Diflucan vs. Ketoconazole

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Diflucan vs. ketoconazole

What is Diflucan? What is ketoconazole?

Diflucan (fluconazole) is an anti-fungal medication related to clotrimazole (Lotrimin), ketoconazole (Nizoral), itraconazole (Sporanox), and miconazole (Micatin, Monistat). Diflucan prevents growth of fungi by preventing production of the membranes that surround fungal cells. Diflucan is used to treat vaginal, oral, and esophageal fungal infections caused by Candida; urinary tract infections, peritonitis, pneumonia and disseminated infections caused by Candida; cryptococcal meningitis; and to prevent Candida infections in patients treated with chemotherapy or radiation after bone marrow transplantation.

Ketoconazole is an anti-fungal medication used to treat fungal infections such as thrush, ringworm, jock itch, athlete's foot, dandruff, tinea versicolor, blastomycosis, histoplasmosis, and coccidiomycosis. Ketoconazole prevents growth of several types of fungi by preventing production of the membranes that surround fungal cells. Ketoconazole is in the same drug class as fluconazole (Diflucan), itraconazole (Sporanox), and miconazole (Micatin, Monistat).

What are the side effects of Diflucan and ketoconazole?

Diflucan

Common side effects of fluconazole include

Other important side effects include

Possible serious side effects include

  • seizures,
  • reduced number of white blood cells,
  • reduced number of blood platelets, and
  • toxic epidermal necrolysis.

Rarely, serious allergic reactions, including angioedema (swelling of tissues), may also occur. Liver dysfunction (jaundice, hepatitis) and abnormal heart beats have been associated with fluconazole. Stevens-Johnson syndrome has also been reported.

Ketoconazole

Ketoconazole generally is well tolerated. Commonly reported side effects of ketoconazole are:

Other important side effects of ketoconazole are rare; they include:

Liver dysfunction also has been reported. Signs of liver problems include unusual fatigue, loss of appetite, nausea and vomiting, yellowing of the skin (jaundice), dark urine, and pale stools. Development of these symptoms while taking ketoconazole should be reported to a physician.

What is the dosage of Diflucan vs. ketoconazole?

Diflucan

  • The usual adult dose is 50-400 mg daily depending on the type of infection. Although symptoms of oral Candida infections may subside in a few days, treatment is continued for 2 weeks.
  • Esophageal Candida infections are treated for 3 weeks or longer.
  • Treatment of cryptococcal meningitis may last for 10-12 weeks after cerebrospinal fluid cultures become negative.

Ketoconazole

  • 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.

What drugs interact with Diflucan and ketoconazole?

Diflucan

Ketoconazole

Systemic exposure to these drugs is increased by ketoconazole: Careful monitoring, with possible adjustment in dosage, is recommended.

(The above drug interaction section for ketoconazole is from FDA prescribing information)

Are Diflucan and ketoconazole safe to use while pregnant or breastfeeding?

Diflucan

  • There are no adequate studies of Diflucan in pregnant women. There are reports of harmful effects to the fetus when high dose fluconazole was administered to pregnant women for a few months. Use of fluconazole during pregnancy is not recommended.
  • Diflucan is secreted in breast milk at concentrations similar to the mother's blood level. However, fluconazole is used for treating neonates with fungal infections and for treating lactation associated Candida infections. Available evidence suggests that use of fluconazole during breastfeeding has little risk.

Ketoconazole

  • A small amount of ketoconazole is secreted in breast milk. Nursing mothers should probably avoid breastfeeding while using ketoconazole.

Summary

Diflucan (fluconazole) and ketoconazole are anti-fungal medications used to treat different types of fungal infections. Diflucan is used to treat vaginal, oral, and esophageal fungal infections caused by Candida; urinary tract infections, peritonitis, pneumonia and disseminated infections caused by Candida; cryptococcal meningitis; and to prevent Candida infections in patients treated with chemotherapy or radiation after bone marrow transplantation. Ketoconazole is used to treat thrush, ringworm, jock itch, athlete's foot, dandruff, tinea versicolor, blastomycosis, histoplasmosis, and coccidiomycosis.

Treatment & Diagnosis

Medications & Supplements

Health Solutions From Our Sponsors

FDA Logo

Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

Medically Reviewed on 1/18/2019
References
REFERENCE:

FDA Prescribing Information