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

What is ketoconazole cream? What is nystatin?

Ketoconazole cream is an antifungal drug. It is in the same class of drugs as itraconazole (Sporanox), fluconazole (Diflucan), 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 jock itch, athlete's foot, ringworm, dandruff, and tinea versicolor.

Nystatin is an oral antifungal medication used to treat intestinal candidiasis. Nystatin works by binding to sterols in the walls of fungal cells, disturbing the function of the cell wall. The fungal cells eventually lose their contents, leading to their death and improvement of the fungal infection.

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What are the side effects of ketoconazole and nystatin?

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.

Nystatin

Common side effects of nystatin tablets and capsules include:

Other side effects of nystatin include:

Possible serious side effects of nystatin include:

  • Stevens-Johnson syndrome

What is the dosage of ketoconazole vs. nystatin?

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.

Nystatin

The recommended dose for treating intestinal candidiasis is 500,000 to 1,000,000 units (1 to 2 tablets) every 8 hours.

What drugs interact with ketoconazole and nystatin?

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.

Nystatin

There are no significant drug interactions with nystatin oral tablets and capsules.

Are ketoconazole and nystatin safe to use when pregnant or breastfeeding?

Ketoconazole

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

Nystatin

There are no adequate studies done with nystatin to determine safe and effective use in pregnant women. It is not known whether nystatin enters breast milk; therefore, it is best for nursing mothers to be cautious before breastfeeding.

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Summary

Ketoconazole (Nizoral) and nystatin are antifungal medications prescribed to treat different types of fungal infections. Ketoconazole cream is a topical (for the skin) medication used to treat ringworm, jock itch, athlete's foot, dandruff, and tinea versicolor. Nystatin is an oral anti-fungal medication used to treat intestinal candidiasis.

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Medically Reviewed on 6/4/2019
References
FDA Prescribing Information
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