprirox Nail Lacquer (Penlac)

Prior to beginning treatment with ciclopirox, the diagnosis of onychomycosis due to Trichophyton rubrum should be confirmed by submitting nail specimens for laboratory testing (KOH preparation, fungal culture, or nail biopsy).

Dosage and Administration of Ciclopirox

Ciclopirox topical solution should be used as a component of a comprehensive management program for onychomycosis. Removal of the unattached, infected nail, as frequently as monthly, by a health care professional, weekly trimming by the patient, and daily application of the medication are all integral parts of this therapy.

Nail Care By Patient

The patient should apply the ciclopirox topical solution once daily (preferably at bedtime or eight hours before washing) to all affected nails with the applicator brush provided. The ciclopirox lacquer should be applied evenly over the entire nail plate. If possible, the solution should be applied to the nail bed, the hyponychium, and the under surface of the nail plate when the nail plate is separated from the nail bed (onycholysis).

The ciclopirox nail lacquer should not be removed on a daily basis. Daily applications should be made over the previous coat for seven days.

Every seven days, the ciclopirox should be removed with alcohol. Patients should file away (with an emery board) loose nail material and trim nails, as required, or as directed by the health care professional, after the layers of ciclopirox are removed with alcohol.

This cycle should be repeated throughout the duration of therapy.

Patients should not use nail polish or other nail cosmetic products on the nails treated with ciclopirox.

Nail Care By Health Care Professionals

As often as monthly, a health care professional should remove any unattached infected nail, trim the remaining nail, and file away any excess nail material.

How Does Ciclopirox Work on Toenail Fungus?

Ciclopirox is thought to work by combining with other substances to prevent the degradation of peroxide within the fungus cell nucleus.

Is Ciclopirox Effective Against Toenail Fungus?

Ciclopirox has been shown to be effective for toenail fungal infections due to the dermatophyte Trichophyton rubrum both in laboratory and in clinical infections.

The results of two clinical studies of patients receiving treatment of ciclopirox for toenail fungus, as evaluated at week 48 (after 48 weeks of ciclopirox treatment), found that 29% and 36%, respectively, of patients were cured (defined as having both a negative KOH smear plus a negative culture). A complete cure (defined as clear nails) was achieved in less than 12% of the patients in the studies.