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Nizoral vs Lamisil
Introduction
For individuals suffering from fungal infections of the skin and nails, certain antifungal medications can help in eliminating infectious agents and managing symptoms. Nizoral (ketoconazole) and Lamisil (terbinafine) are two such drugs that are commonly prescribed for these conditions. They each work by inhibiting the growth of fungus but do so through different mechanisms.
Nizoral is a broad-spectrum synthetic antifungal drug effective against various types of fungi. It works by interfering with the synthesis of ergosterol, which is a critical component of fungal cell membranes.
On the other hand, Lamisil specifically targets dermatophytes - a type of fungi causing most skin, hair and nail infections. It inhibits an enzyme crucial to fungal sterol biosynthesis pathway thus disrupting cell membrane function leading to its death.
While both drugs have proven efficacy in treating fungal infections, side effects may vary between them; hence individual tolerance should be considered while opting for either one.
Nizoral vs Lamisil Side By Side
| Attribute | Nizoral | Lamisil |
|---|---|---|
| Brand Name | Nizoral | Lamisil |
| Contraindications | Should not be taken with certain medications like rifampin or cimetidine without discussing it with a physician first. Requires careful use in patients with liver disease. | Requires careful use in patients who have liver disease due to its potential hepatotoxicity. |
| Cost | Around $15 for a 120 mL bottle of 2% solution | Around $400 for a 30 tablets pack of 250 mg |
| Generic Name | Ketoconazole | Terbinafine |
| Most Serious Side Effect | Severe liver problems--nausea, vomiting, stomach pain, tiredness, dark urine, yellowing of the skin or eyes (liver failure) | Liver problems such as nausea, upper stomach pain, loss of appetite leading to yellowing of your skin or eyes (jaundice). |
| Severe Drug Interactions | Can interact negatively with many different types of medication due to its potent inhibition effect on liver enzymes that metabolize a wide range of drugs (particularly CYP3A4). | Specific interactions are not detailed, but as with all medications, it's important to discuss all current medications with a healthcare provider to avoid potential harmful interactions. |
| Typical Dose | 200–400 mg per day for adults, with a maximum daily dosage limit of 400mg. For children, the dosage may start at 3.3-6.6 mg/kg/day. | 250 mg/day for six weeks for fingernail infections and twelve weeks for toenail infections. |
What is Nizoral?
Ketoconazole, the active ingredient in Nizoral, was one of the first antifungal medications developed to treat a wide range of fungal infections. It became available for use by the FDA in 1981. Nizoral works by interfering with fungal cell membranes, essentially causing contents to leak out and resulting in the death of the fungus. This medication is often used for treating various forms of skin and hair conditions such as dandruff or seborrheic dermatitis.
On the other hand, Terbinafine (the generic name for Lamisil) is another type of antifungal medication that came later on—a part of allylamines class which represents an evolution from azoles like Ketoconazole. Approved by FDA in 1996, it has proven effective against different types and ranges of fungi including those causing athlete's foot and ringworms due to its ability to inhibit an enzyme crucial to fungal growth.
While both medicines are quite effective at combating fungi-related issues, they have different focuses: Nizoral targets more superficial skin conditions while Lamisil deals well with nail-based fungal infections too. However, both medications can bring about side effects—Lamisil may sometimes cause gastrointestinal problems or changes in taste sensation whereas Nizoral might lead to potential liver damage if taken orally over long periods.
What conditions is Nizoral approved to treat?
Nizoral and Lamisil are both approved for the treatment of different types of fungal infections:
- Nizoral is primarily used to treat seborrheic dermatitis, dandruff, tinea versicolor (a fungus that can cause a skin rash) and in some cases systemic fungal infections.
- Lamisil on the other hand, is mainly prescribed for treating nail fungus, ringworm (tinea corporis), athlete's foot (tinea pedis), jock itch (tinea cruris), and several other skin infections caused by fungi.
How does Nizoral help with these illnesses?
Nizoral manages fungal infections by interfering with the production of ergosterol, a crucial component of fungal cell membranes. It achieves this by inhibiting an enzyme known as cytochrome P450 14α-demethylase, necessary for ergosterol synthesis. The disruption in the production of ergosterol leads to holes forming in the fungus's cell membrane, causing essential constituents to leak out and ultimately leading to its death. Fungi are responsible for conditions such as athlete's foot, jock itch, ringworm and certain kinds of dandruff. By disrupting their cellular structure, Nizoral can limit the negative effects of these conditions and help patients manage their symptoms.
Similarly, Lamisil works against fungi through altering the ability to synthesize ergosterol. However, it operates differently from Nizoral by inhibiting squalene epoxidase - another key enzyme involved in this process - which eventually results in a toxic buildup of squalene within the fungal cell that causes it to die off. Both drugs serve effectively as antifungal agents but may be recommended differently based on individual patient needs or specific types or severities of infection.
What is Lamisil?
Lamisil, also known as terbinafine, is an antifungal medication primarily used to treat fungal infections of the fingernails or toenails. It works by inhibiting a specific enzyme (squalene epoxidase), which interrupts the biosynthesis of ergosterol in the fungi cell membrane - effectively halting its growth. Lamisil was first approved by the FDA in 1996.
Unlike Nizoral (ketoconazole), Lamisil does not work on yeast-based infections and it's more commonly prescribed for dermatophyte based fungal infections. Available over-the-counter or by prescription, it can be taken orally or applied topically depending on your condition.
Its side-effect profile differs from that of azole antifungals like Nizoral; while both medications may cause gastrointestinal issues such as nausea and diarrhea, Lamisil is less likely to cause hepatotoxicity but could potentially lead to a loss in taste sensation temporarily. The effects of Lamisil are often preferred for treating certain types of fungal nail infections due to its excellent penetration into nail tissue.
What conditions is Lamisil approved to treat?
Lamisil is a medication that's approved by the FDA for the treatment of:
- Fungal infections in nails (Onychomycosis)
- Athlete’s foot, jock itch and ringworm (Tinea pedis, Tinea cruris, Tinea corporis). It acts to eradicate fungi by inhibiting an enzyme required for their growth.
How does Lamisil help with these illnesses?
Lamisil, similar to Nizoral, is an antifungal medication used in the treatment of various fungal infections. It works by inhibiting the enzyme squalene epoxidase which plays a crucial role in the synthesis of ergosterol, a vital component of fungal cell membranes. As with ergosterol, reduced production leads to increased cellular permeability causing leakage and eventual death of the fungus. Lamisil has been found effective especially against dermatophytes - fungi that cause skin infections including ringworm and athlete's foot. Its action on other types of fungi may also contribute to its broad-spectrum antifungal property. Since it does not significantly affect human sterols, it is often prescribed when patients do not respond well or have contraindications with azole-class antifungals (such as Nizoral), or may be combined with these drugs for enhanced effect.
How effective are both Nizoral and Lamisil?
Both ketoconazole (Nizoral) and terbinafine (Lamisil) have proven efficacy in treating fungal infections, with their initial FDA approval coming a few years apart. They operate on different mechanisms as antifungal agents: Nizoral works by interfering with the synthesis of ergosterol, a key component of fungal cell membranes, while Lamisil primarily inhibits the enzyme squalene epoxidase, disrupting cell membrane production in fungi.
The therapeutic benefits of both ketoconazole and terbinafine were evaluated directly in numerous clinical trials over the years; these studies have shown comparable effectiveness between both drugs when it comes to managing symptoms and eradicating various types of fungal infections. However, some metrics did differ notably between patients receiving Nizoral versus those taking Lamisil. For instance, a 2002 study found that for toenail fungus specifically (onychomycosis), oral treatment with Lamisil was more effective than topical application of Nizoral cream.
Reviews dating back to 1989 highlight that ketoconazole is very effective at alleviating symptoms associated with seborrheic dermatitis from as early as one week into treatment and has been favoured due to its relatively safe side effect profile. Ketoconazole also boasts extensive usage worldwide for other conditions like athlete's foot or jock itch.
On the other hand, analyses conducted around 2010 assert that oral terbinafine appears more efficacious than placebo against several forms of cutaneous mycoses - ranking similarly amongst other standard antifungals used systemically. Nonetheless, Terbinafine is often considered first-line therapy for most superficial fungal infections owing to its unique pharmacological properties which include good bioavailability after oral administration and accumulation at high concentrations within skin and nails - sites where these pathogens are predominantly located.
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At what dose is Nizoral typically prescribed?
Oral dosages of Nizoral typically range from 200–400 mg per day, but studies have suggested that a daily dose of 200 mg is adequate for the treatment of most fungal infections in adults. For children, the dosage may be started at 3.3-6.6 mg/kg/day depending on their weight and condition. In either population group, if there is no response within a few weeks, consult your healthcare provider as they might consider increasing the dosage or switching to another medication like Lamisil. However under any circumstance, do not exceed the maximum daily dosage limit which is 400mg for Nizoral.
At what dose is Lamisil typically prescribed?
Lamisil treatment is typically initiated at a dosage of 250 mg/day for a cycle of six weeks for fingernail infections and twelve weeks for toenail infections. The dose should be taken once daily, preferably at the same time each day to maintain consistency. A maximum dose of 250 mg/day is recommended; no increase in dosage is necessary as this can lead to potential adverse effects. Improvement may not be visible until several months after completion of therapy due to the rate nails grow. If there's no sign of improvement or infection worsens after completing the full course, re-evaluation by your healthcare provider would be advised.
What are the most common side effects for Nizoral?
Common side effects of Nizoral may include:
- Nausea, vomiting and abdominal pain
- Diarrhea, constipation
- Headache or dizziness
- Fatigue, general weakness
- Itching or rash on the skin
- Dry mouth
On the other hand, Lamisil might cause:
- Diarrhea or stomach upset
- Rash that could be itchy
- Taste disturbances (including loss of taste)
- Headaches and dizziness,
- Liver problems (though rare)
As always with medications, individual reactions can differ vastly. Always consult a healthcare provider when choosing between these two drugs.
Are there any potential serious side effects for Nizoral?
While both Nizoral and Lamisil are antifungal medications, they may cause different side effects. For instance, with Nizoral:
- Allergic reactions can occur, including hives; difficulty breathing; swelling of your face, lips, tongue or throat.
- Serious skin reactions could occur: fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
- Some people may experience vision problems such as blurred vision. If you notice changes to your sight while taking this medication contact a healthcare professional immediately.
- Symptoms similar to those of low sodium levels like headache confusion slurred speech loss of coordination vomiting severe weakness have been reported
- Severe liver problems--nausea,vomiting,stomach pain,tiredness,dark urine,yellowing of the skin or eyes(liver failure)
With Lamisil:
- Allergic reaction symptoms such as hives; difficult breathing; swelling of your face,lips,tongue ora throat should be monitored closely -Symptoms suggestive of serious skin conditions include fever,sore throat,burning eyes,rash,pale red colored raised patches forcefully scratching(seriously life threatening Skin Reaction). -Severe gastrointestinal issues such as nausea,vomiting,stomach pain diarrhea etc.
If any signs mentioned above occur whilst on treatment with either drug it is advised you seek medical help straight away.
What are the most common side effects for Lamisil?
Lamisil, a popular antifungal medication, can cause a range of side effects including:
- A metallic or altered sense of taste
- Nausea, upset stomach and diarrhea
- Headaches and dizziness
- Mild skin rash or itching
- Changes in vision (rare)
- Unusual tiredness or weakness It's important to note that although these side effects can occur, they are generally mild and manageable. As with all medications though, users should immediately report any severe reactions to their doctor such as persistent nausea/vomiting, loss of appetite, severe stomach/abdominal pain or yellowing eyes/skin.
Are there any potential serious side effects for Lamisil?
Lamisil, while generally a safe antifungal medication, may sometimes lead to serious side effects in rare cases. These can include:
- Indications of an allergic reaction like hives, severe skin rash with blistering and peeling, swelling on your face or throat causing difficulty in breathing.
- Liver problems such as nausea, upper stomach pain and loss of appetite leading to yellowing of your skin or eyes (jaundice).
- Mood changes including depression and thoughts about self-harm.
- Unusual behavior patterns or confusion creating difficulties in daily life activities.
- Blood related issues marked by easy bruising, unusual bleeding from the nose/mouth/anus/vagina which could be due to low platelet count (thrombocytopenia).
- Skin color changes with light sensitivity causing rashes that worsen under sunlight.
If you notice any of these symptoms after starting Lamisil treatment it is important you cease use immediately and consult with your healthcare provider for further evaluation.
Contraindications for Nizoral and Lamisil?
Both Nizoral and Lamisil, as with other antifungal medications, may cause some side effects in certain individuals. If you observe any severe allergic reactions or worsening of skin infection symptoms after starting the treatment with these drugs, please seek immediate medical care.
Neither Nizoral nor Lamisil should be taken if you are using certain medications like rifampin or cimetidine without discussing it with your physician first. Always inform your healthcare provider about all the medicines you are currently taking; this is crucial to prevent potential harmful interactions between these antifungals and other drugs.
Nizoral can interact negatively with many different types of medication due to its potent inhibition effect on liver enzymes that metabolize a wide range of drugs (particularly CYP3A4). Meanwhile, Lamisil requires careful use in patients who have liver disease due to its potential hepatotoxicity.
How much do Nizoral and Lamisil cost?
For the brand name versions of these drugs:
- The price of 120 mL bottle of Nizoral (2%) averages around $15, which works out to about $0.50/day, depending on your usage.
- The price of 30 tablets pack of Lamisil (250 mg) is approximately $400, working out to roughly $13.33/day.
Thus, if you are using Lamisil for a typical one-month course for treating fungal infections, it will be significantly more expensive than Nizoral on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which antifungal drug is right for you.
For the generic versions of Nizoral (ketoconazole) and Lamisil (terbinafine), costs are significantly lower:
- Ketoconazole shampoo can be obtained at an average cost as low as $10 per bottle.
- Terbinafine tablets are available in packs from 7 up to 90 tablets with the costs starting from as low as about $1/day if you buy larger quantities upfront.
These medications treat different types and severities of fungal infections so always consult with your healthcare provider before making medication decisions based solely on cost.
Popularity of Nizoral and Lamisil
Ketoconazole, available as the brand name Nizoral among others, is a medication primarily used to treat fungal infections. It was estimated to have been prescribed to about 2 million people in the US in 2020. Ketoconazole accounted for just over 5% of antifungal prescriptions in the US. Although it's not classified as an azole broad-spectrum antifungal, its use has been gradually increasing since 2013 due to its effectiveness against a wide range of fungi.
Terbinafine, sold under the brand name Lamisil among others, was prescribed to approximately 4 million people in the USA in 2020. In terms of antifungal medications, terbinafine accounts for about 20% of all prescriptions and just under half of allylamine class prescriptions—an impressive share given that this category includes several other effective drugs. The prevalence of terbinafine has remained steady over the last decade despite competition from newer medications.
Conclusion
Both Nizoral (ketoconazole) and Lamisil (terbinafine) have a long-standing record of effectively treating fungal infections. Numerous clinical studies support their efficacy over placebo treatments. Depending on the type and location of the infection, one may be recommended over the other by healthcare professionals due to their different mechanisms of action: Nizoral works by preventing fungi from producing ergosterol, which is vital for cell membrane synthesis, while Lamisil disrupts an enzyme crucial in fungal cell wall production.
Nizoral is often used as a first-line treatment for several types of skin and mucosal surface infections like seborrheic dermatitis or tinea versicolor, whereas Lamisil is typically prescribed for nail fungus or tinea pedis (athlete's foot). Both medications are available in generic form, providing significant cost savings especially for patients paying out-of-pocket.
As with any medication, both Nizoral and Lamisil may require some time before noticeable effects occur. Side effect profiles are similar between these two drugs; they're generally well-tolerated but can cause side effects such as nausea or rash. Unlike Wellbutrin compared to Prozac though, neither has been notably classified as being less prone to specific side effects than the other. As always when starting treatment with either drug, patients should closely monitor themselves and seek medical help immediately if they notice symptoms worsening significantly or experience severe adverse reactions.
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Refrences
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- GOODFIELD, M. J. D., ROWELL, N. R., FORSTER, R. A., EVANS, E. G. V., & RAVEN, A. (1989, December). Treatment of dermatophyte infection of the finger- and toe-nails with terbinafine (SF 86-327, Lamisil), an orally active fungicidal agent. British Journal of Dermatology. Oxford University Press (OUP).http://doi.org/10.1111/j.1365-2133.1989.tb08217.x
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