Compounding Options for Nail Fungus

There have been numerous advertisements lately promoting topical medication products for toenail fungus. Although the commercials claim effectiveness, clinical trials reveal a different outcome.

In two trials comparing a commercial product to placebo, complete cure four weeks after treatment (defined as 0% clinical involvement of the target toenail plus negative KOH and negative culture) was achieved in 17.8% and 15.2% of commercial product recipients compared to 3.3% and 5.5% of patients receiving the placebo solution.

In addition to low efficacy, these products are costly. The average price of a new commercial nail antifungal solution is $550 for a 4 mL bottle. With topical commercial products having high costs and low efficacy, Pavilion Compounding Pharmacy uses our resources to try to provide better topical medications at lower costs.

Here are some formulations with various agents that Pavilion Compounding Pharmacy uses to try to eradicate the fungus without the daunting price tag. Anything compounded does require a prescription from a licensed provider.

UREA

Urea has keratolytic, hydrating and softening properties that enhance the permeability of the nail plate to drugs. Diseased nails may be chemically removed using urea ointment. A urea formulation is applied onto the diseased nail plates under occlusive dressings. Urea softens the plate and, after 5–10 days, the entire nail plate may be lifted off the nail bed and trimmed behind the proximal nail fold. A disease-free nail may then grow back.

• Urea 40% Nail Gel

• Fluconazole 1%/Urea 20% Nail Lacquer

• Ketoconazole 2%/Urea 40%/DMSO Nail Suspension

DMSO

DMSO has been used for many years to help increase penetration through the nail. DMSO has also been shown to have keratolytic properties.

• Ketoconazole 2%/Urea 40%/DMSO Nail Suspension

• Itraconazole 1%/Ibuprofen 2%/DMSO Nail Solution

• Itraconazole 1%/Undecylenic Acid 17% (W/V)/Tea Tree Oil 16.7%/DMSO Nail Solution

TEA TREE OIL

Tea Tree Oil has antibacterial, antifungal and anti-inflammatory properties. This agent has been shown to be an effective adjunctive therapy for toenail fungus.

• Ketoconazole 2%/Tea Tree Oil 5%/DMSO Topical Solution

• Clotrimazole 2%/Ibuprofen 2%/Tea Tree Oil 1% Topical Gel (MucoLox™/VersaBase®)

• Tea Tree Oil 5.4%/Lavender Oil 1%/Clotrimazole 1%/ Undecylenic Acid 5%/Urea 5% Topical Cream

IBUPROFEN

Ibuprofen, as a review of the literature indicates, has some antifungal properties of its own. It also can synergize the effect of several antifungal drugs on various fungal infections. Ibuprofen can disrupt the biofilm of various fungal infections as well.

• Itraconazole 1%/Ibuprofen 2%/DMSO Nail Solution

• Thymol 4%/Ibuprofen 2%/Ethyl Alcohol Nail Solution

• Terbinafine HCl 1%/Fluconazole 3%/Ibuprofen 2%/Itraconazole 1% Nail Suspension

CICLOPIROX

Ciclopirox is a broad-spectrum antimycotic that is effective against dermatophytes, yeasts and molds. Ciclopirox, combined with a penetration enhancer, can potentially be an effective formulation for the treatment of toenail fungus.

• Ciclopirox 8%/Fluconazole 1%/Terbinafine HCl 1% Topical Gel

THYMOL

Thymol has been successfully used in vitro against pathogenic fungi, including Aspergillus, C. albicans and molds.

• Thymol 4%/Ibuprofen 2%/Ethyl Alcohol Nail Solution

• Thymol 4%/Ethyl Alcohol Topical Solution

• Ciclopirox 8%/Fluconazole 1%/ Terbinafine HCl 1% Topical Gel

• Terbinafine HCl 1%/Fluconazole 3%/ Ibuprofen 2%/Itraconazole 1% Nail Suspension

• Itraconazole 1%/Terbinafine HCl 3%/Tea Tree Oil 6.6%/Urea 10%/Biotin 0.6%/DMSO Nail Suspension

AZOLES

Azoles, such as itraconazole, fluconazole, ketoconazole, etc., are popular medications to eliminate fungal infections. Azole drugs inhibit CYP-dependent sterol 14α-demethylase, which causes depletion of ergosterol, accumulation of precursor sterols, impairments in fungal membrane structure and function, and fungal cell death.

• Itraconazole 1%/Ibuprofen 2%/DMSO Nail Solution

• Ketoconazole 2 %/DMSO Nail Solution

• Terbinafine HCl 1%/Fluconazole 3%/ Ibuprofen 2%/Itraconazole 1% Nail Suspension

TERBINAFINE

Terbinafine inhibits the enzyme squalene epoxidase, blocking the conversion of squalene to squalene epoxide in the biosynthetic pathway of ergosterol. This action results in both a depletion of ergosterol, which has a fungistatic effect, together with an accumulation of squalene, which appears to be directly fungicidal.

For questions, please contact Pavilion Compounding Pharmacy LLC

p: 404-350-5780

f: 404-350-5640

Staff@pavilionrx.com

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