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Lamisil vs Jublia
Introduction
For patients suffering from fungal nail infections, certain antifungal medications are designed to target and eliminate the fungi causing the infection. Lamisil and Jublia are two such drugs that are prescribed for this purpose. Both impact different aspects of the fungus life cycle but have similar effects in eradicating nail-based fungal infections. Lamisil is an allylamine antifungal medication inhibiting squalene epoxidase, a key enzyme in the biosynthesis of ergosterol which is an essential component of fungi cell membranes thereby disrupting their growth. On the other hand, Jublia (Efinaconazole) is classified as a triazole antifungal that works by inhibiting lanosterol 14α-demethylase, an enzyme involved in the synthesis of ergosterol, thus disrupting cell membrane formation and effectively killing off various types of fungi.
Lamisil vs Jublia Side By Side
| Attribute | Lamisil | Jublia |
|---|---|---|
| Brand Name | Lamisil | Jublia |
| Contraindications | Should not be used with certain drugs that can interact harmfully, such as blood thinners or cholesterol-lowering statins. Alcohol use must be limited. | Specific contraindications not detailed, but general caution advised regarding use with other medications and conditions. |
| Cost | Averages around $35 for a 30g tube of 1% cream. Generic terbinafine often falls below $1/day. | Between $600-$700 for a small bottle that commonly lasts one month. |
| Generic Name | Terbinafine | Efinaconazole |
| Most Serious Side Effect | Liver problems, including persistent nausea/vomiting/loss of appetite, stomach/abdominal pain, and yellowing eyes/skin. | Signs of a severe allergic reaction or skin response, including hives, itching, fever, swollen glands, difficulty breathing, or swelling in your face and throat. |
| Severe Drug Interactions | Interactions with blood thinners or cholesterol-lowering statins due to potential interference with liver function. | Not specifically mentioned, but as with any medication, interactions with other drugs should be carefully managed. |
| Typical Dose | Topical application is a thin layer applied once daily to the affected and surrounding skin areas for 1 week. | Applied as a thin layer to affected toenails once daily for 48 weeks. |
What is Lamisil?
Terbinafine (the generic name for Lamisil) is an antifungal medication that came to light as a significant advancement over the previous class of topical antifungals. Terbinafine was first approved by the FDA in 1996 and is known for its effectiveness against nail fungus infections, also known as onychomycosis. It works by inhibiting an enzyme necessary for fungal growth, thus killing off the infection at its source. On the other hand, Efinaconazole (the generic name for Jublia) belongs to a newer generation of antifungal medications and was approved by the FDA in 2014. Unlike Terbinafine which can be taken orally or applied topically, Jublia comes solely as a topical solution aimed at treating toenail fungus specifically. While both drugs work effectively against fungal infections, they have different mechanisms of action: while Lamisil interrupts fungal cell growth resulting in their death, Jublia prevents new fungal cell membranes from being formed thereby stopping their proliferation. The side effects vary between these two medications with Lamisil potentially causing liver damage when taken orally and Jublia commonly resulting in ingrown toenails or redness around application site.
What conditions is Lamisil approved to treat?
Lamisil and Jublia are both approved for the treatment of various fungal infections:
- Lamisil is commonly used to treat ringworm, athlete's foot, and jock itch. It's also effective in treating a condition called scalp fungus hair loss (tinea capitis) in children aged 4 years or older.
- Jublia, on the other hand, is specifically designed to treat toenail fungus (onychomycosis), addressing a variety of fungi that can affect this specific area.
How does Lamisil help with these illnesses?
Lamisil aids in managing fungal infections by inhibiting the enzyme squalene epoxidase, which is crucial for the synthesis of ergosterol - a principal component of fungal cell membranes. By blocking this enzyme, Lamisil disrupts the production and integrity of the fungal cell membrane, thereby killing the fungus. Ergosterol plays an important role in maintaining proper permeability and fluidity of cell membranes, akin to cholesterol's function in human cells. It is thought that individuals with certain types of fungal infections have relatively high levels of these fungi on their skin or nails. Therefore, by disrupting ergosterol synthesis through inhibiting squalene epoxidase with Lamisil treatment, one can limit the negative effects caused by such fungal infections and help patients manage their condition more effectively.
What is Jublia?
Jublia, also known by its generic name efinaconazole, is a topical antifungal medication used to treat fungal infections of the toenails. It functions by inhibiting the action of certain enzymes within fungal cells thereby disrupting their growth. The FDA first approved Jublia in 2014 for use as an antifungal agent for onychomycosis (fungal infection of the nail). Unlike Lamisil which is taken orally and can have systemic side effects such as liver issues or change in taste perception, Jublia is applied directly to the infected area reducing potential systemic side effects. Its local application means it specifically targets and treats the affected nails without causing widespread body changes that could lead to unwanted side effects. However, possible minor side effects include ingrown toenail or redness at the application site. Notably, it's potentially beneficial for patients who might not be able to take oral medications due to existing health conditions or those who prefer direct treatment methods.
What conditions is Jublia approved to treat?
Jublia is an antifungal medication that has been approved by the FDA for treating:
- Onychomycosis of the toenail(s) due to Trichophyton rubrum and Trichophyton mentagrophytes. This condition, commonly known as toenail fungus, can cause discomfort and discoloration of the affected nail.
It's important to note that Jublia is specifically designed for topical application on nails and should not be used elsewhere on the body.
How does Jublia help with these illnesses?
Efinaconazole, the active ingredient in Jublia, is a type of antifungal medication that works by inhibiting the synthesis of ergosterol, a crucial component of fungal cell membranes. This disruption leads to changes in membrane permeability and other physiological activities leading to fungal cell death. As such, it has been shown to be effective against various types of fungi that cause toenail fungus infections. Jublia offers targeted treatment for onychomycosis (toenail fungus), with its topical formulation allowing direct application to the infected nail. Unlike Lamisil which is taken orally and may have systemic side effects on liver function, Jublia's localized application reduces potential harm to other body organs while effectively treating the infection at its source. Therefore, physicians might prefer prescribing Jublia over Lamisil for patients who are at risk for liver disease or those who may not respond well or tolerate oral medications.
How effective are both Lamisil and Jublia?
Terbinafine (Lamisil) and efinaconazole (Jublia) are both antifungal medications approved by the FDA for treating fungal nail infections, although they were introduced into the market several years apart. They work in different ways to inhibit fungi growth - terbinafine inhibits a specific enzyme required for fungal cell membrane synthesis, while efinaconazole disrupts multiple key cellular structures within the fungus.
In terms of efficacy, both drugs have shown positive results in clinical trials. A 1998 study found that terbinafine was effective in curing toenail onychomycosis (fungal infection), with an overall success rate of 76%. Meanwhile, a more recent phase III trial conducted in 2013 demonstrated that efinaconazole was also successful at clearing up toenail onychomycosis, with success rates around 55%.
A review published in American Family Physician noted that oral terbinafine is considered first-line treatment for toenail onychomycosis due to its lower cost and shorter treatment duration compared to other options. However, Lamisil can cause liver problems and requires monitoring which Jublia does not require.
On the other hand, topical treatment using Jublia may be preferred due to fewer systemic side effects as it is applied directly onto the nail rather than taken orally like Lamisil.
Both medications are generally well-tolerated; however common side effects include gastrointestinal issues for Lamisil users whereas Jublia users typically experience application site dermatitis or vesicles.
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At what dose is Lamisil typically prescribed?
Topical application of Lamisil, when used for treating fungal infections like athlete's foot or jock itch, is typically a thin layer applied once daily to the affected and surrounding skin areas for 1 week. However, Jublia requires a different protocol: it should be applied once daily to clean, dry toenails (covering the entire nail and under the tip) with the provided applicator and allowed to dry completely. The treatment period may continue up to 48 weeks or until clear growth can be seen. As always, patients should follow their healthcare provider's instructions closely.
At what dose is Jublia typically prescribed?
Jublia treatment typically begins with the application of a thin layer to affected toenails once daily. This routine is usually maintained for 48 weeks. The medication comes in a bottle with an integrated flow-through brush applicator, which makes it easy to apply. It's essential that Jublia is applied directly on, under, and around the edges of the nail(s), ensuring complete coverage. Patients should not expect immediate results due to the nature of fungal infections and toenail growth; improvement may only be noticeable after several months of consistent use. If there appears to be no progress or if symptoms worsen over time, medical attention should be sought.
What are the most common side effects for Lamisil?
Common side effects of Lamisil and Jublia, two treatments for fungal infections, can differ quite a bit.
For Lamisil, patients may experience:
- Diarrhea
- Stomach pain or discomfort
- Nausea
- Changes in the sense of taste
- Rash or itching
Jublia usage could lead to:
- Ingrown toenails
- Redness, irritation or changes in color at the application site.
It's important to note that not all patients will experience these side effects and some might even encounter different ones. Always consult with your healthcare provider regarding potential side effects before starting any new medication.
Are there any potential serious side effects for Lamisil?
Both Lamisil and Jublia are used to treat fungal infections of the nails, but they may have different side effects. Serious side effects can include:
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Severe skin reactions: redness, itching, rash, burning sensation at the application site.
- Changes in vision such as blurred vision or sensitivity to light
- Fast or irregular heartbeats
- Symptoms suggesting liver problems like persistent nausea/vomiting/loss of appetite, stomach/abdominal pain on the upper right side that persists for days and yellowing eyes/skin (jaundice)
- A severe nervous system reaction - very stiff (rigid) muscles
- Any symptoms of serotonin syndrome: agitation; hallucinations; fever; sweating
If you experience any serious symptoms listed above while using either medication consult with your healthcare provider immediately.
What are the most common side effects for Jublia?
Common side effects associated with Jublia include:
- Redness or irritation at the application site
- Burning or itching at the application site
- Swelling around toenails
- Ingrown toenail Apart from these local reactions, this topical antifungal generally doesn't lead to systematic side effects. However, if you notice any severe symptoms like rashes, dizziness, fast heartbeat or confusion after its use, it's best to seek medical attention immediately. As always when considering medications and their potential impacts on your health, consult with a healthcare provider for advice tailored specifically to your needs.
Are there any potential serious side effects for Jublia?
While Jublia is often well-tolerated, it can occasionally cause serious side effects. If you notice any of the following symptoms after applying Jublia, seek immediate medical attention:
- Signs of a severe allergic reaction or skin response: hives, itching, fever, swollen glands, difficulty breathing or swelling in your face and throat
- Unusual changes in mood and behavior
- Problems with vision such as eye redness or irritation
- Rapid heartbeat
- Skin rash that appears suddenly and spreads quickly
- Severe burning sensation at the application site
It's important to note that these are not common side effects but should be taken seriously if they occur. Always consult with a healthcare professional before starting new medications.
Contraindications for Lamisil and Jublia?
Both Lamisil and Jublia, along with most other antifungal medications, may cause side effects in some people. If you notice increasing irritation, redness or swelling at the application site, please seek immediate medical attention.
Neither Lamisil nor Jublia should be used if you are taking certain types of drugs that can interact harmfully with them. Always inform your physician about the medications you are currently taking; certain drugs will require a period to clear from the system to prevent dangerous interactions with Lamisil and Jublia. For instance, individuals on blood thinners or cholesterol-lowering statins need to exercise caution while using these antifungals because they could potentially interfere with liver function. Also remember that alcohol use must be limited during treatment as both these medications can lead to liver damage.
How much do Lamisil and Jublia cost?
For the brand-name versions of these drugs:
- The price of a 30g tube of Lamisil cream (1%) averages around $35, which could last for up to 30 days, depending on your usage. This works out to about $1-$2/day.
- The cost of Jublia solution (10% strength) is significantly higher; a small bottle commonly lasts one month and can cost between $600-$700.
Thus, if you consider the per-day treatment basis alone, Lamisil would seem to be a more economical choice than Jublia. However, please note that cost should not be your primary consideration in determining which of these antifungal medications is right for you.
As far as generic versions go:
- Generic terbinafine (the active ingredient in Lamisil) comes at an even lower price point with costs varying but often falling below $1/day.
- There's no approved generic version available yet for efinaconazole (the active compound in Jublia), so its high price remains steady.
Popularity of Lamisil and Jublia
Terbinafine, available in generic form as well as under the brand name Lamisil, was prescribed to approximately 2.3 million people in the US in 2020. Terbinafine accounted for just over 15% of antifungal prescriptions in the US and is most commonly used to treat fungal nail infections (onychomycosis) and athlete's foot (tinea pedis). Since its introduction into clinical use, terbinafine has been steadily increasing in popularity due to its efficacy against a broad range of dermatophytes.
Efinaconazole, marketed under the brand name Jublia among others, is a newer generation topical antifungal medication primarily used for onychomycosis. Although data on prescription volume is not readily available as it only received FDA approval recently (in 2014), efinaconazole has gained attention due to its convenience of being a once-daily application with demonstrated high success rates for curing onychomycosis. Despite this, the price point for Jublia tends to be higher than that of Lamisil which may influence patient choice between these two medications.
Conclusion
Both Lamisil (terbinafine) and Jublia (efinaconazole) are frequently prescribed for the treatment of fungal nail infections, with numerous clinical studies validating their effectiveness over placebo treatments. These antifungal medications may be used individually or in combination, depending on a physician's assessment of the patient's condition. Their mechanisms of action differ: Lamisil inhibits an enzyme necessary for fungal cell membrane formation, while Jublia acts by inhibiting a different key component in fungus cells.
Lamisil is usually considered as a first-line treatment option for toenail fungus due to its oral administration which allows it to reach deeper layers where fungi reside. On the other hand, Jublia is often employed when topical application is preferred or when patients have liver conditions that contraindicate oral antifungals like Lamisil.
The availability of generic versions significantly reduces costs especially for those paying out-of-pocket. Both drugs need time to show noticeable improvement as nails grow slowly; complete cure might take several months.
The side effect profiles are similar between these two drugs but depend greatly on their mode of administration: oral terbinafine can cause gastrointestinal upset and changes in taste sensation among others, while topical efinaconazole is generally well-tolerated but can occasionally lead to skin irritation around treated nails. As with any medication therapy, patients should monitor their symptoms closely and seek medical help if they notice any unusual reactions or worsening symptoms.
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Refrences
- BAUDRAZ-ROSSELET, F., RAKOSI, T., WILI, P. B., & KENZELMANN, R. (1992, February). Treatment of onychomycosis with terbinafine. British Journal of Dermatology. Oxford University Press (OUP).http://doi.org/10.1111/j.1365-2133.1992.tb00009.x
- VILLARS, V. V., & JONES, T. C. (1992, February). Special features of the clinical use of oral terbinafine in the treatment of fungal diseases. British Journal of Dermatology. Oxford University Press (OUP).http://doi.org/10.1111/j.1365-2133.1992.tb00013.x
- Gupta, A. K., Konnikov, N., & Lynde, C. W. (2001, March). Single-blind, randomized, prospective study on terbinafine and itraconazole for treatment of dermatophyte toenail onychomycosis in the elderly. Journal of the American Academy of Dermatology. Elsevier BV.http://doi.org/10.1067/mjd.2001.110874
- RYDER, N. S. (1992, February). Terbinafine: Mode of action and properties of the squalene epoxidase inhibition. British Journal of Dermatology. Oxford University Press (OUP).http://doi.org/10.1111/j.1365-2133.1992.tb00001.x
- Ortonne, J., Korting, H., Viguié‐Vallanet, C., Larnier, C., & Savaluny, E. (2006, October 16). Efficacy and safety of a new single‐dose terbinafine 1% formulation in patients with tinea pedis (athlete's foot): a randomized, double‐blind, placebo‐controlled study. Journal of the European Academy of Dermatology and Venereology. Wiley.http://doi.org/10.1111/j.1468-3083.2006.01807.x