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Ketoconazole - Brand names: Daktarin, Dandrazol, Nizoral

On this page

  1. About ketoconazole
  2. Key facts
  3. Who can and cannot use ketoconazole
  4. How and when to use ketoconazole
  5. Side effects of ketoconazole
  6. How to cope with side effects of ketoconazole
  7. Pregnancy and breastfeeding
  8. Cautions with other medicines
  9. Common questions about ketoconazole

1. About ketoconazole

Ketoconazole is an antifungal medicine. It's used to treat skin infections caused by a fungus (yeast). It can also prevent them coming back.

It treats different types of fungal infections including:

  • athlete's foot
  • jock itch, an infection in the groin area
  • sweat rash (intertrigo), a rash that usually appears in folds of skin
  • dandruff and seborrhoeic dermatitis, where your scalp or other areas of your skin become scaly and dry or greasy
  • pityriasis versicolor, sometimes called tinea versicolour, where small patches of skin become scaly and change colour

Ketoconazole is available as a cream or shampoo.

You can buy most ketoconazole creams and shampoos in pharmacies and supermarkets, or get them on prescription. For treating pityriasis versicolor, you will need a prescription.

Ketoconazole also comes as tablets but these usually only treat a rare condition called Cushing's syndrome. The tablets are available on prescription only, and they are not covered here.

2. Key facts

  • Ketoconazole usually works within 2 to 3 weeks for most fungal infections, but it can take 6 weeks for athlete's foot to get better.
  • It works by killing the yeasts (fungi) that cause the infections.
  • The most common side effects of the cream and shampoo are irritated or red skin.
  • For most infections, you'll usually use the cream once or twice a day and the shampoo once or twice a week.
  • Some people use ketoconazole shampoo every 1 to 2 weeks to help stop dandruff coming back.

3. Who can and cannot use ketoconazole

Ketoconazole creams and shampoos can be used by most adults and children aged 12 years and over.

Ketoconazole is not suitable for everyone. To make sure it's safe for you, talk to your doctor or pharmacist before using it if you have ever had an allergic reaction to ketoconazole or any other medicine.

4. How and when to use ketoconazole

Always follow the instructions that come with your medicine, or your doctor's advice.

How long you use ketoconazole for and how often depends on the type of skin problem you have.

How often to use cream for athlete's foot, jock itch and sweat rash

Use the cream once or twice a day on the infected skin and surrounding area. For athlete's foot, you need to use it twice a day regularly.

Carry on using the cream for 3 days after your symptoms have cleared up, to stop the infection coming back.

How often to use shampoo or cream for seborrhoeic dermatitis

Use the shampoo twice a week for 2 to 4 weeks until your symptoms have cleared. Then use it once every 1 to 2 weeks, to stop them coming back.

Alternatively, you can use the cream once or twice a day, for 2 to 4 weeks, and then use the shampoo once every 1 to 2 weeks to stop your symptoms coming back.

How often to use shampoo for dandruff

Use the shampoo twice a week for 2 to 4 weeks, then once every 1 to 2 weeks to stop your dandruff coming back.

How often to use cream or shampoo for pityriasis versicolor

Use the shampoo once a day, for up to 5 days.

For treating small areas of skin, you can use the cream instead. Put the cream on once or twice a day for 2 to 3 weeks.

If your symptoms tend to return in sunlight, use the shampoo once a day for up to 3 days before going out in the sun.

How to use ketoconazole cream

  1. Wash and dry the infected area of skin. If you're treating your feet, make sure you dry between your toes.
  2. Use your own towel or flannel. This stops you passing the infection on to anyone else.
  3. Gently rub the cream into the infected area and surrounding skin. You'll usually need a small amount, depending on the size of the area you're treating. Be careful not to let the cream get into your eyes or mouth. If it does get into your eyes or mouth, rinse them with water.
  4. Wash your hands afterwards. This stops you spreading the infection to other parts of your body or other people.

If you're using any other creams, ointments or lotions on the same area of skin, do not put them on at the same time as ketoconazole cream. After putting on the ketoconazole cream, wait 30 minutes before you use different products on the same area. This gives the ketoconazole time to be absorbed into your skin.

How to use ketoconazole shampoo

  1. Rinse your hair or the infected area of skin with water.
  2. Shake the shampoo bottle, then squeeze a small amount onto the infected area.
  3. If you're treating your scalp, massage the shampoo into your scalp until it makes a lather.
  4. Leave the shampoo on for 3 to 5 minutes, then wash it off with water. Try not to get the shampoo into your eyes or mouth. If it gets into your eyes or mouth, rinse them with water.
  5. Wash your hands afterwards. This stops you spreading the infection to other parts of your body or other people.

What if I forget to use it?

If you forget to use your ketoconazole cream or shampoo, just skip the missed dose and then keep to your usual routine.

What if I use too much?

If you use too much ketoconazole shampoo or cream, or use it more often than you need to, it may make your skin irritated or red. If this happens, use less the next time.

5. Side effects of ketoconazole

Like all medicines, ketoconazole cream and shampoo can cause side effects, but not everyone gets them.

Most side effects are minor. You can try using a smaller amount of the cream or shampoo to see if that helps.

Common side effects

You're unlikely to have common side effects when using the right amount of ketoconazole shampoo.

With ketoconazole cream, common side effects happen in more than 1 in 100 people. They usually affect your skin where you've applied the cream.

Talk to a pharmacist or doctor if these side effects bother you or do not go away, or if they spread beyond the area of skin you've treated:

  • itching or redness
  • a burning feeling on your skin

Serious allergic reaction

Serious allergic reactions (anaphylaxis) are rare but can happen with ketoconazole cream or shampoo.

Immediate action required: Call 999 or go to A&E now if:
  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of ketoconazole. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

6. How to cope with side effects of ketoconazole

What to do about:

  • itching, redness, or a burning feeling on your skin – try using less cream. Apply it carefully, just to the area you need to treat. Rub it in gently. Try wearing loose clothing to reduce sweat. If the itching, redness or burning feeling is no better after a few days, or it gets worse at any time, stop using the cream and speak to a pharmacist or doctor.

7. Pregnancy and breastfeeding

Ketoconazole and pregnancy

You can use ketoconazole cream or shampoo if you're pregnant. Only tiny amounts are absorbed into your body so it will not affect your baby.

Ketoconazole and breastfeeding

If you want to breastfeed and are using ketoconazole on your chest, wash any cream off your breasts and nipples and then wash your hands before feeding your baby.

Non-urgent advice: Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

8. Cautions with other medicines

Only tiny amounts of ketoconazole are absorbed into your body when you use it as a cream or shampoo. You can usually use ketoconazole skin treatments while taking most medicines.

Using ketoconazole with other skin treatments

If you're using a mild steroid cream (such as hydrocortisone) to help with swelling or inflammation caused by the skin infection, put the steroid cream on in the morning and the ketoconazole cream in the evening.

If you're using ketoconazole twice a day, make sure you wait at least 30 minutes after putting it on before using the steroid cream.

Mixing ketoconazole with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements while using ketoconazole. They are not tested in the same way as other medicines.

Important: Medicine safety

Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about ketoconazole

How does ketoconazole work?

Ketoconazole is an antifungal medicine. It works on the fungus (yeast) that is causing the infection.

Ketoconazole causes holes to appear in the fungus's cell membrane and the contents to leak out. This kills the fungus and treats the infection.

How long does ketoconazole take to work?

Ketoconazole cream and shampoo usually take 2 to 4 weeks to work for dandruff, scaly and dry or greasy skin (seborrhoeic dermatitis), jock itch and sweat rash.

Athlete's foot and some other skin infections can take up to 6 weeks to get better.

Pityriasis versicolor (a fungal infection that causes skin to become scaly and discoloured) gets better within 5 days of treatment with ketoconazole shampoo, or after 2 to 3 weeks of treatment with the cream. However, it can take several weeks or months for your skin colour to return to normal.

Talk to your pharmacist or doctor if your symptoms are no better after 4 weeks.

After your skin infection has cleared up, continue to use the cream for a few days, to stop your symptoms coming back.

What if ketoconazole does not work?

Talk to your pharmacist or doctor if:

  • your symptoms have not improved after 4 weeks
  • your symptoms have not improved after 2 weeks after you used ketoconazole shampoo for pityriasis versicolor.

You may need to use a different treatment.

If your symptoms get worse at any time, speak to your doctor.

What do I do if the infection comes back after treatment?

Dandruff and seborrhoeic dermatitis

Dandruff and other types of seborrhoeic dermatitis can come back. You can usually use ketoconazole again if it worked well before.

When the infection is under control again, you can continue to use ketoconazole shampoo less often, so the skin infection does not come back.

Some people use ketoconazole shampoo every 1 to 2 weeks for months, or even for years, to stop dandruff or seborrhoeic dermatitis returning.

Athlete’s foot, jock itch, sweat rash

Athlete's foot, jock itch and sweat rash can come back.

You can usually use ketoconazole cream again if it worked well before and as long as the infection is mild and has not spread.

Pityriasis versicolor

Pityriasis versicolor (a fungal infection that causes skin to become scaly and discoloured) can come back. Warm, damp conditions or being in the sun sometimes bring it back.

You can usually use ketoconazole again in the same way as before.

If your symptoms tend to return in sunlight, use the shampoo once a day for up to 3 days before going out in the sun.

You can then use ketoconazole shampoo 1 to 4 times a month to stop symptoms coming back.

Are there other treatments for fungal infections?

There are many different antifungal medicines. Some are available to buy from a pharmacy, and others are available on prescription.

They can come as creams, gels, sprays, tablets, capsules and liquid.

Your doctor or a pharmacist will be able to recommend the best treatment for you, based on your condition.

Antifungal medicines include:

Can I drink alcohol?

Yes, you can drink alcohol while using ketoconazole cream or shampoo.

Is there any food or drink I need to avoid?

No, you can eat and drink normally while using ketoconazole cream or shampoo.

Will it affect my fertility?

When ketoconazole is used as a cream or shampoo, only tiny amounts are absorbed into the body. There's no evidence that it affects the fertility of men or women.

Will ketoconazole affect my contraception?

When it's used as a cream or shampoo, ketoconazole does not affect any type of contraceptive, including the combined pill or emergency contraception.

Can I drive or ride a bike?

Yes, you can drive or ride a bike while using ketoconazole cream or shampoo.

What else can I do to help fungal infections?

If you have a fungal skin infection, these tips may help:

  • always wash your hands after treating the infection to stop it from spreading
  • do not scratch the area with the infection, as this can make the infection worse
  • keep the affected areas of your skin clean and dry
  • do not share towels, bedsheets or combs with other people as you could spread the infection to them
  • wash towels and bedding regularly