2011501583 Health Library | Health and Wellness | Wellmont Health System
  • Ketoconazole Topical

    (kee toe kon' na zole)

    WHY is this medicine prescribed?

    Ketoconazole cream is used to treat tinea corporis (ringworm; fungal skin infection that causes a red scaly rash on different parts of the body), tinea cruris (jock itch; fungal infection of the skin in the groin or buttocks), tinea pedis (athlete's foot; fungal infection of the skin on the feet and between the toes), tinea versicolor (fungal infection that causes brown or light colored spots on the chest, back, arms, legs, or neck), and yeast infections of the skin. Prescription ketoconazole shampoo is used to treat tinea versicolor. Over-the-counter ketoconazole shampoo is used to control flaking, scaling, and itching of the scalp caused by dandruff. Ketoconazole is in a class of antifungal medications called imidazoles. It works by slowing the growth of fungi that cause infection.

    HOW should this medicine be used?

    Prescription ketoconazole comes as a cream and a shampoo to apply to the skin. Over-the-counter ketoconazole comes as a shampoo to apply to the scalp. Ketoconazole cream is usually applied once a day for 2 to 6 weeks. Prescription ketoconazole shampoo is usually applied one time to treat the infection. Over-the-counter ketoconazole shampoo is usually used every 3 to 4 days for up to 8 weeks, and then used as needed to control dandruff. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use ketoconazole exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
    One treatment with prescription ketoconazole shampoo may successfully treat your tinea versicolor infection. However, it may take several months for your skin color to return to normal, especially if your skin is exposed to sunlight. After your infection is treated, there is a chance that you will develop another tinea versicolor infection.
    If you are using over-the-counter ketoconazole shampoo to treat dandruff, your symptoms should improve during the first 2 to 4 weeks of your treatment. Call your doctor if your symptoms do not improve during this time or if your symptoms get worse at any time during your treatment.
    If you are using ketoconazole cream, your symptoms should improve at the beginning of your treatment. Continue to use ketoconazole cream even if you are feeling well. If you stop using ketoconazole cream too soon, your infection may not be completely cured and your symptoms may return.
    Ketoconazole cream and shampoos are only for use on the skin or scalp. Do not let ketoconazole cream or shampoo get into your eyes or mouth, and do not swallow the medication. If you do get ketoconazole cream or shampoo in your eyes, wash them with plenty of water.
    To use the cream, apply enough cream to cover the affected area and all of the skin around it.
    To use the prescription shampoo, follow these steps:
    1. Use a small amount of water to wet your skin in the area where you will apply ketoconazole shampoo.
    2. Apply the shampoo to the affected skin and a large area around it.
    3. Use your fingers to rub the shampoo until it forms a lather.
    4. Leave the shampoo on your skin for 5 minutes.
    5. Rinse the shampoo off of your skin with water.
    To use the over-the-counter shampoo, follow these steps:
    1. Be sure that your scalp is not broken, cut, or irritated. Do not use ketoconazole shampoo if your scalp is broken or irritated.
    2. Wet your hair thoroughly.
    3. Apply the shampoo to your hair.
    4. Use your fingers to rub the shampoo until it forms a lather.
    5. Rinse all of the shampoo out of your hair with plenty of water.
    6. Repeat steps 2 to 5.

    Are there OTHER USES for this medicine?

    Ketoconazole cream and prescription shampoo are also sometimes used to treat dandruff and seborrheic dermatitis (condition that causes flaking of the skin).Ketoconazole cream is sometimes used to treat tinea manuum (fungal infection of the skin on the hands). Ketoconazole cream is also sometimes used with other medications to treat skin conditions that are often worsened by fungal infection such as diaper rash, eczema (skin irritation caused by allergies), impetigo (blisters caused by a bacterial infection), and psoriasis (a lifelong skin condition). Talk to your doctor about the possible risks of using this drug for your condition.
    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before using ketoconazole,
    • tell your doctor and pharmacist if you are allergic to ketoconazole or any other medications, creams, or shampoos. If you will be using the cream, tell your doctor if you are allergic to sulfites.
    • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • tell your doctor if you have or have ever had any medical condition. If you will be using the cream, tell your doctor if you have or have ever had asthma.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using ketoconazole, call your doctor.

    What SPECIAL DIETARY instructions should I follow?

    Unless your doctor tells you otherwise, continue your normal diet.

    What should I do IF I FORGET to take a dose?

    Apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not apply a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Ketoconazole may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • changes in hair texture
    • blisters on scalp
    • dry skin
    • itching
    • oily or dry hair or scalp
    • irritation, itching, or stinging in the place where you applied the medication
    Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
    • rash
    • hives
    • difficulty breathing or swallowing
    • redness, tenderness, swelling, pain, or warmth in the place where you applied the medication
    Ketoconazole may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Protect the medication from light and do not allow it to freeze. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    If someone swallows ketoconazole cream or shampoo, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor.
    Ketoconazole shampoo may remove the curl from hair that has been permanently waved ('permed').
    Do not let anyone else use your medication. Your prescription is probably not refillable. If you still have symptoms of infection after you finish the ketoconazole, call your doctor.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Nizoral®
    • Nizoral AD®

    Ketoconazole

    (kee toe kon' na zole)

    IMPORTANT WARNING:

    Ketoconazole may cause liver damage. Tell your doctor if you drink or have ever drunk large amounts of alcohol and if you have or have ever had liver disease. Tell your doctor and pharmacist if you are taking acetaminophen (Tylenol, others); cholesterol-lowering medications (statins) such as atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), or simvastatin (Zocor); isoniazid (INH, Nydrazid); methotrexate (Rheumatrex); niacin (nicotinic acid); or rifampin. If you experience any of the following symptoms, call your doctor immediately: extreme tiredness, loss of appetite, nausea, vomiting, yellowing of the skin or eyes, dark yellow urine, pale stools, pain in the upper right part of the stomach, or flu-like symptoms.
    Keep all appointments with your doctor and the laboratory. Your doctor will order certain tests to check your body's response to ketoconazole.
    Do not take astemizole (Hismanal) (not available in the US), cisapride (Propulsid), or terfenadine (Seldane) (not available in the US) while you are taking ketoconazole.

    WHY is this medicine prescribed?

    Ketoconazole is used to treat fungal infections. Ketoconazole is most often used to treat fungal infections that can spread to different parts of the body through the bloodstream such as yeast infections of the mouth, skin, urinary tract, and blood, and certain fungal infections that begin on the skin or in the lungs and can spread through the body. Ketoconazole is also used to treat fungal infections of the skin or nails that cannot be treated with other medications. Ketoconazole is in a class of antifungals called imidazoles. It works by slowing the growth of fungi that cause infection.

    HOW should this medicine be used?

    Ketoconazole comes as a tablet to take by mouth. It is usually taken once a day. To help you remember to take ketoconazole, take it at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ketoconazole exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
    If you have certain medical conditions, your doctor will tell you to take ketoconazole tablets dissolved in an acid solution. Your doctor will tell you exactly how to do this. Follow these directions carefully.
    Your doctor will probably start you on an average dose of ketoconazole. Your doctor may increase your dose if your infection is very serious or your condition does not improve.
    You may need to take ketoconazole for several weeks or months to cure your infection completely. Your doctor will probably order laboratory tests to be sure your infection has been treated. Continue to take ketoconazole until your doctor tells you that you should stop, even if you feel better. Do not stop taking ketoconazole without talking to your doctor. If you stop taking ketoconazole too soon, your infection may come back after a short time.

    Are there OTHER USES for this medicine?

    Ketoconazole is also sometimes used to treat vaginal yeast infections, tinea versicolor (spots on skin caused by yeast), eumycetoma (a severe fungal skin infection that often affects the foot), leishmaniasis (a disease caused by the bite of an infected sand fly), prostate cancer (cancer that begins in a male reproductive organ), high blood levels of calcium in patients with certain conditions, Cushing's syndrome (high blood levels of a natural substance called cortisol), and excessive hair growth in women. Talk to your doctor about the possible risks of using this drug for your condition.
    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking ketoconazole,
    • tell your doctor and pharmacist if you are allergic to ketoconazole, other antifungal medications such as fluconazole (Diflucan), itraconazole (Sporanox), or voriconazole (Vfend); any other medications; or corn.
    • do not take ketoconazole if you are taking any of the medications listed in the IMPORTANT WARNING section or triazolam (Halcion).
    • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: alprazolam (Xanax); anticoagulants ('blood thinners') such as warfarin (Coumadin); buspirone (BuSpar); calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem, Dilacor, Tiazac), felodipine (Plendil), nifedipine (Adalat, Procardia), nisoldipine (Sular),and verapamil (Calan, Covera, Isoptin, Verelan); clarithromycin (Biaxin); clopidogrel (Plavix);cyclosporine (Neoral, Sandimmune); diazepam (Valium); digoxin (Lanoxin); erythromycin (E.E.S., E-Mycin, Erythrocin); HIV protease inhibitors such as indinavir (Crixivan), ritonavir (Norvir),and saquinavir (Invirase, Fortovase); loratadine (Claritin); medications for diabetes; medications for erectile dysfunction such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra); methadone (Dolophine); methylprednisolone (Medrol); midazolam (Versed); phenytoin (Dilantin); pimozide (Orap); quinidine (Quinidex, Quinaglute); quinine; tacrolimus (Prograf); tamoxifen (Nolvadex); telithromycin (Ketek); trazodone (Desyrel); and vincristine (Vincasar). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • if you are taking antacids; antihistamines; medications for heartburn or ulcers such as cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), or ranitidine (Zantac); or medications for irritable bowel disease, motion sickness, Parkinson's disease, ulcers, or urinary problems, take them 2 hours after you take ketoconazole.
    • tell your doctor if you have or have ever had the conditions mentioned in the IMPORTANT WARNING section or any condition that decreases the amount of acid in your stomach.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking ketoconazole, call your doctor. Do not breast-feed while you are taking ketoconazole.
    • ask your doctor about the safe use of alcoholic beverages while you are taking ketoconazole. You may experience unpleasant symptoms such as flushing, rash, nausea, headache, and swelling of the hands, feet, ankles, or lower legs if you drink alcohol while you are taking ketoconazole.

    What SPECIAL DIETARY instructions should I follow?

    Unless your doctor tells you otherwise, continue your normal diet.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Ketoconazole may cause side effects. Tell your doctor if either of these symptoms is severe or does not go away:
    • stomach pain
    • depression
    Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them or those listed in the IMPORTANT WARNING section, call your doctor immediately:
    • rash
    • hives
    • itching
    • difficulty breathing or swallowing
    • thinking about harming or killing yourself or planning or trying to do so
    A small number of patients who were taking high doses of ketoconazole for prostate cancer died soon after they began taking the medication. It is not known whether they died because of their disease or their treatment with ketoconazole or for other reasons. Talk to your doctor about the risks of taking ketoconazole.
    Ketoconazole may cause a decrease in the number of sperm (male reproductive cells) produced, especially if it is taken at high doses. Talk to your doctor about the risks of taking this medication if you are a man and would like to have children.
    Ketoconazole may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

    What OTHER INFORMATION should I know?

    Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking ketoconazole.
    Do not let anyone else take your medication. Ask your pharmacist if you have any questions about refilling your prescription. If you still have symptoms of infection after you finish the ketoconazole, call your doctor.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Nizoral®
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