Ketoconazole Cream vs. Lamisil (terbinafine)

• Ketoconazole cream and Lamisil (terbinafine) are antifungal medications used to treat fungal infections such as jock itch and athlete's foot.
• Ketoconazole cream is also used to treat ringworm, dandruff, and tinea versicolor.
• Brand names for ketoconazole include Nizoral, Nizoral A-D, Ketodan, Extina, Xolegel, and Kuric.
• Lamisil is available as a generic and over-the-counter (OTC). Oral forms of terbinafine require a prescription.
• Side effects of ketoconazole and Lamisil that are similar include headache, abdominal pain, and itching.
• Side effects of ketoconazole that are different from Lamisil include rash, nausea, vomiting, dizziness, fatigue, impotence, and blood count abnormalities.
• Side effects of Lamisil that are different from ketoconazole include cough, diarrhea, hives, and altered taste and smell sensation.

Ketoconazole cream is an antifungal medication in the same family of drugs as fluconazole (Diflucan), itraconazole (Sporanox), and miconazole (Micatin, Monistat). Ketoconazole cream works by inhibiting the growth of a number of types of fungi by preventing production of the membranes that surround fungal cells. Ketoconazole cream is used to treat fungal infections including ringworm, jock itch, athlete's foot, dandruff, and tinea versicolor.

Lamisil (terbinafine) is an antifungal medication taken by mouth or applied to the skin used to treat fungal nails, jock itch, and athlete's foot. 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.

Ketoconazole

Ketoconazole generally is well tolerated. Commonly reported side effects of ketoconazole are:

• rash,
• itching,
• nausea,
• vomiting,
• abdominal pain,
• headache,
• dizziness,
• fatigue,
• impotence, and
• blood count abnormalities.

Other important side effects of ketoconazole are rare; they include:

• serious allergic reactions (anaphylaxis),
• severe depression,
• hair loss, and
• tingling sensations.

Liver dysfunction also has been reported. Signs of liver problems include unusual fatigue, loss of appetite, nausea and vomiting, yellowing of the skin (jaundice), dark urine, and pale stools. Development of these symptoms while taking ketoconazole should be reported to a physician.

Lamisil

The most common side effects of terbinafine are:

• headache,
• cough,
• diarrhea,
• abdominal pain,
• hives,
• itching and
• altered taste and smell sensation.

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

Ketoconazole

Ketoconazole may be taken with or without food. The oral dose range is 200-400 mg daily. Recurrent tinea versicolor is treated with 400 mg monthly. Topical formulations are administered to affected areas once or twice daily.

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.

Ketoconazole

Avoid using other skin or hair products that can cause irritation, such as harsh soaps or shampoos or skin cleansers, hair coloring or permanent chemicals, hair removers or waxes, or skin products with alcohol, spices, astringents, or lime. Do not use other medicated skin products unless your doctor has told you to.

Avoid getting this medication in your eyes, mouth, and nose, or on your lips. If it does get into any of these areas, wash with water.

Avoid covering treated skin areas with tight-fitting, synthetic clothing (such as nylon or polyester) that doesn't allow air to circulate to your skin. If you are treating your feet, wear clean cotton socks and sandals or shoes that allow for air circulation. Keep your feet as dry as possible.

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.

Ketoconazole

A small amount of ketoconazole is secreted in breast milk. Nursing mothers should probably avoid breastfeeding while using ketoconazole.

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.