Ketoconazole cream vs. miconazole: What's the difference?

What is ketoconazole cream? What is miconazole?

Ketoconazole cream is an antifungal 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. Ketoconazole cream is prescribed to treat fungal infections such as ringworm, jock itch, athlete's foot, dandruff, and tinea versicolor.

Miconazole is an antifungal medication related to fluconazole (Diflucan), ketoconazole (Nizoral), itraconazole (Sporanox), and clotrimazole (Lotrimin, Mycelex). It is used either on the skin or in the to treat vaginal infections and other infections (athlete's foot, ringworm), and severe fungal infections.

What are the side effects of ketoconazole and miconazole?

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.

Miconazole

Irritation, burning, rash and itching have been reported by patients using topical or vaginal miconazole.

What is the dosage of ketoconazole vs. miconazole?

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.

Miconazole

Miconazole vaginal cream and suppositories are for use only in the vagina. These products are not to be taken by mouth. The vaginal suppositories are inserted, one per dose, in an applicator. Alternatively, the tube containing the vaginal cream is screwed onto the end of a special applicator tube, and the tube is then squeezed to fill the applicator. The patient then lies on her back with bent knees, inserts the applicator containing either the suppository or cream so that the tip of the applicator is high in the vagina, and then pushes the plunger in to deposit the suppository or cream into the vagina. The applicator should be washed with warm soap and water after each use.

Miconazole usually is used once daily at bedtime. The 200 mg suppositories (Monistat 3) are inserted once nightly for 3 nights. The 100 mg suppositories (Monistat-7) and intravaginal cream are inserted once nightly for 7 nights. The 1200 mg formulation (Monistat 1) is applied once for one night.

For fungal skin infections, the topical cream is applied as a thin layer to cover the affected skin and surrounding area, usually once or twice daily for 2-4 weeks. The hands should be washed before and after application.

What drugs interact with ketoconazole and miconazole?

Ketoconazole

Avoid using other skin or hair products that can cause irritation, such as harsh soaps or shampoos or skin cleansers, hair coloring or permanent chemicals, hair removers or waxes, or skin products with alcohol, spices, astringents, or lime. Do not use other medicated skin products unless your doctor has told you to.

Avoid getting this medication in your eyes, mouth, and nose, or on your lips. If it does get into any of these areas, wash with water.

Avoid covering treated skin areas with tight-fitting, synthetic clothing (such as nylon or polyester) that doesn't allow air to circulate to your skin. If you are treating your feet, wear clean cotton socks and sandals or shoes that allow for air circulation. Keep your feet as dry as possible.

Miconazole

There are no known drug interactions with vaginal or topical miconazole.

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

Ketoconazole

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

Miconazole

There is very limited information on the use of miconazole during pregnancy. The physician must weigh the potential benefits against possible but unknown risks to the fetus.

It is not known if miconazole is secreted in breast milk in amounts that can affect the infant.

Summary

Ketoconazole (Nizoral) cream and miconazole (Monistat) are antifungal medications prescribed to treat fungal infections such as athlete's foot and ringworm. Ketoconazole cream is used to treat jock itch, dandruff, tinea versicolor, blastomycosis, histoplasmosis, and coccidiomycosis. Miconazole is also used to treat vaginal fungal infections.

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Medically Reviewed on 6/4/2019
References
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