Does Jublia Work on Toenail Fungus? What the Research Shows and How to Get It in Canada

Jublia is a prescription treatment for toenail fungus that you paint onto the affected nail. It comes in a clear liquid containing the active ingredient efinaconazole. Jublia soaks into the nail plate to reach the fungal infection underneath the nail. 

Treatment with Jubila runs for a long time, up to 48 weeks. This is because Jublia works at the pace the nail grows (a big toenail grows about 1.6 mm a month) rather than the pace the fungus dies. Before treatment can finish, the affected area has to grow out and be replaced by healthy nail.

In this article, we cover how Jublia works, how well it clears a fungal nail infection, and how to apply it. We also look at the side effects of efinaconazole (Jublia’s active ingredient), what the treatment costs in Canada, and how to get a prescription.

What Is Jublia?

Jublia is the brand name for efinaconazole 10%, a prescription antifungal made by Bausch Health and registered with Health Canada since 2014. Efinaconazole belongs to a family of antifungal medications called triazoles, which stop fungi from building a substance their cell membranes depend on for survival. Jublia is supplied in an 8 mL bottle with a brush built into the cap, so the liquid goes straight onto the nail.

Jublia is approved to treat fungal infection of the toenail, known medically as onychomycosis. Jublia 10% is applied once daily, and the brush is used to cover the whole nail, the skin around its edges, and underneath the tip of the nail. The affected nail does not have to be filed down first, and there are no additional steps to treatment other than daily application.

The approval for Jublia in Canada covers mild to moderate infection in adults, on toenails rather than fingernails, and only where the fungus hasn’t spread to the base of the nail beneath the cuticle. A badly thickened nail, or one infected right up to the cuticle, is usually better treated with antifungal tablets instead.

How Does Jublia Work?

Fungi build their cell membranes out of a substance called ergosterol. Efinaconazole (the active ingredient in Jublia) blocks the enzyme that produces ergosterol, so the fungus can no longer maintain the membrane it depends on. Whether that stops the fungus from growing or kills it outright isn’t fully settled, but the loss of ergosterol is what brings the infection under control.

The bigger challenge with a nail infection is getting efinaconazole to where the fungus actually lives. Toenail fungus sits under the nail plate, in the nail bed, behind a dense layer of keratin that most topical treatments struggle to cross. A cream rubbed onto the surface of the nail will not reach it.

Why Efinaconazole Reaches the Nail Bed

Keratin is the protein nails are made from, and it binds many drugs so tightly that they never travel any further. Efinaconazole only binds to keratin weakly, which is thought to leave more of it free to reach the infection underneath. Jublia is also thin enough to spread across the nail and run into the nail folds and under the leading edge, rather than pooling on the surface of the nail.

Jublia Effectiveness: What Results to Expect

Jublia’s effectiveness has been tested in two large trials, each running 48 weeks of daily treatment, with results measured at week 52 (1 year). Both trials measured success in three ways:

• Fungal cure — a negative laboratory test for fungus. Reached by 53% and 55% of participants across the two trials.

• Clinical improvement — less than 10% of the nail still affected. Reached by 31% and 46%.
• Complete cure — a negative test and a nail with no visible involvement left at all. Reached by 15% and 19%.

The research shows that most people who complete a course of Jublia clear the fungus itself, and a smaller group finish with a nail that looks completely normal after around 1 year.

Why Nail Regrowth Matters

A nail that has been thick and discoloured for months doesn’t turn clear when the fungal infection dies. The damaged section has already grown, so it has to travel the length of the toe and be trimmed off before the nail looks normal again.

Canada’s drug review agency pointed out that a toenail can take as long as 78 weeks to grow out cleanly, well beyond the 52 weeks at which the Jubila trials stopped following up research participants. The complete cure figure above describes how many people had a fully clear nail on the day researchers looked, not how many eventually got one after the 1-year mark.

How Long Does Jublia Take to Work?

New nail grows at about 1.6 mm a month, so for the first two to three months of treatment with Jublia, there simply isn’t enough regrowth to see change. Three months of daily treatment produces roughly 5 mm of new nail at the base of the toenail, which is usually the point at which a clear band becomes noticeable.

From there, the change is gradual rather than sudden. In the trials, the proportion of people reaching a complete cure from Jublia was still climbing at the final measurement, 52 weeks after starting. Treatment with Jublia runs 48 weeks, and Health Canada’s product information notes that a completely clear nail may only appear some months after the fungus has gone.

Signs Jublia Is Working

People often ask how to know if toenail fungus is dying. The signs are gradual rather than dramatic:

• Clear, healthy nail growing in at the base of the nail bed
• The border between healthy and damaged nail moving toward the tip of the toenail
• Less thickening and crumbly debris on the affected nail

If you notice no clear new growth after several months of using Jublia, infection creeping toward the base of the nail, or new pain in the toe, go back to your doctor for re-assessment.

How to Apply Jublia

Jublia topical solution is applied once a day, ideally at bedtime, for 48 weeks. Here’s how to apply it:

• Start clean and dry — wash and dry the foot, and wait at least 10 minutes after bathing before applying.
• One drop per nail — use two drops on a big toenail.
• Cover the whole nail — brush Jublia over the nail, into the folds of skin at its edges, and underneath the tip.
• Let it dry — before socks or bedding.

Trim your toenails every four weeks or so while undertaking treatment with Jublia. To avoid spreading the fungus, cut the unaffected nails first and don’t share clippers with anyone. No filing or thinning of the nail is required at any point. Store the bottle upright at room temperature, and keep it away from heat and open flame, as Jublia is flammable.

Jublia Side Effects

Side effects from Jublia medication are uncommon, and the ones that do occur happen where Jublia is applied. About 6% of people in the trials reported a side effect related to Jublia, most often mild irritation of the skin around the nail.

Jublia side effects can include:

• Redness, swelling or irritation where Jublia is applied
• Small blisters at the application site
• Peeling skin around the nail
• Pain or tenderness in the toe
• Itching of the toe
• A change in the colour of the nail
• Loosening or shedding of the treated nail

Stop using Jublia and contact your doctor if you develop a rash, or skin that becomes very red, swollen, blistered or crusted, as these can signal an allergic reaction. Jublia should not be used by anyone who has had a reaction to efinaconazole before.

Because Jublia stays on and in the nail, very little of it reaches the bloodstream. Blood tests and liver monitoring are not part of treatment with Jublia, and no drug interactions have been identified.

Topical or Oral: Which Antifungal Treatment Suits You?

Jublia topical solution suits mild to moderate infection in one or two nails, where the fungus hasn’t reached the base. 

Oral treatment is the stronger option for more severe infections, and terbinafine tablets are the usual choice (available as a generic or under the brand name Lamisil). Oral terbinafine has been shown to be the most effective treatment for clearing toenail fungus, taken as one tablet a day for up to 12 weeks.

Here’s what you need to know about topical vs oral treatments for toenail fungus:

• Tablets have higher clearance rates. About 38% of people reach a completely clear nail on oral terbinafine, against 15% to 19% on Jublia.
• Tablets finish sooner. Roughly 12 weeks, against 48 weeks of daily application with Jublia.
• Tablets need monitoring. Terbinafine can affect the liver and interferes with a number of common medicines, including some antidepressants, beta blockers and statins, so a blood test before starting and a review of your other prescriptions may be required.

The right choice depends on how far the infection has spread and your personal health history. A doctor can give advice based on your situation.

How Much Does Jublia Cost in Canada?

Jublia is bought one bottle at a time, and a single 8 mL bottle covers roughly six months of treating one big toenail. Canada’s drug review agency costed a full course at two bottles for one big toenail, or five bottles for someone treating four nails at once. That same review put the manufacturer’s listed price at about $89 a bottle, before pharmacy mark-up and dispensing fees. 

Most public drug plans in Canada don’t cover Jublia. British Columbia’s PharmaCare lists it as a non-benefit, on the reasoning that effective oral antifungals are already covered and Jublia didn’t show an advantage over them. Private plans vary, and some treat nail treatment as cosmetic and exclude it, so it’s worth checking yours before you start.

Why Is Jublia So Expensive?

Jublia has had the Canadian market to itself since 2014. One company makes it, and no Jublia generic is registered with Health Canada. There is no cheaper equivalent to switch to, and nothing is pushing the price down.

Quantity is the other half of the Jublia price equation. A 48-week course needs more than one bottle of Jublia, and treating several nails at once increases how much you will use.

Getting Jublia in Canada

Jublia is prescription-only across Canada, so getting a doctor’s assessment is the first step. A doctor will confirm the problem with the nail is actually fungal, since discoloured or thickened nails aren’t always due to a fungal infection.

In British Columbia, you can see an online doctor with the appointment covered by MSP through Walk In. The doctor can look at the nail, talk through whether a topical or a tablet suits your situation, and provide a Jublia prescription if it’s appropriate.

A BC pharmacist can also assess a nail and prescribe Jublia, under the province’s minor ailments programme. A pharmacist can’t prescribe the antifungal tablets, though. So if you aren’t yet sure which treatment suits your nail, a doctor’s appointment may be the most convenient option.

Frequently Asked Questions

Can I wear nail polish while using Jublia? 

The Canadian advice is to skip it. Consumer information supplied with Jublia asks you to avoid nail polish, cosmetic nail products and salon pedicures during treatment.

Will Jublia work on fingernails? 

Jublia for fingernails isn’t approved in Canada, as fungal infection in fingernails is treated differently. Fingernails grow around twice as fast as toenails, so the timelines described in this article don’t apply to treating fingernail fungus.

Is Jublia the only paint-on treatment available in Canada? 

Ciclopirox 8% nail lacquer is also prescribed in Canada for fungal nail infections. Ciclopirox clears fewer nails than Jublia and has to be filed and stripped off weekly rather than simply reapplied, which is why it is less commonly the first choice.

Does Jublia work on early-stage toenail fungus? 

Early-stage toenail fungus is exactly what Jublia is approved for, since the approval covers mild to moderate infection. Starting treatment early helps because the less of the nail that is damaged, the less has to grow out before it looks normal again.

What stops toenail fungus coming back? 

Three measures have real evidence behind them for preventing recurrence of toenail fungus: 1) Treat athlete’s foot at the same time, since the skin acts as a reservoir; 2) Wash socks at a high temperature; 3) Disinfect or replace the shoes you wore throughout treatment.

Is Jublia Right for You?

Jublia is a reasonable choice for treating a mild to moderate fungal toenail infection that hasn’t reached the base of the nail. Successful treatment requires patience and a daily habit for the better part of a year. If the infection is more advanced, or several nails are involved, antifungal tablets could be worth considering.

While a fungal toenail infection isn’t a medical emergency, it’s worth speaking to a doctor to get advice for how to manage it. Getting the condition under control can take a long time, and a doctor can tell you which treatment is most likely to be effective in your situation.

Speak to a Doctor Online About Toenail Fungus Treatment