Ketoconazole

1 medicine

Ketoconazole is an azole antifungal available as tablets and as topical creams and shampoo. Oral ketoconazole carries a risk of serious liver injury and is reserved for infections with no safer alternative, while topical use does not carry this risk.

Nizoral

Ketoconazole

200mg

Nizoral is a antifungals medication containing Ketoconazole, available as 200mg tablets.

from $2.01 / tablet View

Key facts

  • Ketoconazole is an azole antifungal. Topical forms (cream, shampoo) treat fungal skin and scalp infections; oral tablets treat certain internal fungal infections.
  • Topical ketoconazole is applied once or twice daily for one to several weeks depending on the condition; oral courses can run for weeks to months.
  • Oral ketoconazole carries a risk of serious, sometimes fatal, liver injury and can suppress the adrenal glands' hormone production. Because of this it is now reserved for infections where no other antifungal is suitable, with liver monitoring throughout treatment.
  • Seek urgent care for yellowing of the skin or eyes, dark urine, or severe fatigue with low blood pressure while taking oral ketoconazole.

What ketoconazole treats

Topical ketoconazole treats athlete's foot, ringworm, jock itch, and seborrhoeic dermatitis (a flaky, greasy scalp and skin condition), and the shampoo is also used for dandruff. Oral ketoconazole treats certain internal or widespread fungal infections when other antifungal medicines cannot be used or have failed. It does not treat bacterial or viral infections.

How ketoconazole works

Fungal cells depend on a substance called ergosterol to keep their outer membrane stable. Ketoconazole blocks the fungal enzyme that produces ergosterol, so the membrane weakens, leaks, and the fungal cell dies. At the doses needed for oral treatment, ketoconazole also blocks some human steroid-hormone production, which is why it affects the adrenal glands and interacts with many other drugs.

Before you take it

  • Tell your prescriber about any liver disease before starting oral ketoconazole; it is generally avoided in people with liver problems.
  • Oral ketoconazole interacts with many common medicines through the same liver enzyme (CYP3A4), including some statins, certain heart-rhythm drugs and some sedatives; give your prescriber a full medicine list.
  • Avoid alcohol during oral treatment, since it adds to the strain on the liver.
  • Topical ketoconazole should not be used near the eyes or on broken skin unless your prescriber advises otherwise.

Side effects

Common effects of topical use include mild burning, itching or dryness at the application site. Oral ketoconazole more often causes nausea, an unpleasant taste, or headache.

Stop and seek urgent medical care for any of these:

  • Yellowing of the skin or eyes, dark urine, or persistent nausea and stomach pain.
  • Unusual tiredness, dizziness on standing, or low blood pressure, which can signal adrenal suppression.
  • A severe or blistering skin rash, or facial swelling.

Safety essentials

  • Oral ketoconazole is used only when no safer antifungal will work, with liver function tests checked before treatment and regularly during it; stop and seek advice at any sign of liver trouble.
  • Do not combine oral ketoconazole with other medicines without checking for interactions first, since it changes the levels of many common drugs.
  • Topical creams and shampoos do not carry the liver or hormone risks of the tablets and can be used as directed without blood monitoring.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.