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ketoconazole

Generic Nizoral

Used for Seborrheic Dermatitis, Athlete's Foot, Ringworm, Jock Itch, Candidiasis, Fungal Infection, Thrush, Tinea Versicolor

Ketoconazole (Nizoral A-D) is a prescription shampoo used for treating a fungal infection called tinea versicolor, but it can take months for your skin color to return to normal. It is also available over-the-counter to treat dandruff.

Reviewed by:

Christina Aungst, PharmD

Michelle Nguyen, PharmD

Last reviewed on June 29, 2021

Basics Side effects Pros & cons Pharmacist tips FAQs Warnings Dosage Cost Latest news Images Prices Medicare

What is Ketoconazole (Nizoral A-D)?

What is Ketoconazole (Nizoral A-D) used for?

Tinea versicolor (prescription product)
Dandruff (over-the-counter product)

How Ketoconazole (Nizoral A-D) works

Ketoconazole (Nizoral A-D) is an antifungal shampoo. It slows the growth of the fungus causing your infection by stopping it from reproducing.

Are you looking for information on ketoconazole tablet, Ketozole cream (ketoconazole cream), Xolegel (ketoconazole gel), or Extina (ketoconazole foam) instead?

When does Ketoconazole (Nizoral A-D) start working?

Time passed since treatment started:

HOURS

DAYS

WEEKS

MONTHS

Full effect

Drug Facts

Common BrandsNizoral A-D

Drug ClassAntifungal

Controlled Substance ClassificationNot a controlled medication

Generic StatusLower-cost generic available

AvailabilityPrescription or over-the-counter

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Avg retail price

$26.360

GoodRx discount

$26.36

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What are the side effects of Ketoconazole (Nizoral A-D)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

The following side effects are for the prescription version of ketoconazole (Nizoral A-D):

Itching (<3%)
Irritation (<3%)
Dry skin (<3%)

Other Side Effects

The following side effects are for the prescription version of ketoconazole (Nizoral A-D):

Change to hair texture or color
Loss of curl in wavy hair
Hair loss
Rash
Burning

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.

Allergic reactions

When do Ketoconazole (Nizoral A-D) possible side effects begin and end?

Time passed since treatment started:

MINUTES

HOURS

DAYS

WEEKS

MONTHS

Itching

Irritation

Dry skin

Changes in hair texture or color

Serious skin rash or swelling

Seek immediate medical care if you experience this side effect.

If a line continues to the right, you'll likely keep experiencing this side effect once it starts.

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common—For cream, shampoo, foam, or gel

Itching, stinging, burning, or irritation not present before use of this medicine

Rare—For cream, foam, or gel

Acne

bleeding from sore in the mouth

blistering, crusting, irritation, itching, or reddening of the skin

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

cracked, dry, or scaly skin

discoloration of the fingernails or toenails

dizziness

eye dryness, irritation, or swelling

red rash with watery, yellow-colored, or pus filled blisters with or without thick yellow to honey-colored crusts

skin dryness, pain, rash, redness, or swelling

sore in the mouth or on the gums

swelling of the face

Rare—For shampoo

Hair loss and irritation

Incidence not known—For gel

Pain

Incidence not known—For shampoo

Blistering, burning, crusting, dryness, or flaking of the skin

burning sensation of the skin

burning, itching, redness, skin rash, swelling, or soreness at the application site

discoloration of the hair

dry skin

fast heartbeat

fever

hives

hoarseness

irritation

itching, scaling, severe redness, or soreness of the skin

joint pain, stiffness, or swelling

rash

shortness of breath

swelling of the eyelids, face, lips, hands, or feet

thinning of the hair

tightness in the chest

troubled breathing or swallowing

wheezing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common—For shampoo or gel

Dryness or oiliness of the hair and scalp

headache

Rare—For shampoo

Abnormal hair texture

mild dryness of the skin

scalp pustules

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Pros and cons of Ketoconazole (Nizoral A-D)

Pros

Works well

Cheap and available as a generic

Available without a prescription for dandruff

Only have to use a single dose to treat tinea versicolor

Cons

Shouldn't be used in children under 12

Can cause itching, redness, or dry skin (prescription product)

Harmful if swallowed

Pharmacist tips for Ketoconazole (Nizoral A-D)

Use ketoconazole (Nizoral A-D) in place of your regular shampoo when you are using it. Be sure to leave it on your scalp after lathering up for 5 minutes in you are using ketoconazole (Nizoral A-D) to treat tinea versicolor. Be sure to rinse your hair thorouhgly when you are done using ketoconazole (Nizoral A-D).

You should only need to use ketoconazole (Nizoral A-D) once to treat tinea versicolor. Any itching you were experiencing before using ketoconazole (Nizoral A-D) should stop after applying it. Skin discoloration, on the other hand, can take several months to return to normal. Talk to your healthcare provider if your scalp or skin is still itchy after using ketoconazole (Nizoral A-D).

Most people get relief from dandruff symptoms within a few uses of ketoconazole (Nizoral A-D). If you are not feeling any improvement within 2 to 4 weeks, if your dandruff gets worse at any point, or if you develop a rash, stop using ketoconazole (Nizoral A-D) and contact your healthcare provider.

Some people have noticed that using ketoconazole (Nizoral A-D) changes the texture or color of their hair. It's also possible for you to lose your curl if you have wavy hair. You can use any styling tools or products you would like once you have rinsed out ketoconazole (Nizoral A-D) from you hair.

If you get ketoconazole (Nizoral A-D) into your eyes, wash it out well with water. Ketoconazole (Nizoral A-D) is toxic if you swallow it, so be careful not to get any in your mouth or nose when showering. If you do think you swallowed any, call a poison control center immediately. Store your bottle away from pets or children to prevent them from accidentally swallowing any.

Ketoconazole (Nizoral A-D) hasn't been studied very much in pregnant or nursing women, so experts aren't sure if it is safe for them to use. If you are pregnant or think you could be pregnant, please talk to your healthcare provider before using ketoconazole (Nizoral A-D).

Frequently asked questions about Ketoconazole (Nizoral A-D)

Can I use ketoconazole (Nizoral A-D) every day?

Unless a dermatologist or other healthcare provider tells you to do so, you should not use ketoconazole (Nizoral A-D) every day. Using ketoconazole (Nizoral A-D) more often than every 3 to 4 days for dandruff raises your risk of side effects like irritation, itching, and dry skin.

Can I leave ketoconazole (Nizoral A-D) on overnight?

No, neither the prescription nor the over-the-counter version of ketoconazole (Nizoral A-D) is intended to be left on overnight. Doing so raises your risk of side effects and rashes. Be sure to thoroughly rinse your hair when you are finished using ketoconazole (Nizoral A-D).

Is ketoconazole (Nizoral A-D) safe?

While all medications have risks, ketoconazole (Nizoral A-D) is a safe medication to use for dandruff and tinea versicolor. The risk of side effects is very low and allergies to it are extremely rare. Where ketoconazole (Nizoral A-D) becomes harmful is if it is swallowed, so be careful not to get it in your mouth when showering and keep it away from children and pets.

How long should you use ketoconazole (Nizoral A-D) for?

For tinea versicolor, ketoconazole (Nizoral A-D) only needs to be used once. For dandruff, you should use ketoconazole (Nizoral A-D) every 3 to 4 days for up to 8 weeks and then as needed for any flare ups.

Can ketoconazole (Nizoral A-D) damage the liver?

No, ketoconazole (Nizoral A-D) is not absorbed into the blood stream when used as a shampoo, so it does not affect the liver at all.

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What are the risks and warnings for Ketoconazole (Nizoral A-D)?

Ketoconazole (Nizoral A-D) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Allergic reactions

Severe allergic reactions to ketoconazole (Nizoral A-D) are possible, including life-threatening problems like anaphylaxis (closing of the throat). Call 911 if this happens. If you notice hives, a rash, swelling of the lips or tongue, or difficulty breathing after using ketoconazole (Nizoral A-D), call your healthcare provider right away.

Toxic if swallowed

Risk factors: Small children | Pets

Ketoconazole (Nizoral A-D) is only meant to be used on the scalp and skin. If it is swallowed, it can be harmful. Ketoconazole (Nizoral A-D) should be kept away from small children and pets to prevent them from accidentally swallowing it. If you or someone else has swallowed ketoconazole (Nizoral A-D), call a poison control center immediately.

Ketoconazole (Nizoral A-D) dosage forms

The average cost for 1 bottle of 120ml of 2% of Ketoconazole (Nizoral A-D) is $92.26 with a free GoodRx coupon.0

Bottle of shampoo

Dosage	Quantity	Price as low as	Price per unit
120ml of 2%	1 bottle	$92.26	$92.26

Typical dosing for Ketoconazole (Nizoral A-D)

Tinea versicolor: Wet hair and scalp. Apply ketoconazole (Nizoral A-D) to the affected areas, as well as a large region around the affected areas. Lather the shampoo, leave it in for 5 minutes, and then rinse off with water. A single use should be all you need.
Dandruff: For adults and children over age 12, wet hair and scalp. Apply ketoconazole (Nizoral A-D), lather the shampoo, and then rinse well. Repeat every 3 to 4 days for up to 8 weeks. Then use as needed for dandruff flare ups.