Compare Terbinafine vs. Ketoconazole

Head-to-head comparisons of medication uses, side effects, ratings, and more.

Lamisil
(Terbinafine)

Nizoral
(Ketoconazole)

Treats fungal infections. Lamisil (Terbinafine) has the highest cure rate of all antifungal medications, but you need to take it for a few weeks or months to see if it'll work for you.Treats fungal infections. Nizoral (Ketoconazole) is a medication used on your skin to treat fungal infections; however, it takes several weeks for full recovery, and the directions are specific to each type of medication.
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Reviews & ratings
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Side effects
TerbinafineKetoconazole
  • Rash 4%
  • Headache 3%
  • Diarrhea 3%
  • Taste disturbance 2%
  • Liver enzyme abnormalities 2%
  • Indigestion 1%
  • Itching 1%
More Terbinafine side effects »
  • Any side effect 3%
  • Application site reaction 1%
More Ketoconazole side effects »
How it works
TerbinafineKetoconazole
Lamisil (Terbinafine) is an antifungal medication that prevents the fungi from creating the protective layers it needs to survive. It treats scalp, toenail, and fingernail infections.Nizoral (Ketoconazole) is an antifungal medicine. It prevents yeast and fungi from reproducing and making their protective outer cell wall.
Type of medication
TerbinafineKetoconazole
AntifungalPrescription only
AntifungalPrescription or OTC
Available as
TerbinafineKetoconazole
  • Pill
  • Granule
  • Cream, gel, or ointment
  • Topical spray
  • Pill
  • Cream, gel, or ointment
  • Foam
  • Shampoo
Used for (click to learn more)
TerbinafineKetoconazole
Risk factors for serious side effects
TerbinafineKetoconazole
  • Past history of liver disease
  • Taking Lamisil (Terbinafine) by mouth
  • Taking Lamisil (Terbinafine) by mouth
  • Taking Lamisil (Terbinafine) by mouth
  • Taking Lamisil (Terbinafine) by mouth
  • Past history of lupus
  • Taking Lamisil (Terbinafine) by mouth
Detailed Lamisil (Terbinafine) risks & warnings »
  • Asthma
Detailed Nizoral (Ketoconazole) risks & warnings »
Pregnancy category
TerbinafineKetoconazole
BFDA pregnancy category (Probably safe)

Research studies with animals haven’t found a risk to unborn babies, but it hasn’t been properly studied in humans.

See the FDA package insert
CFDA pregnancy category (Weigh risks vs. benefits)

Research studies with animals found harmful effects on unborn babies. It hasn’t been properly studied in humans. The benefits might outweigh the risks even if you’re pregnant. Talk with your doctor.

See the FDA package insert
Alcohol
No specific alcohol-related info.No specific alcohol-related info.
Food
  • If you're taking the oral granules, mix them in a spoonful of mashed potatoes or pudding, and then swallow it whole without chewing. Don't use fruit-based soft foods.
  • People taking Lamisil (Terbinafine) have reported changes in the way food tastes and how things smell. This can be permanent if the medication's not stopped in time, but this is also very rare.
No specific food-related info.
Kidneys and liver
No specific kidneys and liver-related info.No specific kidneys and liver-related info.
Sex
No specific sex-related info.No specific sex-related info.
Sleep
No specific sleep-related info.No specific sleep-related info.
Weight
No specific weight-related info.No specific weight-related info.
Upsides and benefits
TerbinafineKetoconazole
  • Recommended as a first-choice treatment for fungal infections. It has a high cure rate and very few side effects.
  • Available as a generic medication, so it's cheap.
  • It's the only antifungal medication that is available in different oral forms and can be used by children.
  • Recommended as a first choice medication to treat skin infections caused by fungi, including cradle cap, seborrheic dermatitis, and tinea versicolor.
  • Nizoral (Ketoconazole) isn't taken orally, so it doesn't cause liver issues.
  • Can be used with other medications to help control redness and swelling.
  • The 1% shampoo is available over-the-counter in the drugstore.
Downsides and risks
TerbinafineKetoconazole
  • It can take weeks to months to see any changes in the infection.
  • While Lamisil (Terbinafine) has the highest cure rate of all antifungal medications, there's still a chance it may not work.
  • Can cause headache, nausea, vomiting, and diarrhea.
  • The foams (Extina and Ketodan) and gel (Xolegel) are only available as brand name and can be more expensive.
  • The 2.5% shampoo and creams are available only by prescription, but are generic.
  • The shampoo has to be left on for at least 5-10 minutes after lathering before you rinse it off.
  • It can take a few weeks for the infection to clear and a few months before the skin returns to its normal color.
  • The fungal infections can be confused for other skin infections, so if Nizoral (Ketoconazole) doesn't work, it could be caused by another skin problem.
Tips from our pharmacists for people taking the medication
TerbinafineKetoconazole
  • It can take a few months for improvements to be seen, especially for finger and toenail infections.
  • You can be more likely to get a sunburn, so put on sunblock when you go outside.
  • If you're taking the oral granules, mix them in a spoonful of mashed potatoes or pudding, and then swallow it whole without chewing. Don't use fruit-based soft foods.
  • Your doctor will have you get regular blood work done to make sure Lamisil (Terbinafine) isn't causing side effects.
  • If you forget your daily dose, take it as soon as you remember, unless it's less than 4 hours to your next dose, then skip it. Don't take two doses at once.
  • The shampoo is meant to be used once every 3 to 4 days, while the cream, gel and foam are meant to be used one to three times a day.
  • It can take at least 2 to 6 weeks for the infection to completely clear, and it can take 3 to 6 months before the skin returns to its original color for some infections.
  • Make sure Nizoral (Ketoconazole) doesn't get into the eyes.
  • If you're using the foam, spray the foam into the cap, not your hands since it can melt before you put it on, and apply onto the skin, not the hair.
  • Can cause redness, swelling, and an irritated or burning sensation to the area where you put Nizoral (Ketoconazole) on.
Learn more
More about TerbinafineSide effectsReviews & ratingsAlternativesFDA package insert
More about KetoconazoleSide effectsReviews & ratingsAlternativesFDA package insert