COMPARISON CHART
DRUG NAME Terbinafine
Pharmacokinetic Activei
(Active or
Prodrug)
Terbinafine is hypothesized to
act by inhibiting squalene
monooxygenase, thus blocking
Mechansim the biosynthesis of ergosterol,
Of action an essential component of
fungal cell membranes. This
inhibition also results in an
accumulation of squalene,
which is a substrate catalyzed to
2,3-oxydo squalene by squalene
monooxygenase. The resultant
high concentration of squalene
and decreased amount of
ergosterol are both thought to
contribute to terbinafine's
antifungal activity.ii
Solubility Slightly soluble in wateriv
(Lipid or Water)
Protein Binding >99%vi
Absorption Absortpion >70%
Bioavailabiliy:
40%(adults);36-64%
Peak plasma time :1-2hr
Peak plasma
concentration(250-mg dose):
1mcg/mlvi
Distribution Predominantly distributed
to sebum and skinvi
Amphoteracin B Nystatin
Activei Activei
Amphotericin B is fungistatic or Nystatin exerts its
fungicidal depending on the antifungal activity by
concentration obtained in body binding to sterols in
fluids and the susceptibility of the fungal cell
the fungus. The drug acts by membrane. The drug
binding to sterols (ergosterol) in is not active against
the cell membrane of susceptible organisms (e.g.,
fungi. This creates a bacteria) that do not
transmembrane channel, and the contain sterols in
resultant change in membrane their cell membrane.
permeability allowing leakage of As a result of this
intracellular components. binding, the
Ergosterol, the principal sterol in membrane is no
the fungal cytoplasmic longer able to
membrane, is the target site of function as a
action of amphotericin B and the selective barrier, and
azoles. Amphotericin B, a potassium and other
polyene, binds irreversibly to cellular constituents
ergosterol, resulting in disruption are lost.iii
of membrane integrity and
ultimately cell death.ii
Insoluble in waterv Soluble in wateriii
90%vi Not availablevi
Poor PO
Bioavailability 100% for absorptionvi
intravenous infusion.vii
Onset: symptom
relief for oral
candidiasis 24-72hr
Lipid complex show Not availablevi
lower kidney cons than
conventionalvi
 Metabolism Metabolized in liver by Exclusively through Not availableii
several CYP450 enzyme; renalii
first pass effect (40%)vi
Half Life 36hr(drug released very Elimination half Not availablevi
slowly from skin and life:15days
adipose tissues)vi Half life,Plasma:24hrvi

Active Metabolite Inactive metabolitevi Not availablevi

Hypersensitivity and Hypersensistive people Hypersensitive
Contraindication chronic liver disease should avoid this and also patient its
avoid in nursing contraindicated
females.viii
Anti-fungal Candidiasis,Cutaneous Coccidioidomycosis Oral Candidiasis
spectrum Onychomycosis,Pityriasis Histoplasmosis,Infections, Mucocutaneousvii
versicolor,Sporotrichosis Fungal Invasive
Tinea Capitis,Tinea Aspergillosis
Corporis,Tinea Cruris Invasive Fungal Infections
i
Tinea Pedis. Leishmaniasis Meningitis,
Cryptococcal Meningitis,
Fungal Mucocutaneous
Leishmaniasis,Penicillium
marneffei infection
Visceral Leishmaniasis
Candidal cystitis
Disseminated
Cryptococcosis
Fungal endophthalmitis
Fungal osteoarticular
infections
Ocular aspergillosis
Refractory aspergillosis
Severe
Coccidioidomycosis
Severe Fungal infection
caused by Conidiobolus
spp.
Severe Fungal infection
caused by sporotrichosis
spp.
Severe Histoplasmosis

Usual Adult Dose for
Onychomycosis - Fingernail
Tablets: 250 mg orally once a day
Dosage Schedule Duration of therapy Fingernail
onychomycosis: 6 weeks
-Toenail onychomycosis: 12 weeks
Usual Adult Dose for
Onychomycosis - Toenail
Tablets: 250 mg orally once a day
Duration of therapy:
-Fingernail onychomycosis: 6
weeks
-Toenail onychomycosis: 12 weeks
Usual Adult Dose for Tinea Capitis
Oral granules: 250 mg orally once a
day for 6 weeks
Usual Adult Dose for Tinea
Corporis:
-Tablets: 250 mg orally once a day
for 2 to 4 weeks
Severe Mucocutaneous
leishmaniasis
Severe North American
blastomycosis
Severe Systemic
candidiasisii
Usual Adult Dose for Ocular Fungal
Infection
5 to 10 micrograms INTRAVITREALLY
-Use with systemic voriconazole.
Usual Adult Dose for
AspergillosisInvasive ESPECIALLY IF
DOSE EXCEEDS 1.5 MG/KG**
Test dose: 1 mg in 20 mL dextrose,
slow IV over 20 to 30 minutes, with
monitoring for 2 to 4 hours
afterward.
Initial dose (patients with good
cardio-renal function and well
tolerated test dose): 0.25 mg/kg
slow IV daily
Initial dose (severe and rapidly
progressive infection): 0.3 mg/kg
slow IV daily
Initial dose (patients with impaired
cardio-renal function OR severe
reaction to test dose): use smaller
doses (e.g. 5 to 10 mg)
-Gradually increase dose by 5 to 10
mg/day to a final daily dose of 0.5 to
0.7 mg/kg IV once a day depending
on cardio-renal status.
Maximum dose: 1.5 mg/kg total
Duration of therapy: Up to 11
months
Usual Adult Dose for Candidemia
Candida chorioretinitis without
vitreous and with macular
involvement: 5 to 10 mcg/0.1 mL
sterile water by INTRAVITREAL
injection
-For use with concomitant
antifungal treatment (oral or IV)
Central nervous system candidiasis
in patients in whom a ventricular
device cannot be removed: 0.01 to
0.5 mg in 2 mL of 5% dextrose
administered THROUGH THE DEVICE
into the ventricle
Administration
Guidelines

i
https://www.drugbank.ca/salts/DBSALT000470M
ii
https://www.drugbank.ca/drugs/DB00857
iii
https://pubchem.ncbi.nlm.nih.gov/compound/nystatin#section=Mechanism-of-Action
iv
https://pubchem.ncbi.nlm.nih.gov/compound/terbinafine#section=physical and chemical properties
v
Good man Gillman book
vi
Medscape.com
vii
https://www.drugbank.ca/drugs/DB00681
viii
https://www.drugs.com/pro/amphotericin-b.html