Ciclopirox is a medication used for the treatment of moderate onychomycosis of fingernails and toenails,
In 2022, it was the 247th most commonly prescribed medication in the United States, with more than 1million prescriptions.
Medical uses
Ciclopirox is
indicated as topical treatment in immunocompetent people with mild to moderate onychomycosis of fingernails and toenails without lunula involvement, due to
Trichophyton rubrum,
; and for the treatment of seborrheic dermatitis.
Nail infections
In addition to other formulations, ciclopirox is used in
Nail polish for topical treatment of
onychomycosis (fungal infections of the nails). A
meta-analysis of the six trials of nail infections available in 2009 concluded that they provided evidence that topical ciclopirox had poor
, and that
amorolfine might be substantially more effective, but more research was required. "Combining data from 2 trials of ciclopiroxolamine versus
placebo found treatments failure rates of 61% and 64% for ciclopiroxolamine. These outcomes followed long treatment times (48 weeks) and this makes ciclopiroxolamine a poor choice for nail infections. Better results were observed with the use of amorolfine lacquer; 6% treatment failure rates were found after 1 month of treatment but these data were collected on a very small sample of people and these high rates of success might be unreliable."
Efinaconazole, an azole antifungal, led to cure rates two or three times better than the next-best topical treatment, ciclopirox.
Pharmacology
Pharmacodynamics
In contrast to the
and other antimycotic drugs, the mechanism of action of ciclopirox is poorly understood.
However, loss of function of certain
catalase and
peroxidase enzymes has been implicated as the mechanism of action, as well as various other components of cellular metabolism. In a study conducted to further elucidate ciclopirox's mechanism, several
Saccharomyces cerevisiae mutants were screened and tested. Results from interpretation of the effects of both the drug treatment and mutation suggested that ciclopirox may exert its effect by disrupting
DNA repair,
cell division signals and structures (
) as well as some elements of intracellular transport.
Chemistry
Ciclopirox is a N-hydroxypyridone. Structurally, ciclopirox is the
N-oxide of a 2-hydroxypyridine derivative and therefore can be termed a hydroxypyridine
antifungal agent. Additionally, the structure as drawn above is the
lactam tautomer and indicates the
molecule being an N-hydroxy-2-
pyridone. Hence the classification of ciclopirox as a 2-pyridone antifungal agent.
Society and culture
Brand names
It is sold under many brand names worldwide.
[Drugs.com International brand names for ciclopirox Page accessed January 201, 2016]
Research
In 2007 it was investigated as an alternative treatment to
ketoconazole for seborrhoeic dermatitis as it suppresses growth of the
yeast Malassezia furfur. Initial results showed similar efficacy to ketoconazole with a relative increase in subjective symptom relief due to its inherent anti-inflammatory properties.
