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Drugs reference index «ketoconazole»

ketoconazole


ketoconazole (Oral route)

kee-toe-KON-a-zole

Oral routeTablet

When used orally, ketoconazole has been associated with hepatic toxicity, including some fatalities. Patients receiving this drug should be informed by the physician of the risk and should be closely monitored.

Coadministration of terfenadine with ketoconazole tablets is contraindicated. Rare cases of serious cardiovascular adverse events, including death, ventricular tachycardia and torsades de pointes have been observed in patients taking ketoconazole tablets concomitantly with terfenadine, due to increased terfenadine concentrations induced by ketoconazole tablets.

Pharmacokinetic data indicate that oral ketoconazole inhibits the metabolism of astemizole, resulting in elevated plasma levels of astemizole and its active metabolite desmethylastemizole which may prolong QT intervals. Coadministration of astemizole with ketoconazole tablets is therefore contraindicated.

Coadministration of cisapride with ketoconazole is contraindicated. Serious cardiovascular adverse events including ventricular tachycardia, ventricular fibrillation and torsades de pointes have occurred in patients taking ketoconazole concomitantly with cisapride .

When used orally, ketoconazole has been associated with hepatic toxicity, including some fatalities. Patients receiving this drug should be informed by the physician of the risk and should be closely monitored. Coadministration of ketoconazole with terfenadine, astemizole, and cisapride is contraindicated due to the inhibition of metabolism of these drugs by ketoconazole. Coadministration of these drugs with ketoconazole may result in serious cardiovascular events, including death, ventricular tachycardia, ventricular fibrillation, torsades de pointes, and prolongation of the QT interval .

Commonly used brand name(s):

In the U.S.

  • Nizoral

Available Dosage Forms:

  • Tablet

Therapeutic Class: Antifungal

Chemical Class: Imidazole

Uses For ketoconazole

Ketoconazole is used to treat serious fungal or yeast infections, such as candidiasis (thrush, oral thrush), blastomycosis (Gilchrist's disease), coccidioidomycosis (Valley fever, San Joaquin Valley fever), histoplasmosis (Darling's disease), chromoblastomycosis (chromomycosis), or paracoccidioidomycosis (South American blastomycosis, Lutz-Splendore-Almeida disease). ketoconazole works by killing the fungus or yeast, or preventing its growth .

Ketoconazole is also used to treat parasitic fungal infections on the skin (such as athlete's foot or ringworm) that cannot be treated with topical medicine or griseofulvin, or for patients who cannot take griseofulvin .

ketoconazole is available only with your doctor's prescription .

Before Using ketoconazole

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For ketoconazole, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to ketoconazole or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of ketoconazole in children below 2 years of age. Safety and efficacy have not been established .

Geriatric

No information is available on the relationship of age to the effects of ketoconazole in geriatric patients .

Pregnancy

Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Using ketoconazole with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Alfuzosin
  • Alprazolam
  • Astemizole
  • Cisapride
  • Conivaptan
  • Dihydroergotamine
  • Dofetilide
  • Dronedarone
  • Eplerenone
  • Ergoloid Mesylates
  • Ergonovine
  • Ergotamine
  • Methylergonovine
  • Methysergide
  • Pimozide
  • Ranolazine
  • Silodosin
  • Terfenadine
  • Tolvaptan
  • Triazolam

Using ketoconazole with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Amiodarone
  • Aprepitant
  • Atorvastatin
  • Bretylium
  • Cerivastatin
  • Clopidogrel
  • Colchicine
  • Dasatinib
  • Erythromycin
  • Etravirine
  • Everolimus
  • Fentanyl
  • Fluticasone
  • Ibutilide
  • Iloperidone
  • Irinotecan
  • Ixabepilone
  • Lapatinib
  • Levomethadyl
  • Lovastatin
  • Mefloquine
  • Midazolam
  • Nilotinib
  • Pazopanib
  • Romidepsin
  • Salmeterol
  • Simvastatin
  • Sirolimus
  • Sotalol
  • Sunitinib
  • Tadalafil
  • Tamsulosin
  • Temsirolimus
  • Topotecan

Using ketoconazole with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acenocoumarol
  • Aliskiren
  • Almotriptan
  • Alosetron
  • Amlodipine
  • Amprenavir
  • Anisindione
  • Aripiprazole
  • Bexarotene
  • Bortezomib
  • Bosentan
  • Budesonide
  • Chlordiazepoxide
  • Cilostazol
  • Cinacalcet
  • Conjugated Estrogens
  • Cyclosporine
  • Darifenacin
  • Darunavir
  • Delavirdine
  • Dicumarol
  • Didanosine
  • Dutasteride
  • Efavirenz
  • Eletriptan
  • Erlotinib
  • Escitalopram
  • Esterified Estrogens
  • Estradiol
  • Estriol
  • Estrone
  • Estropipate
  • Eszopiclone
  • Felodipine
  • Fesoterodine
  • Fosamprenavir
  • Fosaprepitant
  • Galantamine
  • Gefitinib
  • Imatinib
  • Indinavir
  • Isoniazid
  • Isradipine
  • Lopinavir
  • Maraviroc
  • Methylprednisolone
  • Mometasone
  • Nevirapine
  • Nicardipine
  • Nifedipine
  • Nisoldipine
  • Oxybutynin
  • Paricalcitol
  • Phenprocoumon
  • Pioglitazone
  • Praziquantel
  • Prednisone
  • Quetiapine
  • Quinidine
  • Rabeprazole
  • Ramelteon
  • Reboxetine
  • Repaglinide
  • Rifampin
  • Rifapentine
  • Ritonavir
  • Saquinavir
  • Sildenafil
  • Solifenacin
  • Tacrolimus
  • Telithromycin
  • Tolbutamide
  • Tolterodine
  • Trazodone
  • Tretinoin
  • Trimetrexate
  • Valdecoxib
  • Warfarin
  • Zolpidem

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using ketoconazole with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use ketoconazole, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of ketoconazole. Make sure you tell your doctor if you have any other medical problems, especially:

  • Achlorhydria (absence of stomach acid)—May not be absorbed from the stomach in patients with this condition .
  • Liver disease—Use with caution. May make this condition worse .

Proper Use of ketoconazole

Keep using ketoconazole for the full treatment time, even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon .

Dosing

The dose of ketoconazole will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of ketoconazole. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For fungal infections:
      • Adults—At first, 200 milligrams (mg) once a day. Your doctor may increase your dose if needed.
      • Children over 2 years of age—Dose is based on body weight and must be determined by your doctor.
      • Children up to 2 years of age—Use and dose must be determined by your doctor .

Missed Dose

If you miss a dose of ketoconazole, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using ketoconazole

It is very important that your doctor check your progress at regular visits to make sure ketoconazole is working properly. Blood tests may be needed to check for unwanted effects .

Ketoconazole should not be taken with astemizole (e.g., Hismanal), cisapride (e.g., Propulsid), or terfenadine (e.g., Seldane). Doing so may increase the risk of serious side effects that affect the heart .

Liver problems may occur while you are taking ketoconazole. Check with your doctor right away if you are having more than one of these symptoms: abdominal pain or tenderness; clay-colored stools; dark urine; decreased appetite; fever; headache; itching; loss of appetite; nausea and vomiting; skin rash; swelling of the feet or lower legs; unusual tiredness or weakness; or yellow eyes or skin .

If your symptoms do not improve, or if they become worse, check with your doctor. You may need to take ketoconazole for several months before your infection gets better .

ketoconazole Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Rare
  • Back, leg, or stomach pains
  • black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • blurred vision
  • burning, crawling, itching, numbness, prickling, "pins and needles," or tingling feelings
  • change in color vision
  • change in the ability to see colors, especially blue or yellow
  • chest pain
  • chills
  • confusion
  • cough
  • dark urine
  • difficulty breathing
  • difficulty seeing at night
  • difficulty swallowing
  • dizziness
  • fast heartbeat
  • fever
  • general body swelling
  • headache
  • hives
  • hoarseness
  • increased sensitivity of the eyes to sunlight
  • irritation
  • itching
  • joint pain, stiffness or swelling
  • light-colored stools
  • loss of appetite
  • mood or mental changes
  • nausea or vomiting, severe
  • nosebleeds
  • painful or difficult urination
  • pale skin
  • pinpoint red spots on the skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips or tongue
  • redness of the skin
  • shortness of breath
  • skin rash
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swelling of the eyelids, face, lips, hands, or feet
  • swollen glands
  • tightness in the chest
  • trouble sleeping
  • troubled breathing or swallowing
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vision changes
  • wheezing
  • yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Rare
  • Change in number of sperm and their ability to move
  • decreased interest in sexual intercourse
  • diarrhea
  • hair loss or thinning of hair
  • inability to have or keep an erection
  • loss in sexual ability, desire, drive, or performance
  • sleepiness or unusual drowsiness
  • swelling of the breasts or breast soreness for both female and male

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

The information contained in the Thomson Healthcare (Micromedex) products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

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  • ketoconazole Concise Consumer Information (Cerner Multum)
  • Ketoconazole Cream Prescribing Information (FDA)
  • Ketoconazole Professional Patient Advice (Wolters Kluwer)
  • Ketoconazole Detailed Consumer Information (PDR)
  • Ketoconazole MedFacts Consumer Leaflet (Wolters Kluwer)
  • Nizoral Prescribing Information (FDA)
  • Nizoral Detailed Consumer Information (PDR)

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