Ketoconazole: What is it and what is it for?

What is ketoconazole?

Ketoconazole is an antifungal drug (to fight fungal infections), whichbelongs to the group ofimidazole drugs among which are otherantifungals such as clotrimazole, fluconazole, itraconazole and imidazole. Ketoconazole exerts its effect by altering the synthesis of the cell membrane of fungi.

This medicinemay be used to treat dermatophyte or yeast infections of the skin, hair and nails; yeast infections of the intestinal tract, recurrent vaginal candidiasis; systemic fungal infections such as candidiasis, coccidioidomycosis, histoplasmosis, paracoccidioidomycosis. (1)

The presentation of this medicine is in tablets of 200 mg, vaginal ovules of 400 mg, cream for topical use, gel and shampoo in concentration to 2%. Its dosage will depend on the characteristics of the pathology to be treated, so it must be prescribed by a doctor. The chemical composition of this medicine will vary according to the presentation.

Note: This medicine is ofdelicate use, so it should be left out of reach of children.

Ketoconazole is alsoused to treat prostate cancer, as certain doses can prevent testosterone production in men. (2)

What is ketoconazole indicated for?

Below we indicate the different pharmacological therapies in which this medication is involved:

1. Ringworms on different parts of the body

Ketoconazole is indicated for the treatment of fungal skin infections such as: ringworm of the body, jock itch, ringworm of the feet, and ringworm of the hands.

To highlight: The therapeutic dose will be adapted to the severity of the lesion, however, the use of cream or gel is recommended and its application will be done once a day, preferably at night and according to the medical evaluation, it can be extended to two times a day, once in the morning and once at night.

If treatment is by mouth, an initial dose of 200 mg once dailyin the morning is recommended. Very severe infections may require 400 mg as a single dose, once a day. Treatment can last between 2 to 4 weeks.

2. Cutaneous candidiasis

Ketoconazole is indicated for the treatment of skin conditions such as cutaneous candidiasis, a fairly common infection caused by the fungus candida.

Note: The use of cream or gel is recommended and its application will be done once a day, preferably at night and as indicated by the doctor, and if necessary it can be applied twice a day, once in the morning and once in the evening. night.

If treatment is by mouth, a starting dose of 200 mg tabletsonce daily in the morning is recommended. Very severe infections may require 400 mg in a single dose, once a day. The treatment can last between 2 to 4 weeks depending on the evolution.

3. Seborrheic dermatitis

To treat seborrheic dermatitis, the use of ketoconazole in 2% shampoo is recommended. Its use should be at least 2 times a week. During the application on the scalp, it is suggested to perform a good massage and repeat the operation for at least 3 more minutes.

There are studies where seborrheic dermatitis is treated orally, with satisfactory results (3) Treatment should last at least 4 weeks, leaving at least 3 days between treatments.

Important:Do not drop ketoconazole shampoo on the skin and other mucous membranes, as irritation may result. If this happens, rinse the affected area with plenty of water and see your doctor.

4. Pityriasis versicolor

Tinea versicolor is a fungal infection that frequently appears on the skin. This medicine will be used in the form of a shampoo, in a 2% ketoconazole concentration on the affected area and surroundings, for 5 minutes and then rinse.

Highlights: This medication is used to control scaling, peeling, and itching of the skin caused by pityriasis versicolor.

5. Chronic superficial dermatophytoses

Dermatophytosis comprises a set of superficial mycosesthat affect the skin, specifically the epidermis and its annexes (nails and hair). The recommended treatment is an initial oral dose of 200 mg once a day, but very severe cases may require 400 mg once a day.

Note: The duration of treatment with ketoconazole is estimated between two to four weeks depending on the medical evaluation.

What contraindications does ketoconazole have?

The use of ketoconazole can cause some conditionsin people with some pathologies or special conditions. We mention below, the most notified:

1. Sensitivity to components

The use of ketoconazole can cause an allergic reaction such as: itching or hives, swelling of the face or hands, swelling or tingling in the mouth or throat, chest tightness, difficulty breathing.

You should be especially careful if you experience any of these symptoms while using this medication, as medication anaphylactic shock can occur .

Note: If you notice any of these allergic reactions in the patient, immediately discontinue use and Consult a doctor.

2. Pregnancy and lactation

During pregnancy, the use of this medication is not recommended since its safety during this stage has not been studied. (4)

On the other hand, it has been proven that ketoconazole is excreted in breast milk, which can causeNuclear jaundice in the infant. It is recommended that women discontinue lactation during treatment with ketoconazole, up to 48 hours after use.(5)

3. Alcoholism and liver failure

The consumption of ketoconazole in people with alcoholism problems is contraindicated, since this medication increases the probability of liver function problems.

If you notice yellowing of your skin or eyes, if your urine is dark or brown, or if you experience abdominal pain, Notify your doctor immediately as these may be signs of liver toxicity.

Important: It is recommended to eliminate the consumption of alcoholic beverages during treatment with ketoconazole and for at least 48 hours after abstention.

Likewise, due to the risk of severe hepatotoxicity, ketoconazole should be restricted to patients with liver failure , as it can cause liver damage. (6)

4. Do not administer to children under 2 years of age

Due to the lack of scientific studies, safety and efficacy have not been confirmed in the use of ketoconazole in the pediatric population,due to adverse reactions not established in previous studies. In this context, no recommendation can be made for its use in children under 12 years of age.

5. Interaction with other drugs

Ketoconazole is one of the medications with the most interaction with other drugs such as antacids, anticoagulants, oral contraceptives, antidepressants, antiepileptics,among others. In these circumstances, it is important that you tell your doctor if you are under pharmacological treatment for other pathologies.

Note: It is important to avoid self-medication with this class of drugs.

What are the side effects of ketoconazole?

The use of ketoconazole can produce some acute and chronic side effects, which we mention below:

1. Gastrointestinal upsets

The consumption of ketoconazole can cause discomfort in the digestive tract such as: nausea, abdominal pain, vomiting, diarrhea. Others of unknown frequency are: dyspepsia, flatulence, discoloration of the tongue, dry mouth and dysgeusia (perception of nauseating, rancid, metallic or salty taste).

Important: If any of these symptoms appear during treatment, consult your doctor or pharmacist for the necessary recommendations.

2. Erythema, pruritus and contact dermatitis

This medicine has effects on the skin, due to its content of propylene glycol, cetyl alcohol and stearyl alcohol, components that can cause allergic reactions such as contact dermatitis.

Bullous rash, exanthema, exfoliation of the skin,sticky oily skin, and less frequently urticariahave also been reported.

Note: If you notice any undesirable skin reaction while using ketoconazole cream, gel, or shampoo, discontinue use and consult your doctor.

3. Headache and dizziness

Another frequently reported side effect of ketoconazole use is that patients may experience headache and dizzinesstag. It is important to notify your doctor so that he can prescribe additional medications to counteract these annoying effects.

4. Menstrual disturbances

Other effects are temporary and do not require medical attention, unless they are very bothersome or last for a long time. They consist of the appearance in women of menstrual alterations such asoligomenorrhea, hypermenorrhea, hypomenorrhea,Menometrorrhagia or metrorrhagia.

Key Conclusions

• The main use of ketoconazole is as an antifungal medication.
• Its application can be through the oral or topical route.
• It is a medicine also used for prostate cancer.
• Its effect in children under 12 years of age has not been proven.
• The dose is at the discretion of the physician according to the severity of the pathology.
• It should not be administered during pregnancy and during lactation it should be discontinued if used.