ketoconazole (Nizoral)

Drug description
Ketoconazole is used to treat fungal infections. Off-label use is for treatment of advanced prostate cancer. Ketoconazole in pill form is used for systemic treatment of thrush. Pill form is more convenient than topical ointment because you only need to take one pill a day. You must have regular blood tests because ketoconazole can damage your liver. Ketoconazole is less expensive but less effective and more toxic than fluconazole.

Side effects
Ketoconazole can suppress hormone production, including testosterone, especially at high doses over a long time. Ketoconazole must be used cautiously if you have a history of liver disease. Hepatitis is the most dangerous side effect of this drug. Antacids and other drugs that increase gastric pH may decrease absorption. Additive liver toxicity can occur if used in combination with other liver toxic agents such as alcohol. You may experience nausea and vomiting. Ketoconazole should not be taken with the antihistimine Seldane (also known as terfenadine). Together they can lead to dangerously irregular heartbeats.

Dosage
Ketoconazole comes in pill, ointment and shampoo forms. Adults take 200-400 mg/day in a single dose. Children older than 2 years take 3.3-6.6 mg/kg/day in a single dose. Topical 2% cream is applied 1-2 times daily. Apply enough ointment to cover affected and surrounding areas and rub in gently. Shampoo is applied twice weekly for 4 weeks waiting at least 3 days between treatments. Rifampin can reduce effectiveness of both drugs.

How long it may take to work
Treatment for candidiasis is 1-2 weeks, and for other systemic infections at least 6 months. Chronic candidiasis usually requires maintenance therapy. Maintenance treatment means you keep taking the drug to control an infection so that you don't become ill.

Managing side effects
Nausea frequently lessens as you get used to the drug. Sometimes you can switch drugs to one that causes less nausea. Drugs that can help reduce the symptoms of nausea include Compazine, Phenergan, and Reglan. Take with meals or snacks to minimize nausea and vomiting. If you have achlorhydria, a condition in which the stomach fails to produce gastric acid, you should take fluconazole. People with AIDS may be at increased risk for achlorhydria. Ketoconazole is not absorbed by people without gastric acid or who take antacids or H2 blockers such as cimetidine.

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