Comparative Pharmacology
Head-to-head clinical analysis: LAMISIL AT versus MYCOSTATIN.
Peer-Reviewed Evidence
Head-to-head clinical analysis: LAMISIL AT versus MYCOSTATIN.
LAMISIL AT vs MYCOSTATIN
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
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.
Mycostatin (nystatin) is a polyene antifungal antibiotic that binds to ergosterol in the fungal cell membrane, forming pores that increase membrane permeability, leading to leakage of intracellular contents and cell death.
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.
Nystatin suspension: 400,000-600,000 units (4-6 mL) orally four times daily for 7-14 days. Nystatin pastilles: 200,000-400,000 units (1-2 pastilles) orally four to five times daily for 7-14 days.
None Documented
None Documented
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.
Not applicable (nystatin is not absorbed systemically; no meaningful plasma half-life exists). For reference, if absorbed, the terminal half-life would be approximately 4-6 hours, but this is not clinically relevant.
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.
Nystatin is not absorbed from the gastrointestinal tract, skin, or mucous membranes. After oral administration, virtually all of the drug is excreted unchanged in feces. Renal excretion is negligible (<0.1%).
Category C
Category C
Antifungal
Antifungal