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Terbinafine vs Nystatin
Introduction
For patients suffering from fungal infections, certain drugs that disrupt the growth of fungus and aid in eradicating infection can be instrumental. Terbinafine and Nystatin are two such antifungal medications frequently prescribed for this purpose. These drugs impact different aspects of fungal cells but both have substantial effects in treating various types of fungal infections. Terbinafine is an allylamine antifungal, working by inhibiting a specific enzyme (squalene epoxidase) necessary for the synthesis of ergosterol, a key component of the fungal cell membrane. This disruption leads to toxic buildup within the cell resulting in its death over time. On the other hand, Nystatin falls under polyenes class which primarily works by binding to sterols in the fungal cell membrane causing an increase in permeability leading to leakage of cellular contents and eventual cell death.
Terbinafine vs Nystatin Side By Side
| Attribute | Lamisil | Mycostatin |
|---|---|---|
| Brand Name | Lamisil | Mycostatin |
| Contraindications | Not recommended for people with chronic or active liver disease, kidney problems, or blood disorders. | Requires careful administration in patients with diabetes due to sugar content. Caution in pregnancy and breastfeeding. |
| Cost | For brand name, around $150 for 30 tablets (250 mg). For generic, $10-$60 for 30 tablets. | For brand name, about $35 for 30 capsules (500,000 units per capsule). For generic, $10-$20 for a month's supply. |
| Generic Name | Terbinafine | Nystatin |
| Most Serious Side Effect | Liver problems, skin issues, changes in sense of taste or smell, depressive symptoms. | Allergic reactions, unusual/extreme tiredness, dark urine, yellowing eyes/skin, persistent nausea/vomiting, stomach/abdominal pain. |
| Severe Drug Interactions | May interact badly with certain drugs; specific interactions were not listed but caution is advised. | Specific severe drug interactions were not listed, but as with any medication, it's important to discuss all current medications with a healthcare provider. |
| Typical Dose | 250 mg/day for adults. For children, dose varies by weight. | 500,000 to 1,000,000 units orally per day, up to a maximum daily dose of 4-6 million units. |
What is Terbinafine?
Terbinafine (the generic name for Lamisil) is an antifungal medication that combats infections caused by fungus. It was first approved by the FDA in 1996 and functions by inhibiting a fungal enzyme to disrupt cell membrane function, effectively killing the fungi responsible for infection. Terbinafine is typically used for treating certain types of fungal infections, such as ringworm of the scalp or body, athlete's foot, jock itch, and onychomycosis (fungal nail infections). This drug has a selective influence in combating dermatophytes with only minor effects on other microorganisms.
On the other hand, Nystatin is a polyene antifungal antibiotic obtained from Streptomyces noursei. It binds to sterols in the cell membrane of susceptible Candida species disrupting osmotic integrity and causing leakage of intracellular contents. Due to its specific target action predominantly against Candida species and limited absorption from mucosal surfaces or skin, it exhibits fewer side effects than systemic antifungals like terbinafine that are absorbed into general circulation.
What conditions is Terbinafine approved to treat?
Terbinafine is approved for the treatment of various fungal infections:
- Onychomycosis, a type of fungal infection in the nails
- Tinea capitis, also known as ringworm of the scalp
- Other forms of cutaneous or epidermal infectious conditions caused by fungus
On the other hand, Nystatin is primarily used to treat strains of candidiasis:
- Oral thrush, which affects the mouth
- Vaginal yeast infections
- Diaper rash caused by yeast infection
How does Terbinafine help with these illnesses?
Terbinafine aids in managing fungal infections by inhibiting an enzyme called squalene epoxidase, necessary for the synthesis of ergosterol, a key component of the fungal cell membrane. By blocking this process, Terbinafine disrupts fungal cell growth and leads to their death over time. Ergosterol is akin to cholesterol in human cells - it plays a vital role in maintaining the integrity and fluidity of fungal cell membranes. Humans do not produce ergosterol, hence why terbinafine specifically targets fungi without harming human cells. The inhibition of squalene epoxidase eventually leads to lower levels of ergosterol and higher levels of squalene which itself is toxic to fungi at high concentrations; thus aiding patients in ridding themselves from persistent or severe mycoses caused mainly by dermatophytes.
What is Nystatin?
Nystatin is a polyene antifungal medication, known for its role in disrupting the cell membrane of fungi by binding to sterols. This hampers their ability to function and grow, effectively treating infections caused by an array of yeasts and yeast-like fungi. Nystatin was first approved by the FDA in 1957.
Unlike terbinafine, which works systemically and therefore can be used for fungal infections anywhere in the body, nystatin is not absorbed into the general circulation from skin or mucous membranes and hence functions as a topical agent only. It is available over-the-counter or via prescription in several forms including creams, ointments, powders, tablets (both oral and vaginal), lozenges for oral thrush, and liquid suspensions for swish-and-swallow administration.
As Nystatin doesn't enter systemic circulation when applied topically or on mucosal surfaces its side effect profile differs from that of Terbinafine - most common adverse effects are mild irritation at application site while systemic use of Terbinafine might cause more serious side-effects such as hepatotoxicity (liver damage). However it's important to remember that effectiveness varies between individuals due to differences in absorption rates across different individuals' skin or mucosa so treatment choice should always be guided by healthcare professional advice.
What conditions is Nystatin approved to treat?
Nystatin has been approved for the treatment of:
- Candidiasis, a type of fungal infection that can affect different parts of the body including mouth (thrush), skin and genitals.
- Intestinal candidiasis, which specifically targets the gut flora.
In comparison to Terbinafine that is often used for treating certain types of fungal infections such as ringworms, jock itch and athlete's foot; Nystatin tends to be more effective in dealing with yeast-based infections caused by Candida species.
How does Nystatin help with these illnesses?
Nystatin is a potent antifungal medication that works by binding to sterols in the cell membrane of susceptible fungi, causing changes in the membrane and leading to leakage of cellular contents. This results in fungal cell death and thus helps to eliminate fungal infections from areas such as skin, mouth or vagina. Unlike terbinafine, which primarily treats dermatophyte infections (such as athlete's foot), nystatin has a broader spectrum of action and can treat yeast infections caused by Candida species. It does not absorb into the bloodstream when applied topically or taken orally for intestinal candidiasis; hence it causes minimal systemic side effects. Nystatin could be an excellent choice if patients do not respond well to other antifungal medications like terbinafine or may even be combined with them for more effective treatment.
How effective are both Terbinafine and Nystatin?
Both terbinafine and nystatin are antifungal medications with a long history of use, having been initially approved by the FDA in 1996 and 1957 respectively. The two drugs act on different structural components of fungal cells which makes them effective against different types of fungus. Terbinafine is primarily used to treat dermatophytic infections (such as athlete's foot, jock itch, and ringworm) while Nystatin is used to tackle yeast infections such as candidiasis.
The efficacy of both drugs was studied independently through several trials over the years. In all these studies, both terbinafine and nystatin exhibited similar potency in controlling their respective target fungi along with comparable safety profiles.
A review published in 2002 highlighted that oral terbinafine has high cure rates for dermatophyte toenail onychomycosis (nail fungal infection), works rapidly, and its effects last even after discontinuation because it remains in the skin for periods longer than most other antifungal treatments.
Similarly, an array of research supports the effectiveness of nystatin against Candida infections especially those located orally or vaginally. It has also proven to be well-tolerated among varied populations including infants where it's commonly used for oral thrush.
While terbinafine can be considered a first-line treatment option for dermatophytic infections due to its excellent absorption when taken orally; nystatin mainly serves as a topical agent owing to poor gastrointestinal absorption hence limiting systemic side-effects but restricting usage mostly externally like mouth or skin.
Terbinafine may be beneficial for patients who need rapid relief from particular types of superficial mycoses due to its quick action whereas Nystatin might serve better if there’s necessity avoiding systemic exposure particularly useful in treating localised Candida infections safely without affecting overall body systems much.
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At what dose is Terbinafine typically prescribed?
Oral dosages of Terbinafine range from 250 mg/day for adults, which studies have indicated is sufficient for treating most fungal infections. For children who weigh less than 20 kg, a dose of 62.5 mg/day may be started. If the child weighs between 20 to 40 kg, then a dosage of 125 mg/day can be used; and if they weigh more than 40kg, the adult dose may apply. Dosage can be increased after a few weeks if there is no response but under strict medical supervision only. The maximum dosage that should not be exceeded in any case is the doctor's prescribed amount.
At what dose is Nystatin typically prescribed?
Nystatin treatment typically begins with a dosage of 500,000 to 1,000,000 units orally per day. The dose can then be increased, if necessary, up to the maximum daily dose of 4-6 million units divided into three or four doses spaced evenly throughout the day. This may be tested if there is no response to initial therapy after several days. Please note that dosing may differ depending on the specific condition being treated and its severity. Always consult your healthcare provider for personalized advice regarding medication dosage and administration.
What are the most common side effects for Terbinafine?
Common side effects of terbinafine can include:
- Upset stomach, including nausea and indigestion
- Diarrhea or constipation
- Headache or dizziness
- Tiredness or sleepiness/drowsiness
- Rash, itching, hives or changes in your sense of taste/smell
- Muscle aches/pain
Nystatin on the other hand might lead to:
- Skin irritation (when used topically)
- Oral irritation and mouth tenderness (when used orally)
- Nausea, vomiting, diarrhea if swallowed accidentally -Nasal irrigation with nystatin can potentially cause nasal discomfort.
It's important to remember that everybody responds differently to medications. Always talk to your healthcare provider about potential side effects before starting any new medication.
Are there any potential serious side effects for Terbinafine?
Terbinafine, an antifungal medication primarily used to treat fungal infections of the fingernail or toenail, can have serious side effects in rare cases. These include:
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
- Symptoms associated with liver problems: nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools and jaundice (yellowing of the skin or eyes).
- Skin issues: severe skin rash leading to blistering and peeling.
- Changes in sense of taste or smell
- Depressive symptoms - feelings of sadness that don't go away.
Nystatin is another antifungal medication which comes with its own potential side effects including:
- Allergic reactions such as rashes and itching
- Gastrointestinal disturbances like nausea and vomiting
- Oral irritation if it's consumed orally
As always if you experience any unusual symptoms while taking these medications contact your healthcare provider immediately. Remember that this list isn't exhaustive - other more occasional adverse effects could occur depending on individual patient characteristics.
What are the most common side effects for Nystatin?
Nystatin, another antifungal medication, can exhibit its own set of side effects which may include:
- Oral irritation or soreness
- Nausea, vomiting and stomach upset
- Diarrhea
- Skin rash or itching
- Unusual tiredness or weakness Despite these potential side effects, it's crucial to remember that your healthcare provider has prescribed this medication because they've judged the benefit to you is greater than the risk of side effects. Many people using Nystatin do not have serious side effects. Always consult with your healthcare professional if any symptoms persist.
Are there any potential serious side effects for Nystatin?
While Nystatin is generally well-tolerated, it may lead to certain side effects in some individuals. The more serious ones warrant immediate medical attention and include:
- Signs of allergic reactions such as rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, or trouble breathing
- Unusual/extreme tiredness
- Dark urine or changes in the amount of urine produced
- Yellowing eyes/skin (indicating potential liver dysfunction)
- Persistent nausea/vomiting
- Stomach/abdominal pain
If you experience any of these symptoms while on nystatin, seek immediate medical help. Remember that your doctor has prescribed this medication because he/she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Contraindications for Terbinafine and Nystatin?
Both Terbinafine and Nystatin, as with most antifungal medications, may cause certain side effects. If you notice any severe reactions or worsening of symptoms after starting these medications, please seek immediate medical attention.
Neither Terbinafine nor Nystatin should be used if you are taking certain other drugs that can interact badly with them. Be sure to inform your healthcare provider about all the medications you are currently taking; some may require a period of time to clear from your system before initiating an antifungal treatment.
Terbinafine is not recommended for people with chronic or active liver disease because it can lead to serious liver problems. Likewise, patients with kidney problems or blood disorders should use terbinafine cautiously under doctor's supervision.
Nystatin has fewer contraindications but still requires careful administration in patients suffering from diabetes due to its sugar content which might affect blood glucose levels. Both drugs demand caution while using in pregnancy and breastfeeding unless directed by a physician.
How much do Terbinafine and Nystatin cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Terbinafine (250 mg) averages around $150, which works out to about $5/day, depending on your dose.
- The price of 30 capsules of Nystatin (500,000 units per capsule) averages is about $35, working out to approximately $1.17/day.
Thus, if you are in the higher dosage range for Terbinafine (i.e., two tablets or more per day), then brand-name Nystatin would be less expensive 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 generic versions:
-
Generic terbinafine costs significantly less than its branded counterpart with prices ranging from $10-$60 for 30 tablets at most pharmacies. This translates into an approximate daily cost between $0.33 and $2.
-
Generic nystatin similarly offers savings compared to its brand-name version with prices averaging around $10-$20 for a month's supply resulting in a daily expenditure from as low as approximately $.033 up to $.67 cents.
Remember that while both medications have antifungal properties they don't treat all the same conditions so make sure discuss your symptoms thoroughly with your healthcare provider before starting any new medication regimen.
Popularity of Terbinafine and Nystatin
Terbinafine, in both brand-name and generic forms, was prescribed to about 6.2 million people in the US in 2020. Terbinafine accounted for approximately 15% of antifungal prescriptions within the country. It is a leading choice among healthcare professionals due to its efficacy against dermatophytic infections (such as athlete's foot), and it has been consistently popular since its introduction.
Nystatin, including branded versions such as Mycostatin, was prescribed to an estimated 4 million people in the USA during the same year. In terms of overall antifungal prescriptions across America, nystatin accounts for about 10%. This medication's prevalence has remained relatively steady over the past decade. Nystatin is primarily used to treat Candida infections of skin or mucous membranes but is not effective against dermatophyte fungal infections.
Conclusion
Both Terbinafine and Nystatin have a long-standing record of use in the treatment of fungal infections, supported by numerous clinical studies indicating their effectiveness. The choice between these two drugs often depends on the type and location of the infection, as they have different mechanisms of action.
Terbinafine is an antifungal medication commonly used to treat nail fungus and other types of dermatophyte infections. It works by inhibiting an enzyme necessary for fungal growth.
Nystatin, on the other hand, is typically used for treating skin and mucous membrane infections such as oral thrush or diaper rash caused by Candida yeast species. It kills fungi by disrupting their cell membranes.
Both medications are available in generic form which provides significant cost savings especially for patients who must pay out-of-pocket. Depending upon the nature and severity of your infection, you may not notice improvement immediately after starting either drug.
Side effects with both drugs are generally mild but can include gastrointestinal issues like nausea or diarrhea with terbinafine or irritation at site-of-application with nystatin topical formulations.
As always when beginning any new medication regimen it's important to closely monitor how you're feeling and report any concerning symptoms to your healthcare provider promptly.
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Refrences
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- Krishnan-Natesan, S. (2009, October 30). Terbinafine: a pharmacological and clinical review. Expert Opinion on Pharmacotherapy. Informa UK Limited.http://doi.org/10.1517/14656560903307462
- 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
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- Gupta, Lynde, Lauzon, Mehlmauer, Braddock, Miller, … Shear. (1998, March). Cutaneous adverse effects associated with terbinafine therapy: 10 case reports and a review of the literature. British Journal of Dermatology. Oxford University Press (OUP).http://doi.org/10.1046/j.1365-2133.1998.02140.x
- Santelmann, H., Laerum, E., Roennevig, J., & Fagertun, H. E. (2001, June 1). Effectiveness of nystatin in polysymptomatic patients. A randomized, double-blind trial with nystatin versus placebo in general practice. Family Practice. Oxford University Press (OUP).http://doi.org/10.1093/fampra/18.3.258
- Katz. (1999, November). Drug interactions of the newer oral antifungal agents. British Journal of Dermatology. Oxford University Press (OUP).http://doi.org/10.1046/j.1365-2133.1999.00011.x
- Abdel-Rahman, S., & Newland. (2009, April). Update on terbinafine with a focus on dermatophytoses. Clinical, Cosmetic and Investigational Dermatology. Informa UK Limited.http://doi.org/10.2147/ccid.s3690