Drug Guide
Efinaconazole
Classification
Therapeutic: Antifungal
Pharmacological: Azole antifungal
FDA Approved Indications
- Onychomycosis (nail fungus) caused by dermatophytes
Mechanism of Action
Efinaconazole inhibits fungal lanosterol 14α-demethylase, an enzyme involved in converting lanosterol to ergosterol, an essential component of the fungal cell membrane. This inhibition impairs cell membrane synthesis, leading to fungal cell death.
Dosage and Administration
Adult: Apply a thin layer of the solution to affected nails once daily for 48 weeks.
Pediatric: Safety and efficacy in pediatric patients have not been established.
Geriatric: No specific dose adjustment necessary; however, monitor for efficacy and tolerance.
Renal Impairment: No specific adjustment; use with caution in severe impairment.
Hepatic Impairment: No specific data; use with caution.
Pharmacokinetics
Absorption: Minimal systemic absorption when applied topically.
Distribution: Primarily localized in the nail and surrounding tissues.
Metabolism: Metabolized minimally; any absorbed drug is cleared hepatically.
Excretion: Primarily via feces; negligible urinary excretion.
Half Life: Not well-defined, as systemic absorption is minimal.
Contraindications
- Known hypersensitivity to efinaconazole or other azole antifungals.
Precautions
- Prior to use, confirm diagnosis of onychomycosis; monitor for local reactions such as irritation or redness.
Adverse Reactions - Common
- Ingrowing toenail, (Rare)
- Nail disorder, abnormal nail, (Rare)
- Application site reactions (redness, pain, irritation) (Uncommon)
Adverse Reactions - Serious
- Hypersensitivity reactions, such as rash, swelling (Very rare)
- Liver enzyme abnormalities (Unreported in topical use)
Drug-Drug Interactions
N/ADrug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Assess affected nails prior to and periodically during therapy for signs of infection and adverse reactions.
Diagnoses:
- Impaired skin integrity related to topical application.
- Risk for allergic reaction.
Implementation: Instruct patient on topical application technique, hygiene measures, and adherence to therapy.
Evaluation: Monitor for clinical improvement and adverse reactions.
Patient/Family Teaching
- Apply the medication as directed, ensuring the nail surface is clean and dry before application.
- Avoid getting the medication in eyes, mouth, or other mucous membranes.
- Report any signs of adverse reactions or worsening infection.
Special Considerations
Black Box Warnings:
- None
Genetic Factors: None identified for this medication.
Lab Test Interference: No known interference with laboratory tests.
Overdose Management
Signs/Symptoms: Local skin irritation or allergic reaction; systemic absorption is unlikely.
Treatment: Discontinue use and provide supportive care; consult poison control or emergency services if ingested.
Storage and Handling
Storage: Store at controlled room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable until expiration if stored properly.