Ketoconazole

What is ketoconazole?

Ketoconazole is an antifungal medication used for treating fungal and yeast infections on the skin, scalp, or other parts of the body. It comes in various forms, such as cream, shampoo, and tablets, and is known by brand names such as Daktarin Gold, Daktarin Intensiv, Dandrazol, and Nizoral. Cream and shampoo forms are available to purchase in pharmacies over the counter or on prescription, whereas tablets are available on prescription only. In the UK, tablets are not commonly used due to their potential side effects, but can be prescribed by a specialist for a rare condition called Cushing’s syndrome[1]. 

What is ketoconazole used for?

Ketoconazole is commonly used to treat a range of conditions. These include fungal skin infections such as athlete’s foot, ringworm, sweat rash, jock itch, and seborrhoeic dermatitis, a condition that causes scaly patches and dandruff. Ketoconazole may also be used to treat pityriasis versicolor, a yeast infection that leads to discoloured patches on the skin, and dandruff – particularly when it’s linked to fungal overgrowth[1]. 

How does ketoconazole work?

Ketoconazole disrupts the membranes of fungal cells, preventing their growth and reproduction. Combined, this helps to address the infection and reduces symptoms such as redness, itching, and flaking skin[1]. 

Who can take ketoconazole?

Most adults and children over 12 can use ketoconazole shampoos, while the creams can be used by most adults aged 18 and over. However, it may not be suitable for people who have[1]: 

• An allergy to ketoconazole or any of the ingredients listed as part of the medication 

• Liver problems, especially when oral tablets are considered 

• Acute porphyria, a genetic disorder affecting the production of red blood cells 

Ketoconazole may also not be suitable for those who are pregnant or breastfeeding, unless advised by a doctor or pharmacist[1].  

Please tell your doctor or pharmacist about any conditions you may have or medication you take before you start treatment, and always follow the instructions in the Patient Information Leaflet[2].  

How do you take ketoconazole?

Ketoconazole can be used in the following ways, depending on the condition being treated[1]: 

• As a cream – apply a thin layer to the cleaned and dry affected area once or twice daily depending on your condition. Wash hands before and after use. Use for three days after your symptoms have cleared up to stop the infection returning. 

• As shampoo – apply to wet hair or skin, leave it on for three to five minutes, then rinse thoroughly. For seborrhoeic dermatitis and dandruff, use for 2 to 4 weeks until symptoms have cleared, then once every 1 to 2 weeks to stop it returning.  For pityriasis versicolor, use once a day for up to 5 days. 

• By taking tablets – take with food, exactly as prescribed by your doctor. Tablets are only prescribed under specialist supervision due to potential liver risks. 

Always use your own towel or flannel when treating fungal infections, and wash your hands thoroughly before and after applying any medication. 

No matter which type of ketoconazole you have, take or apply it according to your doctor or pharmacist’s instructions. 

What is the typical dosage of ketoconazole?

The dosage of ketoconazole also varies based on the type being used. Creams are usually applied once or twice per day for two or more weeks. Shampoos are usually best used twice a week for up to four weeks, or in smaller preventative doses. Tablets are rarely prescribed in the UK, and your specialist would specify a dose for your unique circumstances. Always follow the instructions that your medical professional gave you[1]. 

Can you stop taking ketoconazole suddenly?

When using a ketoconazole cream or shampoo, you should complete the full course of treatment – even if your symptoms improve early. This is because stopping too soon may cause the infection to return and set back your progress[1]. 

If you’re taking ketoconazole tablets, do not stop taking them without speaking to your doctor first. Similarly, stopping tablets early can also lead to the infection coming back[1]. 

What should you do if you take too much ketoconazole?

Using too much ketoconazole cream or shampoo is unlikely to cause much harm – simply rinse off any excess product. If used too often, ketoconazole cream or shampoo may cause burning, redness, or swelling of the affected area. Taking too many tablets can be dangerous and it may lead to serious side effects. If you’ve taken too many ketoconazole tablets, get urgent medical advice or go to A&E, taking the medicine packaging with you[1]. 

What should you do if you forget a dose of ketoconazole?

If you forget to use or take ketoconazole, you can usually use or take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed one and do not take a double dose. You can try to take or apply it at the same time each day to help avoid missing doses[1]. 

What medicines should you avoid while taking ketoconazole?

Topical ketoconazole (cream or shampoo) is unlikely to interact with other medicines. If you’re using other skin treatments at the same time as ketoconazole, such as a mild steroid cream that can help reduce swelling or inflammation, apply the steroid cream in the morning and the ketoconazole cream in the evening. If you’re using ketoconazole twice a day, wait at least 30 minutes after putting it on before using your steroid cream[1]. 

Always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2]. 

What are the side effects of ketoconazole?

The side effects of ketoconazole depend on the type you’re taking[1]: 

• When you use ketoconazole on the skin or scalp, potential side effects include itching, stinging, redness, irritation, and dry or flaky skin 

• With ketoconazole tablets, rare but more serious side effects include liver damage, hormonal imbalances, and allergic reactions 

You should contact your GP if you experience any of these symptoms. In rare cases, the medicine may cause a serious allergic reaction (anaphylaxis). You should call 999 or visit A&E immediately if you believe this is happening[1]. 

Symptoms of anaphylaxis include[1]:  

• Difficulty breathing  

• Tightness in throat and chest  

• Swelling of the tongue or throat  

• Feeling faint or dizzy  

• Blue/grey skin or lips  

• Loss of consciousness 

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice. 

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2]. 

Frequently asked questions about ketoconazole

Is ketoconazole safe for long-term use? 

The safety of ketoconazole comes down to which type you are using. Topical ketoconazole – such as creams and shampoos – is usually safe for longer-term use. However, oral ketoconazole tablets are used only for short periods due to the risk of liver damage[1]. 

Can I use ketoconazole on my face? 

It’s generally safe to use ketoconazole cream on your face – just avoid the eyes, mouth and any broken skin. Only use it as directed by your doctor or pharmacist[1]. 

Is ketoconazole safe during pregnancy? 

Topical ketoconazole may be safe to use during pregnancy, but you should speak to your doctor or pharmacist before doing so[1]. 

Can I use ketoconazole with other skin treatments? 

Yes, in most cases, ketoconazole is safe to use with other skin treatments. However, it’s best to space out applications by at least 30 minutes and check with a pharmacist or doctor first[1]. 

How quickly does ketoconazole work? 

It’s possible to see improvement within a few days of starting to use ketoconazole – but the full course of treatment can take several weeks. Even if you see results early you should still complete your full course[1]. 

Can I use ketoconazole every day? 

Depending on the product you may need to use ketoconazole daily. Creams are often used daily, but shampoo may not be used every day. Always follow the instructions given to you by your doctor or pharmacist[1]. 

Does ketoconazole treat nail fungus? 

No, ketoconazole is not usually effective for nail infections and other treatments are usually prescribed instead[1]. 

Can I drink alcohol while using ketoconazole? 

If you’re using ketoconazole cream or shampoo, it’s usually safe to drink in moderation. You should avoid drinking alcohol while taking ketoconazole tablets – it may increase the risk of liver damage[1]. 

What should I do if ketoconazole does not work? 

If ketoconazole doesn’t work for you, speak to your doctor or pharmacist. You may need a different antifungal treatment or further investigation into your symptoms[1]. 

For the official NHS guide to ketoconazole, visit their website.