Diflucan (fluconazole) vs. Lamisil (terbinafine)

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Diflucan vs. Lamisil: What's the difference?

What is Diflucan? What is Lamisil?

Diflucan (fluconazole) is an antifungal medication used to treat vaginal, oral, and esophageal fungal infections caused by Candida; urinary tract infections, peritonitis, pneumonia and disseminated infections caused by Candida; cryptococcal meningitis; and to prevent Candida infections in patients treated with chemotherapy or radiation after bone marrow transplantation. Diflucan works to prevent growth of fungi by preventing production of the membranes that surround fungal cells. Diflucan is related to clotrimazole (Lotrimin), ketoconazole (Nizoral), itraconazole (Sporanox), and miconazole (Micatin, Monistat).

Lamisil (terbinafine) is an antifungal agent taken by mouth or applied to the skin. Lamisil acts by interfering with the ability of fungi to make chemicals called sterols that are an important part of the membrane that surrounds fungal cells and holds them together. This weakens the cell membrane. Oral terbinafine is more effective for treating fungal nail infections than griseofulvin (Fulvicin; Gris-Peg) and itraconazole (Sporanox), two other antifungal agents used for treating fungal nail infections. Lamisil cream, gel, spray, and solution are applied to the skin to treat jock itch, ringworm, and athlete’s foot.

What are the side effects of Diflucan and Lamisil?

Diflucan

Common side effects of fluconazole include

Other important side effects include

Possible serious side effects include

  • seizures,
  • reduced number of white blood cells,
  • reduced number of blood platelets, and
  • toxic epidermal necrolysis.

Rarely, serious allergic reactions, including angioedema (swelling of tissues), may also occur. Liver dysfunction (jaundice, hepatitis) and abnormal heartbeats have been associated with fluconazole. Stevens-Johnson syndrome has also been reported.

Lamisil

The most common side effects of terbinafine are:

Oral terbinafine can cause liver failure sometimes leading to liver transplantation or death.

What is the dosage of Diflucan vs. Lamisil?

Diflucan

  • The usual adult dose is 50-400 mg daily depending on the type of infection. Although symptoms of oral Candida infections may subside in a few days, treatment is continued for 2 weeks.
  • Esophageal Candida infections are treated for 3 weeks or longer.
  • Treatment of cryptococcal meningitis may last for 10-12 weeks after cerebrospinal fluid cultures become negative.

Lamisil

  • Tablets: The usual dose is 250 mg once daily for 6 weeks for treatment of the fingernails, and 12 weeks for treatment of toenails. Optimal results will not be seen for several months after treatment because it takes time for new healthy nails to grow. Terbinafine may be taken with or without food.
  • Cream, gel, spray, solution: Apply to affected area (s) once (jock itch, ringworm) or twice daily (athletes foot) for about for 1 week.

What drugs interact with Diflucan and Lamisil?

Diflucan

Lamisil

Rifampin reduces oral terbinafine blood concentrations, potentially reducing the efficacy of terbinafine. Cimetidine (Tagamet) may increase oral terbinafine blood levels, potentially increasing side effects of terbinafine. Fluconazole (Diflucan) increases the blood levels of oral terbinafine by 52%-69%. Potentially leading to increased side effects.

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Are Diflucan and Lamisil safe to use while pregnant or breastfeeding?

Diflucan

  • There are no adequate studies of Diflucan in pregnant women. There are reports of harmful effects to the fetus when high dose fluconazole was administered to pregnant women for a few months. Use of fluconazole during pregnancy is not recommended.
  • Diflucan is secreted in breast milk at concentrations similar to the mother's blood level. However, fluconazole is used for treating neonates with fungal infections and for treating lactation associated Candida infections. Available evidence suggests that use of fluconazole during breastfeeding has little risk.

Lamisil

  • There are no adequate studies in pregnant women. Since nail fungus treatment can be delayed until after pregnancy there is no reason to use oral terbinafine during pregnancy.
  • Breastfeeding mothers should not use oral terbinafine because terbinafine passes into breast milk.

Summary

Diflucan (fluconazole) and Lamisil (terbinafine) are anti-fungal medications used to treat different types of fungal infections. Diflucan is used to treat vaginal, oral, and esophageal fungal infections caused by Candida; UTIs, peritonitis, pneumonia and disseminated infections caused by Candida; and cryptococcal meningitis. Lamisil oral is used to treat fungal nail infections. Lamisil cream, gel, spray, and solution are used to treat jock itch, ringworm, and athlete’s foot.

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Medically Reviewed on 1/22/2019
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