Terbinafine vs Clotrimazole

Terbinafine vs Clotrimazole

What is Terbinafine?

Terbinafine belongs to the antifungals class of medication. It works by preventing fungi from growing. It’s used to treat fungal (yeast)-related skin illnesses, such as:

  • Athlete’s foot
  • Fungal nail infection
  • Jock itch ringworm (sometimes called dhobie itch, an infection in the groin area)
  • Pityriasis versicolor is a kind of pityriasis (this causes small patches of scaly and discoloured skin often observed on your back, chest, upper arms, neck, and tummy)

Terbinafine is used to treat pityriasis versicolor, jock itch, and ringworm as a cream, gel, or spray. A fluid (solution) is also available for the athlete’s foot. It can be purchased from pharmacy and supermarket.(Balfour, J.A. and Faulds,)

What is Clotrimazole?

Clotrimazole is over counter medicine used as an antifungal medicine. It works against skin infections caused due to fungi(Gallagher, H.C., 2014).

Terbinafine vs Clotrimazole

Clotrimazole can be used for the treatment of different types of fungal infections, including:

  • Rash in folds of skin
  • Fungal nail infection
  • Ringworm
  • Thrush
  • Athlete’s foot
  • Infected nappy rash

Uses

Terbinafine

This medicine can be consumed meal as directed by your doctor. Dosage and duration of medication are determined by your medical condition and response to treatment.

 This medicine may take several months to work after you stop taking it. It will take time for new healthy nails to grow and replace the infected nails.

 Keep taking this medicine until your prescription is finished. Terminating the medication in the early stage can make the fungus grow and the infection might come back.

Clotrimazole

This medicine should be used externally only. This medication should be applied to the affected area of the skin twice a day or as directed by your doctor.

The type of infection to be treated determines the dose and duration of treatment. It should not be used more than once in a day. Your illness will not improve any faster, but the severity of your side effects may get worse.

Cover the affected area and part of the surrounding skin with enough medication. Wash your hands after using this medicine. Unless your doctor tells you otherwise, do not wrap, cover, or bandage the affected area.

 This medication must not be used in the eyes, nose, mouth, or vaginal area.

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Mechanism of Action

Terbinafine

Most antifungal drugs work by blocking fungal film formation and ergosterol synthesis. Terbinafine is an allylamine that acts as a non-completive inhibitor of squalene epoxidase and the subsequent conversion of squalene-to-squalene epoxide at the initiation of the pathway. 

 The intracellular accumulation of squalene causes fungal cell death, despite the fact that it has no immediate fungicidal effect.

Clotrimazole

Clotrimazole works by disrupting the permeability barrier in the cytoplasmic membrane of fungal cells. Clotrimazole blocks ergosterol formation by preventing demethylation of alpha lanosterol in a concentration-dependent manner.

Cells can no longer make complete and functional cell membranes when ergosterol synthesis is blocked. In terms of hormones, ergosterol also promotes fungal cell growth; Thus, the rapid onset of previous events resulted in dose-dependent inhibition of fungal growth.

Clotrimazole has antifungal properties by inhibiting ergosterol production, but it also has other pharmacological effects. These include blockade of calcium-dependent and potential-dependent calcium channels, as well as inhibition of the ca2+ ATPase substrate network and intracellular calcium depletion.

The action of clotrimazole on several cellular targets explains the additional effects of the drug, unrelated to its antispasmodic properties.

Forms and Strength

Terbinafine

It is also available in tablet form to treat nail fungus and other fungal diseases. If your doctor thinks creams, gels, sprays, or solutions aren’t working, they may recommend pills.

Terbinafine granules are applied to the scalp to treat fungal infections. Terbinafine pills are accustomed to treating toenail and fingernail fungal infections.

Terbinafine: 250mg

Terbinafine tablets can only be purchased with a doctor’s prescription.

Clotrimazole

Clotrimazole is available in the form of cream, spray, and solution that can be applied on skin.

Clotrimazole: Troche- 10mg

                        Lozenge – 10mg

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Dosage

Terbinafine

Disease

Strength & Dosage

Onychomycosis

Fingernail

250mg for 6weeks

Toenail

250mg for 12weeks

Tinea Pedis (Off Label)

Orally 250mg/day single dose or divided every 12hours for 2-6weeks

Tinea Corporis

Orally 250mg/day single dose or divided every 12hours for 2-4weeks

Sporotrichosis, Lymphocutaneous and cutaneous (Off-label)

Orally 500mg/day after every 12hours for 2-6weeks. Can be continued for additional 2-4 weeks after resolution of all lesions.

Tinea Capitis, Pediatric

Less than 25kg weight

125 mg/day orally for 6 weeks

25-35Kg weight

187.5 mg/day orally for 6 weeks

Greater than 35kg weight

250 mg/day orally for 6 weeks

 

Clotrimazole

Disease

For

Application

cutaneous candidiasis

Adults

It can be applied to the affected skin and surrounding areas two times a day.

Children and Adolescents

It can be applied to the affected skin and surrounding areas two times a day.

oropharyngeal candidiasis (thrush)

Adults

10 mg PO 5 times daily for 1-2 weeks.

Children and Adolescents 3-17 Years

10 mg PO 5 times daily for 1-2 weeks.

vulvovaginal candidiasis 

Adult females

1 applicatorful of 1% cream (50 mg) vaginally at bedtime for 7 days 

Adolescent females 12 to 17 years

1 applicatorful of 1% cream (50 mg) vaginally at bedtime for 7 days 

Tinea corporis, Tinea cruris, and Tinea pedis

Adults

It should be applied to the infected skin and surrounding areas twice daily.

Children and Adolescents 2 to 17 years

It should be applied to the infected skin and surrounding areas twice daily.

Tinea versicolor.

Adults

It should be applied to the infected skin and surrounding areas twice daily.

Children and Adolescents

It should be applied to the infected skin and surrounding areas twice daily.

Side effects

Some common side effects of Terbinafine are

If you use a cream, gel, spray, or solution, talk to your pharmacist or doctor if you observe t:

  • Peeling or itching skin

Inform your doctor if you face these side effects:

  • Rash
  • Headache
  • Diarrhea
  • Feeling or being sick (nausea or vomiting)
  • Smaller appetite than usual
  • Stomach ache
  • Indigestion
  • Muscle or joint pain

Common side effects of Clotrimazole are;

  • Red, irritated skin
  • Burning skin or pain

If the side effects bother you for long, start using a smaller amount of treatment or consult your doctor.

Some severe side effects of both Terbinafine and Clotrimazole are;

  • Skin rashes and itchiness
  • Difficulty in breathing
  • swelling of lips and throat

Health Conditions

Terbinafine under condition

       1. Alcohol

Yes, you can drink alcohol while taking terbinafine

  1. In Liver disease

In patients with chronic or active liver disease, oral terbinafine is not indicated. Terbinafine has the potential to be hepatotoxic.

  1. Neutropenia

Isolated cases of severe neutropenia were reported in some patients who consumed oral terbinafine. Although neutropenia resolved after discontinuation of terbinafine with or without adjuvant therapy, no causal link was established.

  1. Depression

People suffering from depression should take this medicine with caution keeping the symptoms in mind. Patients and caregivers should inform patients and caregivers of any symptoms of depression.

  1. Immunosuppression

Full blood count monitoring is required in those taking terbinafine for more than six weeks and with known or suspected immunosuppression.

  1. Lupus

Terbinafine should not be used by patients suffering from symptoms like lupus erythematosus.

Clotrimazole under condition

  1. Budesonide / formoterol

Clotrimazole may help the drug budesonide be absorbed into the bloodstream. Weight gain, high blood pressure, swelling, high blood sugar, muscle weakness, depression, acne, thinning skin, stretch marks, easy bruising, loss of bone density, cataracts, irregular periods, excessive hair growth on face and body and uneven fat distribution are all possible side effects.

  1. Hepatic Dysfunction

When using clotrimazole lozenges, abnormal liver function tests have been reported, most of the SGOT values are usually slightly increased. Patients with pre-existing liver failure should have their liver function tested regularly.

Warnings

Terbinafine

Adults and children one year of age and older may be prescribed tablets, creams, and gels. (Balfour, J.A)

Creams, gels, and sprays available in pharmacies and supermarkets are suitable for people 16 years of age and older. Only adults 18 years and older should use solutions.

Inform your doctor or pharmacist, If

  • Kidney and liver disorders
  • Are pregnant, trying to conceive or breast-feeding
  • Have ever had an adverse reaction to terbinafine or any other medicine.

Clotrimazole

Most adults and children can use clotrimazole cream, spray, or solution. Clotrimazole is not a medicine that should be used by everyone. If you have ever had an allergic reaction to clotrimazole or any other medication, consult your doctor to know the safety of the medicine.((Bodey, G.P., 1972))

Which Is More Effective

A study was conducted to observe the efficacy and safety of terbinafine 1% cream and clotrimazole 1% cream for tinea pedis treatment.

A multicentre, double-blind, parallel-group has taken evaluable 211 patients. 107 with a mean age of 40 were randomized with terbinafine, and the remaining 104 with a mean age of 36 with clotrimazole.

Inert cream was applied two times a day daily for 3 weeks while Terbinafine was used twice a day for a span of 2 weeks. Clotrimazole 1% cream applied daily for four weeks. Mycological cure and effective treatment were measured at 1,2,3,4,5, and 6 weeks.

The results show that a one-week course of 1% terbinafine cream is more effective than a four-week course of 1% clotrimazole cream in treating tinea pedis both in terms of mycological cure effective treatment of the disease.

Terbinafine vs Clotrimazole

Difference between Terbinafine and Clotrimazole:

Particular

Terbinafine

Clotrimazole

Antifungal

Used as antifungal

Used as an antifungal. It is used in the treatment of vaginal yeast infections, oral thrush, tinea versicolor, or tinea corporis.

Over the Counter/ Prescription

 over-the-counter (OTC) and as a generic

 over-the-counter (OTC) and as a generic

Side effects

Similar side effects that include itching and hives

Similar side effects that include itching and hives

Uncommon Side effects

Side effects different from Clotrimazole are diarrhea, cough, abdominal pain, abdominal pain, and headache.

Side effects different from terbinafine are local redness, stinging, blistering, peeling, swelling, or burning at the area of application, and nausea and vomiting.

Conclusion

Terbinafine is more effective than Clotrimazole. One should always consult the doctor and talk about the medical history to prevent from negative effects before taking any medicine.

Clotrimazole vs Nystatin

Clotrimazole vs Nystatin

What is Clotrimazole?

Clotrimazole is an antifungal cream that prevents the growth of fungus. Clotrimazole is used to treat different skin infections such as ringworm, jock itch, candidiasis, athlete’s foot and fungal infections(Crowley, P.D).

What is Nystatin?

Nystatin belongs to the drug class called Polyenes- antifungal medications. Its working is also similar to Clotrimazole. Nystatin is also used in the treatment of fungal infections, especially internal fungal infections(G.W., 1977).

Forms and Strength

Clotrimazole

Clotrimazole is available as – Cream, Powder, lotion, ointment, Gel.

Strengths – 15GM of 1%, 28GM of 1%, 30GM of 1%, 45GM of 1%

Nystatin

Nystatin is available as – Cream, Powder, Ointment, Tablet, and Liquid.

Strengths – 15gm and 30gm (tube), 15gm, 30gm and 60gm (bottle), 500,000units (tablet), 60ml and 480ml (bottle)

Dosage

Clotrimazole

The amount of dosage may vary depending on the condition. Depending on the nature and severity, you can apply the cream around the infected area for 2 to 8 weeks up to two times a day.

Nystatin

Tablet – Adults and children over the age of 5 can take 1-2 pills for about 3 to 5 times a day.

Liquid – 1 teaspoon full is the standard dosage

Side Effects

Clotrimazole vs Nystatin

Clotrimazole

It can cause minor side effects like burning, itching, or irritation when applied. Following are the severe side effects associated with Clotrimazole(Crowley, P.D):

  • Fever
  • Chills
  • Nausea
  • Rash
  • Hives
  • stomach pain

Nystatin

Like Clotrimazole, even Nystatin may irritate, stinging, or burning where it is applied. Following are the adverse effects(Bissell, M.J., 1974):

  • Allergic reaction
  • Slow heart rate
  • Bronchospasm
  • Facial swelling
  • Muscle pain
  • Vomiting
  • Hypersensitivity reactions
  • Skin irritation or redness
  • Mouth irritation
  • Rash
  • Hives
  • Diarrhea
  • Nausea
  • Stomach pain or upset
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Drug Warnings

Clotrimazole

Once you have applied the medication, don’t apply cosmetics on it.

Also, do not use any other creams on the area where you have applied Clotrimazole.

The liquid form may be flammable so take appropriate precautions with it.

Do not breastfeed or use it during pregnancy without consulting your healthcare professional.

Do not use clotrimazole if you have had allergic reactions to other antifungal medications before.

Nystatin

Consult your healthcare professional if you are using any OTC medications, prescription medications, or herbal medicines before using Nystatin.

Can you use Clotrimazole and Nystatin together?

No interactions between Clotrimazole and Nystatin have been discovered yet. Still, there have been no studies implying that you can use them together. Always consult your healthcare professional before mixing medications.

Scientific Study on Clotrimazole and Nystatin

A study was conducted to compare the efficacy and safety of Clotrimazole and Nystatin in the treatment of Diaper dermatitis in infants. Diaper dermatitis is a common type of irritative dermatitis in infancy.

Ninety-six infants were included in this study which was multi-center, controlled, and randomized. The infants were treated with either Nystatin or Clotrimazole two times a day for 14 days straight.

Both medications helped in decreasing the symptoms. However, the clinical cure rate and global assessment of clinical response were higher in Clotrimazole. The frequency of side effects was minimal in both the medications.

In conclusion, Clotrimazole was better in this trial than Nystatin.

Clotrimazole vs Nystatin

Which one is better?

Based on various studies conducted on Clotrimazole and Nystatin, clotrimazole ointment was found to be significantly more effective than Nystatin. However, depending on your condition, one might be better than the other, so speak to your healthcare professional, and he will help you decide which one is suited for you.

Tolnaftate vs Clotrimazole

Tolnaftate vs Clotrimazole

What Is Tolnaftate?

It’s an antifungal cream that comes in many forms; Athlete’s foot, jock itch, and ringworm are among conditions that can be treated with tolnaftate.

What Is Clotrimazole?

Clotrimazole is a topical antibiotic used to treat fungal skin diseases such as athlete’s foot, jock itch, and ringworm. This drug is also used to treat pityriasis, a fungal illness that causes the skin on the neck, chest, arms, and legs to lighten or darken.

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How Does Clotrimazole Work?

Clotrimazole kills the fungus that is the source of the infection. The fungus is killed, and the condition is treated.

Forms And Strengths Of Tolnaftate:

The following dose formulations are available for this product:

  • Spray
  • Cream
  • Powder
  • Solution

Maximum strength- 1%- tolnaftate 1% liquid

Forms And Strengths Of Clotrimazole:

It comes in a variety of dose forms, such as

  • Topical cream
  • Ointment
  • Vaginal suppository
  • It’s also available as a prescription-only oral troche or throat lozenge.

Topical solution in a bottle :

  • 10 mL of 1% lozenge,
  • 30 mL of 1% lozenge Cream tube with 10mg.
  • 15 grammes of 1%, 30 grammes of 1%, and 45 grammes of 1%

Side Effects Of Tolnaftate:

Common Side Effects:

  • It is possible that the treated skin will become irritated. Notify your doctor or pharmacist right once if this effect persists or worsens.
Tolnaftate vs Clotrimazole Severe Side Effects

Severe Side Effects:

Although a severe allergic reaction to this medicine is unusual, get medical help right once if one does develop.

  • Rashes,
  • itching/swelling
  • extreme dizziness
  • difficulty breathing
Side Effects Of Clotrimazole

Side Effects Of Clotrimazole:

Common Side Effects:

  • Pimples
  • Acnes
  • Skin Irritation
Severe Side Effects

Severe Side Effects:

  • Extreme dizziness
  • Rash
  • Allergic reaction

Precautions of Tolnaftate:

  • Do not take this medication by mouth.
  • This drug should not be used on open wounds, sunburned, windburned, dry, chapped, or irritated skin.
  • It is unknown if this medication goes into breast milk. Before you start breastfeeding, talk to your doctor.

Precautions of Clotrimazole:

  • Inform your doctor or pharmacist about your medical history before taking this drug.
  • During pregnancy, this medicine should only be used if necessary. Consult your doctor about the dangers and advantages.
  • It is unknown if this medication goes into breast milk. Before you start breastfeeding, talk to your doctor.
  • Do not take this medication by mouth.
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Case Study:

Tolnaftate vs Clotrimazole

Patients with external fungal otitis who were treated with topical antifungals were randomized into two treatment groups in a controlled, randomised, and open clinical trial: (2) tolnaftate solution; (1) clotrimazole cream. They were examined microscopically after one and two weeks of treatment to see if the disease had resolved. There was a record of recurrence and problems. We gathered and analyzed demographic and clinical data. The groups were compared in terms of follow-up and end outcomes.

The study included 48 patients: 28 in the clotrimazole group and 20 in the tolnaftate group. The most prevalent season linked with otomycosis was spring, and otic manipulation was the most common risk factor in both groups. Itching and otic fullness were the most common complaints. The organism Aspergillus niger was isolated the most. At one week of treatment, clotrimazole medication resulted in 75 percent resolution compared to 45 percent resolution with tolnaftate treatment. The Tolnaftate therapy group had a greater rate of recurrence.

Synopsis:

For uncomplicated otomycosis, clotrimazole cream is more effective than tolnaftate.

Ketoconazole vs. Clotrimazole: Which Is Effective?

Ketoconazole vs. Clotrimazole: Which Is Effective?

Ketoconazole is the medication that treats fungal infections whereas, Clotrimazole is the medication that treats yeast infection and is not suitable to treat fungal infection.

What Is Ketoconazole?

Ketoconazole is an antifungal medication sold under the brand name Nizoral that treats fungal infections caused due to fungus. Ketoconazole is an anti-androgen medication that is remedial to the conditions, namely, cutaneous candidiasis, dandruff, pityriasis Versicolor, seborrheic dermatitis(Cantilena, L.R., 1993).

What is Clotrimazole?

Clotrimazole is an FDA-approved medication sold under the brand name Lotrimin that is primarily used to treat infections such as yeast infections in the vaginal area, oral thrush, diaper rash, pityriasis Versicolor, and ringworm infections such as athlete’s foot and jock itch(Gallagher, H.C., 2014).

How does Ketoconazole work?

Clotrimazole kills the fungus (yeast) that is the source of the infection. Clotrimazole kills fungus by causing holes in its cell membrane to emerge, allowing the components to escape. The fungus is killed, and the infection is treated(Müller, R.H., 2005).

How does Clotrimazole work?

Clotrimazole kills the fungus (yeast) that is the source of the infection. Clotrimazole kills fungus by causing holes in its cell membrane to emerge, allowing the components to escape. The fungus is killed, and the infection is treated.

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Ketoconazole: Form and Strength

  • Form: This drug comes in the form of a tablet.
  • Strength: 200mg 

Clotrimazole: Form and Strength

  • Form: cream, ointment and also available as a troche. 
  • Strength: lozenge 10mg
  • troche 10mg

Ketoconazole: How to take it?

Ketoconazole is available as a pill that can be swallowed. It is typically taken once per day. Ketoconazole should be taken at the same time each day. Follow the medication as directed carefully, and if there is anything you don’t understand, consult your veterinarian or pharmacist. Ketoconazole should be taken exactly as prescribed(D.A.J., 1981).

Clotrimazole: How to take it?

It is generally taken five times a day for 14 days to treat yeast infections. It is commonly taken three times a day to prevent yeast infections. The course of the preventative treatment is determined according to one’s condition.

Ketoconazole: dosage

  • The dosage for fungal infection:
  • Adults: 200-400 mg orally per day
  • Children under the age of two: Safety and efficacy have yet to be determined.

Clotrimazole: dosage

  • The troche (lozenge) should dissolve gradually. One troche is given five times a day for 14 days.
  • For 7 days, the vaginal cream is injected by the applicator once daily, ideally at night.
  • For 7 days, the 100 mg vaginal suppository is injected once daily, ideally at bedtime.
  • The 200 mg vaginal suppository is administered once a day, ideally before night, for three days.

Ketoconazole: side effects

The side effects of this medication can be common or adverse. In any case, consult the physician immediately. 

Adverse Side effects:

Ketoconazole vs Clotrimazole Which Is Effective Adverse Side effects

Contact the medical practitioner as fast as possible if you notice any of these symptoms:

  • Nausea or vomiting
  • foul-smelling vaginal discharge 
  • rash
  • hive
  • stomach discomfort 
  • fever chills 
  • increased vaginal burning
  • itching, or irritation

Clotrimazole: Side Effects

The side effects of this medication can be common or adverse. In any case, consult the physician immediately.

Adverse side effects

  • Loss of hair
  • Headache
  • Dizziness
  • Hyperlipidemia
  • Loss of breath 
  • Allergy 
  • Drowsiness 
  • Fever or Chills

Common side effects

  • Vomiting and nausea
  • Itching 
  • rash on the skin
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Ketoconazole: Who should not take it?

  • Ketoconazole can injure your liver severely, requiring a liver transplant or perhaps death. If you noticed any symptoms of liver damage, such as nausea, vomiting, stomach discomfort, urine, clay-colored stools, or jaundice, call your doctor (yellowing of the skin or eyes)
  • Ketoconazole might potentially be dangerous to your heart. If you develop fast or pounding heartbeats, shortness of breath, or abrupt dizziness, call your doctor straight away(Borelli, D., 1980).

Clotrimazole: who should not take it?

  • Don’t consume this medication if you are allergic to it
  • Do not take the medicines if you are suffering from any liver or heart conditions. 
  • Consult the doctor before taking the medication

Ketoconazole: Medical conditions

  • Overdose:The side effects overdosed on this medication can lead to side effects nausea or vomiting, feeling tired, stomach pain or tenderness, dark urine, or light-colored stools. You overdosed on Ketoconazole, contact your doctor or your local Poison Control Center straight away, or seek emergency medical help.
  • Alcohol:Do not consume alcoholic beverages. It’s possible that you’ll have dangerous side effects.
  • During pregnancy:Animal reproduction studies have revealed an unfavorable effect on the fetus, and there are no appropriate and well-controlled trials in humans. However, possible benefits may justify the use of the medicine in pregnant women despite potential risks, according to the US FDA pregnancy category C.

Clotrimazole: Medical conditions

  • Overdose: If overdosed, it can lead to side effects, namely burning, stinging, swelling, irritation, redness, pimple-like lumps, soreness, or peeling. I overdosed on Clotrimazole. Contact your doctor or your local Poison Control Center straight away, or seek emergency medical help.
  • Alcohol: Alcohol can be consumed when taking Clotrimazole.
  • During pregnancy: Clotrimazole is generally thought to be safe for use by pregnant women. It is suggested that you insert the pessary using your fingers rather than the applicator supplied if you are treating vaginal thrush during pregnancy.

Study: ketoconazole v/s Clotrimazole

Research: This study was conducted by the Department of Dermatology, University Clinic of the RWTH Aachen, Germany.

Aim: In a double-blind, randomized study, the efficacy of two topical cream formulations containing Clotrimazole 1 percent and Ketoconazole 2 percent, respectively, were clinically evaluated for a 28-day treatment of interdigital tinea pedis in 106 patients.

Conclusion: Both Clotrimazole and Ketoconazole may successfully treat tinea pedis within 28 days of treatment. Once-daily Clotrimazole is similarly effective as twice-daily Ketoconazole, with favorable effects on the disease’s most bothersome symptoms.

Synopsis: Ketoconazole and Clotrimazole are both effective medications, as proved in the study. Both the medicines treat infections ranging from yeast infection to candidiasis; however, Clotrimazole does not treat other fungal infections. In any case, confirm with the doctor regarding any history of medical problems to take suitable precautions or can be lethal. Do not consume any of these medications without the doctor’s prescription or consultation.