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Ketoconazole

Antifungal

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What is ketoconazole?

Ketoconazole (also called Nizoral®) is used to treat fungal infections. It is available as a 200-mg white tablet taken by mouth. It is also available as a white cream that is applied to the affected area of skin, and as a red-orange liquid shampoo that is applied to the scalp to control dandruff.

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Possible side effects

For shampoo only

  • Removal of curl from permanent wave
  • Hair loss
  • Dry skin
  • Itching

For skin cream only

  • Irritated skin
  • Itching
  • Stinging
  • Irritated scalp

For oral tablets only

  • Nausea and vomiting
  • Stomach upset

Later (usually more than a day after treatment starts)

  • Constipation
  • Diarrhea
  • Temporary changes in liver function
  • High blood pressure
  • Itching
  • Rash
  • Feeling dizzy
  • Headache
  • Increase in the size of the breasts and breast tenderness may occur in men

These are the most common side effects, but there may be others. Please report all side effects to the doctor or nurse.

Symptoms of an allergic reaction include: rash, hives, itching, chills, fever, headache, muscle ache, shortness of breath, coughing, tightness in the throat, swelling of the face or neck.

Not all patients who take ketoconazole will experience these side effects. Common side effects are bolded, but there may be others. Please report all suspected side effects to your doctor or pharmacist.

Find more information on side effects.

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Tips for patients and families

Be sure to discuss all questions and instructions with your doctor or pharmacist. 

  • If stomach upset occurs, take ketoconazole with food.
  • The staff will draw blood samples regularly to check for liver function changes.
  • If you have unusual fatigue, nausea, and vomiting, loss of appetite, yellowing of eyes or skin, dark urine, or pale stools, tell your doctor right away. These symptoms could mean that ketoconazole is severely affecting the liver.
  • Ketoconazole may affect the way many other medicines work. These medicines include:
    • Oral medicines for diabetes
    • Warfarin
    • Phenytoin
    • Medicines used to suppress the immune system in transplant patients: cyclosporine, sirolimus, tacrolimu
    • Digoxin
    • Midazolam
    • Theophylline
    • Methylprednisolone
    • These and other chemotherapy medicines: vincristine, etoposide, daunorubicin, doxorubicin, idarubicin, mitoxantrone, ifosfamide, and cyclophosphamide.
  • Several medicines can affect how ketoconazole works. These medicines include: antacids, ranitidine, famotidine, sucralfate, isoniazid, and rifampin.
  • Always give a complete list of medicines you are taking to your doctor or pharmacist. Check with your doctor or pharmacist before starting any new vitamins, herbals, or other medicines while you are taking ketoconazole.
  • Follow these guidelines if you are using the shampoo:
    • Avoid contact with the eyes
    • Apply the shampoo to the damp skin of the affected and surrounding areas
    • Lather, wait for 5 minutes, and then rinse with water
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Always check the medication label. Many medicines look the same. Do not take any new medicine, including over-the counter medicines or supplements, without checking with your doctor or pharmacist. Talk to your doctor or pharmacist about what to do in the case of a missed dose, allergic reaction, or medical emergency. 

This information is not intended to be a complete guide and is not a substitute for talking with your provider. Medicine names, appearance, formulas, or availability may vary by clinic location. Always follow the instructions given by your care team.

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Reviewed: June 2024