Imidazole antifungal

Ketoconazole

Brand names: Nizoral

Adult dose

Dose: Topical 2% shampoo: twice weekly. Oral systemic restricted (Cushing's only): refer to specialist

Route: Topical/PO

Frequency: varies

Clinical pearls

Topical: seborrhoeic dermatitis, dandruff, pityriasis versicolor
Oral: severely restricted to Cushing's syndrome 2nd-line (MHRA/EMA suspension for fungal infections due to hepatotoxicity)

Contraindications

Acute or chronic liver disease (oral)
Pregnancy/breastfeeding (oral)
Concurrent QT-prolonging drugs (oral)
Concurrent simvastatin/lovastatin (oral)

Side effects

Topical: local irritation
Oral (rarely used): severe hepatotoxicity, adrenal suppression, QT prolongation, gynaecomastia

Interactions

Many CYP3A4 (oral) — refer BNF
Statins
Warfarin
Tacrolimus

Monitoring

LFTs (oral)
Cortisol (oral, Cushing's)

Reference: BNF; MHRA Drug Safety Update 2013; https://bnf.nice.org.uk/drugs/ketoconazole/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Miconazole · Imidazole antifungal

Pathways