ketoconazole, Nizoral, Extina, Xolegel, Kuric
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: ketoconazole
BRAND NAME: Nizoral, Extina, Xolegel, Kuric
DRUG CLASS AND MECHANISM: Ketoconazole is an anti-fungal medication in the same family of drugs as fluconazole (Diflucan), itraconazole (Sporanox), and miconazole (Micatin, Monistat). It prevents growth of several types of fungi by preventing production of the membranes that surround fungal cells. The FDA approved ketoconazole in June 1981.
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 200 mg; Shampoo: 1% and 2%; Cream: 2%, Gel: 2%, Foam: 2%
PRESCRIBED FOR: Oral ketoconazole treats a variety of fungal infections such as candidiasis of the skin or mouth (thrush), blastomycosis, histoplasmosis, coccidiomycosis, and others. Ketoconazole also is used to treat fungal infections that have not responded to griseofulvin, another antifungal medication. Topical ketoconazole is used for treating ringworm, jock itch, athlete's foot, dandruff, and tinea versicolor.
DOSING: Ketoconazole may be taken with or without food. The oral dose range is 200-400 mg daily. Recurrent tinea versicolor is treated with 400 mg monthly. Topical formulations are administered to affected areas once or twice daily.
DRUG INTERACTIONS: There are no known drug interactions with topical ketoconazole.
Ketoconazole tablets require stomach acidity to dissolve. Therefore, ketoconazole should be administered at least two hours before taking antacids or other acid reducing medications such as cimetidine (Tagamet) or ranitidine (Zantac). Combining ketoconazole with alcohol may cause a very unpleasant reaction (disulfiram reaction).
Rifampin (Rifadin, Rimactane, Rifamate, Rifater) reduces the blood concentration of oral ketoconazole, probably by increasing the elimination of fluconazole by the liver. This may reduce the effectiveness of ketoconazole.
Ketoconazole may increase the concentration of warfarin (Coumadin) in blood by reducing the elimination of warfarin. Therefore, the effect of warfarin may increase, leading to an increased tendency to bleed.
Ketoconazole also increases the concentrations in the blood of phenytoin, (Dilantin) cyclosporine, zidovudine (Retrovir), theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphyl, Slo-Phyllin), tolbutamide, glyburide (Micronase, Diabeta, Glynase), glipizide (Glucotrol), protease inhibitors (for example, indinavir [Crixivan], ritonavir [Norvir], saquinavir [Invirase, Fortovase]), midazolam (Versed), triazolam (Halcion), and alprazolam (Xanax). Increased drug concentrations usually increase the incidence of side effects.
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