BMA Concise Guide to Medicine & Drugs

Ketoconazole

Brand names Boots Anti-Dandruff Ketoconazole Shampoo, Daktarin Gold, Dandrazol, Nizoral

Used in the following combined preparations None

QUICK REFERENCE

Drug group Antifungal drug

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes (except for some shampoos)

Available as generic Yes

GENERAL INFORMATION

Ketoconazole was previously used to treat severe, internal systemic fungal infections by mouth, but this use has been discontinued because of the risk of severe liver damage. However, ketoconazole is still available as a topical cream to treat fungal skin infections, and as a shampoo for the treatment of scalp infections and seborrhoeic dermatitis. Used in this way, ketoconazole is extremely safe because very little of this drug is absorbed into the blood, so little, in fact, that blood levels of the drug are usually undetectably low.

Side effects of ketoconazole are uncommon. The drug may occasionally alter the colour of the hair or cause itching, skin rashes, or in rare cases, hair loss.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Cream, shampoo.

Frequency and timing of doses 1–2 x daily (cream); 1–2 times weekly (shampoo used for seborrhoeic dermatitis).

Dosage range As directed.

Onset of effect Within a few hours; full beneficial effect may take several days (or weeks in severe infections).

Duration of action Up to 24 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose No cause for concern, but apply the missed application as soon as you remember.

Stopping the drug Apply the full course. Even if you feel better, the original infection may still be present and may recur if treatment is stopped too soon.

Exceeding the dose An occasional unintentional extra application is unlikely to be a cause for concern.

POSSIBLE ADVERSE EFFECTS

When applied to the skin or hair, ketoconazole is extremely safe and rarely causes adverse reactions. However, it may sometimes affect hair colour or cause itching or a rash. Rarely, it may cause hair loss (alopecia). If changes to hair colour are severe, consult your doctor. If itching, rash or hair loss occur, stop using the drug and consult your doctor.

INTERACTIONS (ADMINISTRATION BY MOUTH ONLY)

None known.

SPECIAL PRECAUTIONS

Be sure to tell your doctor or pharmacist before taking this drug if:

· You have previously had an allergic reaction to antifungal drugs.

· You are taking other medicines.

Pregnancy No evidence of risk.

Breast-feeding No evidence of risk. The drug does not pass into the breast milk in detectable amounts.

Infants and children No special problems.

Over 60 No special problems.

Driving and hazardous work No special problems.

Alcohol No known problems.

PROLONGED USE

No problems expected. However, the drug is usually used only until the infection has cleared up.