ketoconazole at a glance
Class
Imidazole antifungal; oral ketoconazole also inhibits adrenal steroid production.
Skin uses
Selected products cover dandruff, athlete’s foot and fungal infection of the groin.
Tablet use
Specialist treatment of endogenous Cushing’s syndrome in adults and adolescents over 12 years.
Absorption
Very little reaches the bloodstream from cream or shampoo; tablets have important systemic risks and interactions.
What is ketoconazole used for?
Uses represented by the selected products include:
Shampoo: prevention and treatment of dandruff.
Cream: fungal athlete’s foot and fungal infection of the groin in adults.
Tablets: endogenous Cushing’s syndrome in adults and adolescents over 12 years. Oral ketoconazole should not be used for fungal infections because its liver risk outweighs the benefit.
How does ketoconazole work?
On the skin or scalp, ketoconazole disrupts fungal cell membranes. Orally, it blocks adrenal enzymes involved in producing cortisol and other steroid hormones.
ketoconazole preparations and strengths
Cream
Route: Cutaneous
Strengths: 2%
Shampoo
Route: Cutaneous
Strengths: 2%, 2% w/w
Tablet
Route: Oral
Strengths: 200 mg
How to take ketoconazole
Follow the product leaflet or specialist instructions.
Cream: apply gently to affected and immediately surrounding skin. Avoid the eyes and wash your hands afterwards.
Shampoo: wet the hair and scalp, massage into a lather and rinse thoroughly. Rinse the eyes with water after accidental contact.
Apply other skin products separately from ketoconazole cream.
Tablets: use only under specialist supervision. Tell the team about antacids or medicines that reduce stomach acidity because they can impair absorption.
ketoconazole side effects
Common or expected effects
- Cream: itching, burning or redness where applied.
- Shampoo: local irritation, itching, dry skin, altered hair texture or rash can occur.
- Tablets: nausea, vomiting, abdominal pain, diarrhoea, itching and rash; abnormal liver tests are very common.
Get urgent medical advice
- Severe allergic reaction, including facial or throat swelling and breathing difficulty.
- Tablets: serious liver injury.
- Tablets: adrenal insufficiency, including profound weakness, vomiting, weight loss, faintness or low blood sugar.
- Tablets: QT prolongation and potentially dangerous abnormal heart rhythms, particularly with interacting medicines.
ketoconazole in pregnancy
Cream and shampoo can generally be used during pregnancy because systemic absorption is very low. Tablets are contraindicated; effective contraception is required where pregnancy is possible.
ketoconazole while breastfeeding
Cream and shampoo can generally be used while breastfeeding. Prevent the baby touching treated skin, wash your hands after application and remove cream from the breast or nipple before feeding. Breastfeeding is contraindicated during tablet treatment.
ketoconazole interactions
Topical products have few expected systemic interactions. Tablets have numerous clinically important interactions.
Simvastatin, atorvastatin and lovastatin
Oral ketoconazole can greatly increase exposure and the risk of severe muscle injury; the combination is contraindicated.
Methadone and several QT-prolonging medicines
Raised concentrations can cause dangerous QT prolongation and ventricular arrhythmias; several combinations are contraindicated.
Dabigatran
Oral ketoconazole increases exposure and bleeding risk; concomitant use is contraindicated.
Common questions about ketoconazole
Answers are fully visible for fast scanning and source review.
Is ketoconazole an antifungal treatment?
Cream and shampoo are antifungal treatments. Tablets also inhibit steroid production and are licensed for endogenous Cushing’s syndrome rather than fungal infection.
Can the shampoo treat dandruff?
Yes. The selected shampoo is licensed to treat dandruff and help prevent its recurrence.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.