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Nystatin vs Clotrimazole
Introduction
For patients suffering from fungal infections, certain antifungal medications that alter the structure of the fungi and prevent them from growing can help in alleviating symptoms and managing conditions. Nystatin and Clotrimazole are two such drugs that are prescribed for fungal infections. They each impact different aspects of the fungi but both have fungus-inhibiting effects in patients with these types of infections. Nystatin works by binding to sterols in the cell membrane of susceptible Candida species disrupting normal function, whereas Clotrimazole is classified as an imidazole antifungal agent affecting ergosterol synthesis leading to impaired cell membrane formation and ultimately causing fungal cell death.
Nystatin vs Clotrimazole Side By Side
| Attribute | Mycostatin | Canesten lotrimin |
|---|---|---|
| Brand Name | Mycostatin | Canesten, Lotrimin |
| Contraindications | Allergy to Nystatin or severe reaction to similar antifungal medicines. | Allergy to Clotrimazole or severe reaction to similar antifungal medicines. |
| Cost | For brand name: $60-$80 for a 30 grams tube. Generic: 0.50 cents to $2.00 per gram. | For brand name: $15-$25 for a 30 grams tube. Generic: 0.20 cents to $1.00 per gram. |
| Generic Name | Nystatin | Clotrimazole |
| Most Serious Side Effect | Signs of an allergic reaction: hives; difficulty breathing or swallowing; swelling of the face, lips, tongue, or throat. | Severe skin irritation, redness, blistering, peeling or oozing of treated skin; signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat. |
| Severe Drug Interactions | Not specifically mentioned, but it's important to inform healthcare providers about all medications and health products being used. | Not specifically mentioned, but it's important to inform healthcare providers about all medications and health products being used. |
| Typical Dose | Oral dosages range from 1–5 mL four times a day. | 1-2% concentration, applied to the affected area twice daily. |
What is Nystatin?
Nystatin (the generic name for Mycostatin, among other brands) is an antifungal medication that has been widely used since its approval by the FDA in 1954. Nystatin works by binding to sterols in the fungal cell membrane, causing leakage of cellular contents and subsequent destruction of the fungus. It is primarily prescribed for treating different forms of Candida infections, including oral thrush and skin infections.
On the other hand, Clotrimazole (known as Lotrimin or Canesten among others) represents a newer class of antifungals called azoles. Approved by the FDA in 1975, Clotrimazole inhibits ergosterol synthesis, an essential component of fungal cell membranes – effectively disrupting their growth and multiplication.
While both drugs are designed to treat similar conditions like yeast infections and athlete's foot, they have distinct mechanisms and potential side effects. Nystatin tends to cause fewer systemic side effects because it isn't well-absorbed through skin or mucous membranes; most adverse reactions occur at application sites such as rash or irritation. Conversely, clotrimazole may be more effective against a broader range of fungi but carries a slightly greater risk for systemic absorption if applied on large surface areas.
What conditions is Nystatin approved to treat?
Nystatin is approved for the treatment of various fungal infections:
- Skin and mouth infections caused by Candida (commonly known as thrush)
- Intestinal candidiasis
- Vaginal yeast infections
Clotrimazole, on the other hand, is also used to treat fungal conditions such as:
- Athlete's foot
- Jock itch
- Ringworm Both Nystatin and Clotrimazole have their specific uses depending upon the type and location of infection.
How does Nystatin help with these illnesses?
Nystatin helps manage fungal infections by increasing the permeability of the fungal cell membrane. This is accomplished by binding to sterols in the cell membrane, which disrupts its integrity and results in leakage of intracellular components. Fungi, such as Candida species that cause conditions like oral or vaginal thrush, rely heavily on their cell membranes for survival and propagation. Thus, by disrupting this essential structure with Nystatin, we can effectively control and treat these infections.
On the other hand, Clotrimazole also combats fungal infections but does so slightly differently. It inhibits an enzyme called lanosterol 14-alpha-demethylase which is crucial for synthesizing ergosterol—an integral part of fungal cell membranes similar to cholesterol in human cells—thereby disrupting fungus growth and proliferation. While both drugs are used for managing topical fungal infections effectively, choice between them usually depends on specific patient factors like drug tolerance or type of infection being treated.
What is Clotrimazole?
Clotrimazole, commercially known as Canesten or Lotrimin among others, is an antifungal medication used to treat a variety of fungal skin infections such as ringworm, athlete's foot and jock itch. It operates by inhibiting the growth of certain types of fungus through altering their cell membrane structure. Clotrimazole was first approved by the FDA in 1975.
Unlike Nystatin which specifically targets systemic Candida infections, clotrimazole has broader applications against many different types of fungi. Its common forms include creams, solutions and lozenges for oral thrush. Possible side effects are generally mild but can include skin irritation or burning where applied.
The broad-spectrum nature of clotrimazole makes it a popular choice for treating varied fungal infections particularly when exact identification isn't possible or practical.
What conditions is Clotrimazole approved to treat?
Clotrimazole is a widely recommended antifungal medication, approved for the treatment of various fungal infections including:
- Tinea pedis (athlete's foot)
- Tinea cruris (jock itch)
- Cutaneous candidiasis (yeast infection of the skin)
- Tinea corporis (ringworm) These conditions can cause symptoms such as itching, burning, and cracked or peeling skin. Clotrimazole works by inhibiting the growth of these fungi to provide relief.
How does Clotrimazole help with these illnesses?
Clotrimazole is a powerful antifungal medication that works by disrupting the synthesis of ergosterol, a critical component of fungal cell membranes. This action results in increased membrane permeability and leakage of essential cellular contents, ultimately leading to the death of the fungus. Like nystatin, clotrimazole is used to treat various yeast and fungal infections; however, it also has broader applications due to its efficacy against different types of fungi including dermatophytes and molds. Clotrimazole's ability to inhibit biosynthesis not only at the plasma level but also within intracellular organelles gives it an advantage over nystatin which primarily targets surface-level fungi. Therefore, clotrimazole may be preferred when dealing with more stubborn or complex infections where deeper penetration into affected tissues is required for effective treatment.
How effective are both Nystatin and Clotrimazole?
Both Nystatin and Clotrimazole have established histories of success in treating fungal infections such as candidiasis, or yeast infection. They were initially approved by the FDA in 1950 and 1973 respectively. Since they act on different aspects of the fungal cell, they may be prescribed under different circumstances. The effectiveness of Nystatin and Clotrimazole in alleviating symptoms of vaginal yeast infection was directly studied in a double-blind clinical trial; both drugs exhibited similar efficacy in managing symptoms along with comparable safety profiles.
A review demonstrated that Nystatin is effective in reducing symptoms associated with oral thrush starting from the first few days of treatment, that its side effect profile is favorable over many other antifungal treatments, especially because it does not absorb into the body's systemic circulation when applied topically or taken orally for local action within the gut. Similarly, clotrimazole has also been shown to be highly effective against most strains of Candida species causing superficial infections.
Clotrimazole is commonly used as an initial choice among topical antifungals due to its wide spectrum activity including dermatophytes and yeasts which cause skin related fungal infections. Significant research on its use involves clotrimazole co-prescribed alongside another class known as azoles for resistant cases so data confirming its efficacy as a stand-alone treatment is robust.
Due to their unique pharmacological properties, either nystatin or clotrimazole may be optimal treatments depending on patient-specific factors like site of infection (skin vs mucous membranes), severity (mild vs severe) and individual tolerance towards these medications.
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At what dose is Nystatin typically prescribed?
Oral dosages of Nystatin range from 1–5 mL four times a day, with studies indicating that a consistent dosage is effective in treating most cases of oral fungal infections. Infants and children may be started on 1 mL four times daily. In either population, the dosage can be increased after several days if there is no response. The maximum dosage that should not be exceeded under any circumstances is 5 mL four times per day. Clotrimazole, on the other hand, has different instructions depending upon its form (cream, solution or lozenge), so it's crucial to follow your healthcare provider's advice when using this medication.
At what dose is Clotrimazole typically prescribed?
Treatment with Clotrimazole typically begins at a concentration of 1-2%, applied to the affected area twice daily. The cream or lotion should be used for two weeks, even if symptoms improve before this time to ensure complete eradication of the fungus. If there is no improvement after four weeks, consult your healthcare provider for further advice. In more stubborn cases, your doctor may advise using Clotrimazole twice a day and continuing treatment for up to four weeks. To ensure optimal effectiveness, it's crucial that you use this antifungal medication regularly and consistently as prescribed by your doctor.
What are the most common side effects for Nystatin?
Common side effects of Nystatin include:
- Nausea
- Vomiting
- Diarrhea
- Stomach pain or upset stomach
- Rash (skin irritation)
While Clotrimazole may cause:
- Mild skin irritation, burning, or itching at the application site
- Abdominal cramps and bloating if used orally for fungal infections of the mouth and throat.
Contact your healthcare provider immediately if you experience any severe reactions to either medication. It's important that patients understand their options when it comes to treatment, as well as potential risks associated with each medication.
Are there any potential serious side effects for Nystatin?
While both Nystatin and Clotrimazole are antifungal medications, they can cause different side effects in rare instances. When using Nystatin, you should watch for:
- Signs of an allergic reaction: hives; difficulty breathing or swallowing; swelling of the face, lips, tongue, or throat
- Skin irritation where the medicine was applied: redness, itching, burning sensation
- Unusual tiredness or weakness
Clotrimazole may also cause some serious side effects such as:
- Blistering, peeling or severe skin rashes
- Swelling around your mouth and face
- Itching or burning sensation that doesn't go away after a few days
- Stomach pain (in case Clotrimazole is swallowed)
If you experience any of these symptoms while using either medication - whether it be Nystatin or Clotrimazole - stop use immediately and consult with a healthcare professional.
What are the most common side effects for Clotrimazole?
Clotrimazole, an antifungal medication, may cause some side effects similar to those of Nystatin. These can include:
- Irritation or burning at the site of application
- Peeling or flaking skin
- Redness or swelling
- Mild stomach pain
- Unusual or unpleasant taste in your mouth.
However, it's important to note that not everyone experiences these side effects and they often subside as the body adjusts to the medication. If severe reactions such as blistering, oozing, open sores or signs of a skin rash occur after applying Clotrimazole, medical attention should be sought immediately.
Are there any potential serious side effects for Clotrimazole?
Clotrimazole is generally well-tolerated, but like any medication it can cause side effects in some people. While most of these are mild and temporary, there are a few symptoms that may indicate a more serious problem:
- Severe skin irritation after applying the cream or lotion
- Redness, blistering, peeling or oozing of your treated skin
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat.
If you experience any severe symptoms after using clotrimazole for fungal infections, discontinue use and seek immediate medical attention. It's important to remember that these instances are rare and clotrimazole remains highly effective for many types of fungal infections when used properly.
Contraindications for Nystatin and Clotrimazole?
Both Nystatin and Clotrimazole, like many antifungal medications, may cause side effects in some individuals. If you notice worsening skin irritation or any signs of an allergic reaction such as hives, difficulty breathing or swelling of the face, lips or throat after applying these drugs, seek immediate medical attention.
Neither Nystatin nor Clotrimazole should be used if you are allergic to them or have had a severe reaction to other similar antifungal medicines. Always inform your healthcare provider about all the medications and health products that you use; this includes prescription drugs, over-the-counter (OTC) drugs, vitamins and herbal supplements. This information can help prevent potential drug-drug interactions and adverse reactions.
It's also important to note that while both Nystatin and Clotrimazole are topical treatments for fungal infections on the skin surface only; they should not be ingested or applied internally.
How much do Nystatin and Clotrimazole cost?
For the brand name versions of these drugs:
- The price of 30 grams tube of Nystatin (100,000 units/gram) averages around $60-$80, which works out to approximately $2-$3 per gram.
- The price for a similar quantity (30 grams) of Clotrimazole cream (1%) is about $15-$25.
Therefore, if you are using a typical dose range (for instance applying the cream twice daily), then brand-name Clotrimazole can be less expensive on a per-application basis. However, cost should not be your primary consideration in determining which medication is right for you.
For generic versions of Nystatin and Clotrimazole products:
- Generic Nystatin is available in several forms such as creams, powders or oral suspension with costs ranging from 0.50 cents to $2.00 per gram depending on the product form.
- Meanwhile, generic clotrimazole comes in various forms like creams or lotions and typically costs between 0.20 cents to $1.00 per gram.
Again prices may vary based on location and point-of-purchase but generally speaking both generic options offer significant savings over their branded counterparts.
Popularity of Nystatin and Clotrimazole
Nystatin, available in both generic form and brand names such as Mycostatin, was estimated to have been prescribed to about 2.6 million people in the US in 2020. Nystatin accounted for just over 13% of antifungal prescriptions in the US. However, it appears to be the most-common polyene antifungal (a class of large spectrum antimycotics). The use of Nystatin has been generally increasing since 2013.
Clotrimazole, including brand versions such as Canesten or Lotrimin, was prescribed to approximately 1.9 million people in the USA in 2020. In the US, clotrimazole accounts for just under 10% of imidazole class antifungal prescriptions (a broad-spectrum group), and around 8% of overall antifungal prescriptions. The prevalence of clotrimazole has been fairly steady over the last decade.
Conclusion
Both Nystatin and Clotrimazole have a long history of use in the treatment of fungal infections. They are both antifungal agents that work by inhibiting the growth of fungi, however they do so through different mechanisms. Nystatin functions by binding to sterols in the cell membrane of susceptible fungi, altering cell wall permeability allowing leakage of cellular contents. On the other hand, Clotrimazole works mainly by inhibiting enzymes responsible for producing ergosterol which is vital for fungus survival.
In terms of usage circumstances, Nystatin is often chosen as a first-line therapy against intestinal Candida overgrowth or oral thrush due to its poor absorption from the gastrointestinal tract into bloodstream, confining its action largely within gut lumen and oral cavity. In contrast, clotrimazole can be used topically on skin or mucous membranes for conditions like athlete's foot or vaginal yeast infections.
As with all medications cost may also factor into decision making; both nystatin and clotrimazole are available in generic form providing significant savings especially for those paying out-of-pocket.
The side effect profiles between these two antifungal agents vary slightly but they're generally well-tolerated when used correctly. Some users experience minor skin irritation at application sites while others might experience stomach upset if taken orally. Close monitoring during treatment is highly advised - should any adverse reactions occur immediate medical assistance must be sought.
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Refrences
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- Crowley, P. D., & Gallagher, H. C. (2014, June 30). Clotrimazole as a pharmaceutical: past, present and future. Journal of Applied Microbiology. Oxford University Press (OUP).http://doi.org/10.1111/jam.12554
- Zaias, N. (1977, March 1). Superficial Mycoses. Archives of Dermatology. American Medical Association (AMA).http://doi.org/10.1001/archderm.1977.01640030053007
- Wolfson, N., Riley, J., Samuels, B., & Singh, J. M. (1981, January). Clinical Toxicology of Clotrimazole When Administered Vaginally. Clinical Toxicology. Informa UK Limited.http://doi.org/10.3109/15563658108990012
- Burgess, M. A., & Bodey, G. P. (1972, December). Clotrimazole (Bay b 5097): In Vitro and Clinical Pharmacological Studies. Antimicrobial Agents and Chemotherapy. American Society for Microbiology.http://doi.org/10.1128/aac.2.6.423
- Pugh, D., & Cawson, R. A. (1978, January). The effect of nystatin on the morphology of<i>Candida albicans</i>. Medical Mycology. Oxford University Press (OUP).http://doi.org/10.1080/00362177885380421
- Ouédraogo, M., Konaté, K., Lepengué, A. N., Souza, A., M’Batchi, B., & Sawadogo, L. L. (2012). Free radical scavenging capacity, anticandicidal effect of bioactive compounds from Sida Cordifolia L., in combination with nystatin and clotrimazole and their effect on specific immune response in rats. Annals of Clinical Microbiology and Antimicrobials. Springer Science and Business Media LLC.http://doi.org/10.1186/1476-0711-11-33