Ketoconazole

Ketoconazole

Table of Contents

  1. What is Ketoconazole?
  2. Constituents
  3. Indications
  4. How does Ketoconazole work?
  5. How to Take Ketoconazole?
  6. Common Dosage for Ketoconazole?
  7. When to Avoid Ketoconazole?
  8. Side-effects of Ketoconazole?
  9. Effects on organs?
  10. Reported Allergic Reactions?
  11. Effect of the medicine on menstrual cycle?
  12. Drug Interactions To Be Careful About
  13. Food interactions
  14. Interactions with laboratory procedures
  15. Shows Effects / Results in (how long does the effect stay?)
  16. Is Ketoconazole Addictive?
  17. Can I have Ketoconazole with alcohol?
  18. Can I have Ketoconazole When Pregnant?
  19. Can I have Ketoconazole when feeding a baby?
  20. Can I drive after taking Ketoconazole?
  21. Effect of an overdose of Ketoconazole?
  22. Effect of using expired Ketoconazole?
  23. Effect of missing a dose of Ketoconazole?
  24. Storage requirements
  25. Substitutes for Ketoconazole
  26. Expert comments

What is Ketoconazole?

Ketoconazole belongs to an anti-fungal medication prescribed to treat certain types of fungal infections. Let’s get to know more details about this medication written and reviewed by medical experts.

Type of drug

Ketoconazole belongs to azole antifungals class of medicine. Ketoconazole is available in different forms like –

  • Oral tablet
  • Topical cream
  • Topical foam
  • Topical gel
  • Shampoo

Use in brief

Ketoconazole is prescribed to use as an antifungal medication in case of certain fungal infections.

Constituents

Ketoconazole itself is an active ingredient in some brands of medicine. This medicine was approved by the FDA in 1981. Mentioned below are some brands of medicine available with Ketoconazole as an active ingredient.

Molecular Formula of Ketoconazole: C26H28Cl2N4O4

Ketoconazole chemical structure

Medicine brands available in the USA

  • Extina
  • Ketodan Kit
  • Kuric
  • Nizoral
  • Nizoral A-D
  • Xolegel

Medicine brands available in Canada

  • Ketoderm

Indications

This medication is prescribed in the treatment of some significant fungal infections. This is a prescription-only medication. The form of medicine suggested depends on the condition treated. Ketoconazole is available in topical and oral forms. Further, topical is available as cream, gel, and shampoo. Tablets are available for oral administration.

Indications of Ketoconazole cream:

The cream form is prescribed to treat conditions like –

  • Athlete’s foot
  • Ringworm or Jock itch
  • Seborrheic dermatitis
  • Sun fungus
  • Yeast infection of the skin

Indications of Ketoconazole foam:

Ketoconazole foam is prescribed to treat conditions like –

  • Seborrheic dermatitis, a condition characterized by scaly patches with red skin particularly on the scalp.

Indications of Ketoconazole shampoo:

Shampoo form of this medication is available in two variations like 1% shampoo and 2% shampoo.

  • Ketoconazole 1% shampoo is prescribed to treat conditions like dandruff.
  • Ketoconazole 2% shampoo is prescribed to treat a fungal skin condition called Sun fungus, characterized by small and discolored patches on the skin.

Indications of Ketoconazole oral medication:

Ketoconazole is available in tablet form and is prescribed to treat fungal infections that are not possible to treat with other forms of medicine like topical creams or shampoos. Tablets are used to treat some serious yeast infections or fungal infections. Some infections that are treated by this medication are –

  • Candidiasis
  • Gilchrist’s disease, a fungal infection caused by a fungus called Blastomyces dermatitidis
  • Valley fever or San Joaquin Valley fever – This is a fungal infection caused by a fungus known as coccidioides immitis. This fungal infection occurs when the spores of these fungi are inhaled by humans. Valley fever is also called San Joaquin Valley fever since it was initially discovered in California’s San Joaquin Valley. The fungi are known to grow in the arid soils of Mexico, South-western United States, Central America, and South America.
  • Darling’s disease – also called Histoplasmosis, and is caused by the fungus called Histoplasma capsulatum.
  • Chromomycosis – also called as Chromoblastomycosis, and is caused by various fungi genera called Fonsecaea pedrosoi, Cladosporium carrionii, or Fonsecaea compacta, Phialophora verrucosa. This is a skin infection caused by these fungi. They generally live in soil or wood.
  • South American blastomycosis/ Lutz Splendore Almeida disease –is a fungal infection also known as Paracoccidioidomycosis and caused by fungi called Paracoccidioides. These fungi live in parts of Central and South America.
  • Ketoconazole oral medication is also prescribed in conditions where it is not possible to treat a fungal infection with other anti-fungal medication called Griseofulvin.

How does Ketoconazole work?

This medicine basically belongs to azole antifungal group of drugs, and it works by preventing the formation of a protective cell membrane of the fungi which is critical for the survival of the fungus.

How to Take Ketoconazole?

Depending on the form of medicine prescribed to your condition, follow the instructions by your doctor or dermatologist.  

When to use

Follow the instructions as mentioned in the prescription. Generally used after food to avoid stomach upset but can also be used without food.

How to use

Follow the instructions as mentioned in the prescription. In case of oral medication, never crush or chew the tablet but swallow the whole medicine along with some water or liquids.

Common Dosage for Ketoconazole

  • Dosage depends on the severity of the infection and is decided by the doctor. Follow the instruction by your doctor.
  • In the case of oral medication, your doctor may prescribe the initial dosage of 200mg tablets once a day. And depending on the responsiveness to the dosage, it may be increased to twice daily.
  • Ketoconazole lotion is generally prescribed to use for two to six weeks. Ketoconazole shampoo is prescribed to use for every three to four days for up to eight weeks duration.

These dosage details are for adults only. Child dosage would vary and the deciding factors are the severity of the condition and weight of the kid. Please consult your doctor for proper instruction and dosage details.

When to Avoid Ketoconazole?

Ketoconazole is not advised to use in some health conditions such as:

  • Patients suffering from chronic or acute liver disorders
  • Patients with hypersensitivity towards this medication

Side-effects of Ketoconazole

Ketoconazole may possibly show some side effects in some patients. Consult your doctor in case you observe any such side effects and they tend to continue for a longer duration. Below mentioned are some possible side effects by Ketoconazole. It may possibly show side effects that are not mentioned here in this list too. As a safety measure avoid direct contact of the medicine with eyes, nose, and lips. If such contact happens, wash it thoroughly and consult your doctor immediately for medical attention.

  • Insomnia
  • Nervousness
  • Headache
  • Dizziness
  • Paresthesia – a temporary tingling sensation that occurs in limbs both arms and legs.
  • Severe itching and burning at the site of application in case of topical usage
  • Dryness or oiliness of scalp and light hair loss in case of topical usage or shampoo.
  • Redness, dryness, itching or irritation or pain at the site of the application over the skin
  • Irritation or redness in the eyes
  • Loss of sexual desire and ability

Effects on organs

This medicine may possibly show adverse effects on the liver and cause damage to the liver which may even require a liver transplant or may possibly cause death. It is advised to consult the doctor and share detailed information about the current health condition so that the doctor can alter the dosage depending on the patient’s health condition.

Reported allergic reactions?

Ketoconazole may possibly show an allergic reaction at the site of application in case of topical usage. The reported allergic reactions are stinging, swelling, itching, and irritation of the skin at the site of application.

Effect of the medicine on menstrual cycle

Ketoconazole may possibly show an effect on the menstrual cycle and alter it. Bring it to the notice of your doctor if you notice any abnormalities after starting the course of medicine.

Drug Interactions to be careful about

 Ketoconazole is a cyp 3A inhibitor which is a key enzyme in the metabolism of many drugs.

Drugs affecting the metabolism of Ketoconazole:

  • Isoniazid
  • Rifampicin
  • Rifabutin
  • Nevirapine
  • St. John’s wort

Metabolism of drugs affected by the intake of Ketoconazole:

  • Benzodiazepines like alprazolam, midazolam
  • Domperidone, eplerenone
  • Ergotamine
  • Nisoldipine.
  • Drugs used to treat Erectile Dysfunction 
  • Drugs used to treat pulmonary hypertension.
  • HIV protease inhibitors
  •  Drugs used to treat seizures-carbamazepine, phenytoin.
  •  Atorvastatin
  • Ketoconazole needs acids in the stomach to undergo metabolism. If you are taking any drugs to reduce acidity or heartburn or stomach ulcers such as ranitidine, sucralfate or drugs like anticholinergics which reduce bowel movements like atropine, propantheline. It is advised to take ketoconazole 2 hours before the above medicines to avoid drug interaction and increase the efficacy of the drug.

Also, Ketoconazole has the possibility of showing drug interactions if used along with the below-mentioned list of medicines.

  • Cisapride
  • Disopyramide
  • Dofetilide
  • Dronedarone
  • Methadone
  • Pimozide
  • Quinidine
  • Ranolazine

It is always advised to carry the previous prescriptions to show your doctor to avoid any drug interactions. A detailed history of previous health conditions acute or chronic should be shared with your doctor.

Food interactions

There is no major food interactions noticed to be taken care of while using this medicine. Stick to the guidelines provided in the prescription.

Interactions with laboratory procedures

There is no interaction noticed with any diagnostic test while under the medication but it is always good to share details about your current medication with your doctor and lab technician before attending any diagnosis. This medication may alter the metabolism of some other medications if used together. So it is advised to share the details about all the medication you are using currently or used recently.

Shows Effects / Results in (how long does the effect stay?)  

This medication is generally known to show effect in 1 to 2 hours after oral administration. In the case of topical administration, your doctor would prescribe it based on the severity of the condition.

Is Ketoconazole Addictive?

No drug addiction is noticed in the case of Ketoconazole.

Can I have Ketoconazole with alcohol?

It is not advised to use along with alcohol as it might increase the risk of severe liver damage, QT prolongation that can lead to loss of consciousness, fainting, seizures, all these may lead to sudden death.

Can I have Ketoconazole When Pregnant?

No adverse effects are noticed in case of usage during pregnancy.

Can I have Ketoconazole when feeding a baby?

No adverse effects are noticed in case of usage during breast feeding.

Can I drive after taking Ketoconazole?

Some patients may feel dizzy and it may not be safe for activities such as driving in conditions like that.

Effect of overdose Ketoconazole

Consult your doctor immediately in overdosage. This medicine may affect the liver function and severely damage the liver that may even require liver transplantation, sometimes may lead to death if not treated on time.

Effect of using expired Ketoconazole?

As a safety measure, to avoid any adverse effects, it is advised not to use any medicine that is expired. Emergency medical attention may be required if an expired medication is used. Check for the manufactured and expiry dates while purchasing any medication a general safety precaution. 

Effect of missing a dose of Ketoconazole

There might be no major trouble if one dose is missed. Try setting up a reminder to take the medicine regularly for the successful completion of the schedule.

Storage requirements

General storage requirements of the Ketoconazole are that you –

  • Keep them at room temperature
  • Keep away from kids and pets
  • Keep away from direct sunlight

Substitutes for Ketoconazole

There is no exact match of the medication to use as an alternative to Ketoconazole. Your doctor may decide to prescribe few near possible alternatives depending on your condition. Few of them are –

  • Ritonavir
  • Cobicistat
  • Ciclopirox
  • Selenium Sulfide

All these medications are prescription-only medications and require a proper diagnosis before administration. Details provided in this article are for informational purposes only and must not be considered as a treatment plan.

Image Reference:

  1. https://pubchem.ncbi.nlm.nih.gov/compound/Ketoconazole

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