Comparative Pharmacology
Head-to-head clinical analysis: DIFLUCAN versus LAMISIL AT.
Peer-Reviewed Evidence
Head-to-head clinical analysis: DIFLUCAN versus LAMISIL AT.
DIFLUCAN vs LAMISIL AT
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Diflucan (fluconazole) is a triazole antifungal agent that inhibits fungal cytochrome P450 14-alpha-demethylase, thereby blocking the conversion of lanosterol to ergosterol, an essential component of the fungal cell membrane. This leads to increased membrane permeability and inhibition of fungal growth.
Terbinafine inhibits squalene epoxidase, an enzyme in the fungal ergosterol biosynthesis pathway. This leads to accumulation of squalene and depletion of ergosterol, disrupting fungal cell membrane integrity and causing cell death.
Oral or IV: 200-400 mg loading dose, then 100-200 mg once daily. Dose and duration depend on indication.
Terbinafine 250 mg orally once daily for 6 weeks for fingernail onychomycosis or 12 weeks for toenail onychomycosis. Topical: 1% cream applied once daily for 1 week for tinea pedis; 1% solution applied once daily for 1 week for tinea corporis/cruris.
None Documented
None Documented
30 hours (range 20-50 hours); prolonged in renal impairment (up to 98 hours in CrCl <20 mL/min)
The terminal elimination half-life is approximately 11-17 hours in healthy adults; however, it increases to about 200-400 hours in the distribution phase from tissues (e.g., skin, adipose). Steady-state is reached after 10-14 days of oral dosing.
Renal: 80% unchanged; fecal/biliary: 11% as metabolites
Terbinafine is extensively metabolized in the liver; approximately 80% of a dose is excreted in urine as metabolites, and 20% in feces. Less than 1% is excreted unchanged in urine.
Category C
Category C
Antifungal
Antifungal