Ketoconazole

Ketoconazole Brand Names

Extina | Ketodan | Kuric | Nizoral | Nizoral A-D 

What is Ketoconazole

Ketoconazole is an imidazole antifungal agent and is available as an oral tablet and various topical formulations.

Oral ketoconazole has been associated with fatal hepatotoxicity, adrenal gland suppression, and harmful drug interactions.

Due to the potential for severe adverse events, oral ketoconazole should only be used to treat serious blastomycosis, histomycosis, coccidioidomycosis, paracoccidioidomycosis, and chromomycosis infections when no other antifungal therapies are available.

The topical formulations are indicated for the treatment of tinea corporis, tinea cruris, tinea pedis, tinea versicolor, mucocutaneous candidiasis, seborrheic dermatitis, and dandruff.

Ketoconazole was FDA-approved in 1981.

Indications

1. Actinomadura madurae
2. Actinomadura sp.
3. Blastomyces dermatitidis
4. blastomycosis
5. Candida albicans
6. Candida glabrata
7. Candida guilliermondii
8. Candida kefyr
9. Candida krusei
10. Candida parapsilosis
11. Candida pseudotropicalis
12. Candida sp.
13. Candida stellatoidea
14. Candida tropicalis
15. chromomycosis
16. Coccidioides immitis
17. coccidioidomycosis
18. Cryptococcus neoformans
19. dandruff
20. Epidermophyton floccosum
21. Epidermophyton sp.
22. Histoplasma capsulatum
23. histoplasmosis
24. Leishmania braziliensis
25. Leishmania major
26. Leishmania mexicana
27. Leishmania panamensis
28. Leishmania tropica
29. leishmaniasis
30. Malassezia furfur
31. Microsporum audouinii
32. Microsporum canis
33. Microsporum gypseum
34. Microsporum sp.
35. mucocutaneous candidiasis
36. Paracoccidioides brasiliensis
37. paracoccidioidomycosis
38. Petriellidium boydii
39. Phialophora sp.
40. prostate cancer
41. seborrheic dermatitis
42. Sporothrix schenckii
43. tinea corporis
44. tinea cruris
45. tinea pedis
46. tinea versicolor
47. Trichophyton mentagrophytes
48. Trichophyton rubrum
49. Trichophyton sp.
50. Trichophyton tonsurans

Side Effects

1. abdominal pain
2. acne vulgaris
3. adrenocortical insufficiency
4. alopecia
5. anaphylactoid reactions
6. angioedema
7. anorexia
8. cheilitis
9. chills
10. contact dermatitis
11. depression
12. diarrhea
13. dizziness
14. drowsiness
15. elevated hepatic enzymes
16. erythema
17. fatigue
18. fever
19. gynecomastia
20. hair discoloration
21. headache
22. hemolytic anemia
23. hepatitis
24. hepatotoxicity
25. hypertriglyceridemia
26. impotence (erectile dysfunction)
27. increased intracranial pressure
28. jaundice
29. keratoconjunctivitis
30. leukopenia
31. nail discoloration
32. nausea
33. ocular irritation
34. oligospermia
35. papilledema
36. paresthesias
37. photophobia
38. photosensitivity
39. pruritus
40. QT prolongation
41. rash
42. skin irritation
43. suicidal ideation
44. thrombocytopenia
45. urticaria
46. vitamin D deficiency
47. vomiting
48. xerosis

Monitoring Parameters

• hepatitis A serology
• hepatitis B serology
• INR
• LFTs
• partial thromboplastin time (PTT)
• serum bilirubin

Contraindications

• achlorhydria
• adrenal insufficiency
• apheresis
• AV block
• azole antifungals hypersensitivity
• bradycardia
• breast-feeding
• cardiomyopathy
• celiac disease
• children
• driving or operating machinery
• ethanol ingestion
• females
• fever
• geriatric
• heart failure
• hepatic disease
• hepatitis
• hepatotoxicity
• human immunodeficiency virus (HIV) infection
• hyperparathyroidism
• hypocalcemia
• hypochlorhydria
• hypokalemia
• hypomagnesemia
• hypothermia
• hypothyroidism
• infants
• ketoconazole coadministration with other drugs
• long QT syndrome
• myocardial infarction
• neonates
• ocular exposure
• pheochromocytoma
• pregnancy
• QT prolongation
• rheumatoid arthritis
• sickle cell disease
• sleep deprivation
• stroke
• surgery
• systemic lupus erythematosus (SLE)
• tobacco smoking
• torsade de pointes
• ventricular arrhythmias

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