ketoconazole
Ketoconazole shampoo is an antifungal medication that comes in two strengths. The 2% prescription strength is FDA approved to treat a fungal scalp condition called tinea versicolor in adults. The 1% over-the-counter (OTC) version, also sold as Nizoral A-D, treats dandruff symptoms like flaking and itching in people 12 years and older. You apply it to the affected area and rinse it off after a few minutes. A common side effect is scalp irritation.
What is Ketoconazole shampoo?
What is Ketoconazole shampoo used for?
- Tinea versicolor - prescription only
- Dandruff - OTC only
How Ketoconazole shampoo works
Ketoconazole shampoo is an antifungal medication. It works by stopping the fungus from making a substance it needs for its protective outer covering. This prevents it from growing and spreading in the body.
Drug facts
Side effects of Ketoconazole shampoo
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
- Skin irritation
Less Common Side Effects
- Dry skin
- Change to hair texture or color
- Hair loss
- Rash
- Itching
Ketoconazole shampoo serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic reactions: rash, skin reactions, facial or throat swelling, shortness of breath
The following Ketoconazole shampoo 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
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
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
fast heartbeat
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
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.
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Pros and cons of Ketoconazole shampoo
Pros
- Easy-to-use scalp shampoo
- 1% version for dandruff is available OTC
- 2% version for tinea versicolor is typically used one time
Cons
- Can take some time to see improvement
- Can cause dryness or irritation
- Not well studied in pregnancy or breastfeeding
Pharmacist tips for Ketoconazole shampoo
- Use ketoconazole shampoo only as directed and don’t use it more often than recommended. Using it too often can irritate your skin or scalp.
- Avoid getting ketoconazole shampoo in your eyes. If it gets in your eyes, rinse well with water.
- Stop using ketoconazole shampoo and talk to your prescriber or pharmacist if you have severe burning, redness, or a rash.
Ketoconazole 1% shampoo (OTC)
- Apply ketoconazole shampoo to your scalp and work it into a thick lather. Rinse it out, then repeat.
- Start using ketoconazole shampoo every 3 to 4 days (about 2 times a week) for about 8 weeks. Once your symptoms improve, use it only when dandruff flares up.
- Most people feel relief after a few uses of ketoconazole shampoo. If you don’t see improvement within 2 to 4 weeks or your dandruff gets worse, talk to a healthcare professional.
Ketoconazole 2% shampoo (Prescription)
- Apply ketoconazole shampoo on the affected areas and a large area around it, and leave it on for 5 minutes before rinsing.
- You usually only need one treatment with ketoconazole shampoo for tinea versicolor. Even after the infection clears, skin color changes can take weeks or months to fade.
Common questions about Ketoconazole shampoo
Hair loss isn't a common side effect of ketoconazole shampoo, but it has been reported in some studies. In fact, ketoconazole shampoo has been shown to help improve hair loss in certain people. If you're worried about hair loss, speak with your prescriber.
If you’re using ketoconazole shampoo for dandruff, you should start to see improvement within 2-4 weeks. Tinea versicolor usually starts to get better within about 5 days after using ketoconazole shampoo, but keep in mind that it can take several weeks or months for your skin color to go back to normal.
Check with your prescriber if you can use ketoconazole shampoo on your face. Be careful to avoid getting it in your eyes. If this happens, rinse your eyes well with water.
You generally shouldn’t use ketoconazole shampoo every day unless your prescriber tells you to. For dandruff, it’s usually used 2 times a week or every 3 to 4 days, since daily use can irritate your scalp. For tinea versicolor, the 2% shampoo is typically used just once. This one treatment is often enough to clear the infection.
Yes. While all medications have risks, ketoconazole shampoo is generally safe to use when used as directed. Avoid getting it in your eyes, and stop using it if you have severe burning, redness, or a rash.
Some studies suggest ketoconazole shampoo might help with hair growth in some people with hair loss. But it isn’t FDA approved for this use. Talk with your primary care provider about the best and safest options to treat hair loss.
You can buy ketoconazole 1% shampoo for dandruff over the counter at a local pharmacy or online. If you're looking to treat tinea versicolor, you'll need a prescription for the stronger 2% strength, which you can fill at a pharmacy.
Prescription ketoconazole 2% shampoo is only approved for adults. But the 1% OTC version for dandruff can be used by children 12 years and older. Talk with your child’s pediatrician to make sure this product is safe for them.
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Risks and warnings for Ketoconazole shampoo
Ketoconazole shampoo 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 shampoo can happen, including life-threatening problems like anaphylaxis (closing of the throat). If you notice hives, a rash, swelling of the lips or tongue, or difficulty breathing after using ketoconazole shampoo, get medical care right away.
Ketoconazole shampoo dosage
Bottle of shampoo| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 120ml of 2% | 1 bottle | $13.29 | $13.29 |
Typical dosage for Ketoconazole shampoo
- Ketoconazole 2% shampoo
- Tinea versicolor (adults): Apply to damp skin of the affected areas, and to a large part of the skin around them. Lather it, leave it on for 5 minutes, then rinse with water. One treatment is usually enough.
- Ketoconazole 1% shampoo (Nizoral A-D)
- Dandruff (adults and children over age 12): Wet your hair and scalp.Then apply the shampoo and lather well. Rinse thoroughly and repeat every 3 to 4 days for up to 8 weeks. Use as needed when dandruff flares up.
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Interactions between Ketoconazole shampoo and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
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