Kiton

Indications

Ketoconazole is an antifungal medicine. It is mainly used on the skin and scalp:

• Cream: fungal skin infections such as ringworm (tinea) of the body, groin and feet, candida skin infections, pityriasis versicolor (patches of lighter or darker skin), and seborrhoeic dermatitis (flaky, red skin on the face and chest).
• Shampoo: dandruff, seborrhoeic dermatitis of the scalp and pityriasis versicolor.
• Tablets: only for serious fungal infections when other antifungals cannot be used, under close medical supervision, because of the risk of liver damage.

How It Works

Ketoconazole stops fungi from making ergosterol, an essential part of their cell wall. Without it, the fungal cells leak and stop growing.

Dosage and Administration

• Cream: apply to the affected skin and the area around it once or twice a day. Continue for a few days after the skin clears, usually 2 to 4 weeks in total.
• Shampoo for dandruff: wet the hair, lather, leave on for 3 to 5 minutes, then rinse; use twice a week for 2 to 4 weeks, then once every 1 to 2 weeks to prevent return.
• Shampoo for pityriasis versicolor: apply to the affected skin, leave for 3 to 5 minutes and rinse, once a day for up to 5 days.
• Tablets: only as prescribed, with liver blood tests before and during treatment.

Interactions

Cream and shampoo: no important interactions. Tablets have many serious interactions, including with Simvastatin, Domperidone, Colchicine, Midazolam taken by mouth and some heart rhythm medicines; with Warfarin; and with antacids and stomach acid reducers such as Omeprazole, which lower its absorption. Tell your doctor about all medicines you take.

Contraindications

• Allergy to ketoconazole or other azole antifungals.
• Tablets: liver disease, and use with medicines that must not be combined with it.

Side Effects

Cream and shampoo: burning, itching, redness or irritation at the application site; shampoo may make hair oily or dry or change its texture.

Tablets: nausea, stomach pain, headache and, rarely, serious liver damage. Get urgent medical help for yellow skin or eyes, dark urine, pale stools, severe tiredness or loss of appetite, or swelling of the face or throat, blistering rash or difficulty breathing with any form.

Pregnancy and Lactation

Cream and shampoo are not expected to cause harm because very little is absorbed, but use them only if your doctor or pharmacist advises. Do not apply to the breast while breastfeeding. Tablets should not be used in pregnancy or breastfeeding.

Precautions and Warnings

• Keep away from the eyes; rinse with water if contact occurs.
• If you have been using a steroid cream on the same area, the doctor may advise stopping it gradually.
• See a doctor if the infection does not improve after 2 to 4 weeks.
• Tablets must not be used for minor skin or nail infections.

Overdose

Accidentally swallowing cream or shampoo may cause stomach upset; seek medical advice. Overdose of tablets needs urgent medical help.

Therapeutic Class

Imidazole antifungal.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Keep the cap tightly closed.