Drug reference

Ketoconazole

Antifungal

AntifungalATC null

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Manufacturer advises avoid—toxicity in

FDA category + note

Top interactionssee all 12 →

AstemizoleContraindicatedTextbook-citedKDT 7e · p948
CisaprideContraindicatedTextbook-citedKDT 7e · p948
TerfenadineContraindicatedTextbook-citedKDT 7e · p948
CilostazoleContraindicatedTextbookKDT 7e · p555

Mechanism

May have a direct effect on corticotropic tumour cells in patients with Cushing's disease.

Indications

Local treatment of vaginal candidiasisDermatophyte infectionsEndogenous Cushing's syndromeblocking androgen biosynthesis (for hirsutism)hypercortisolism (off-label)To reduce adrenal androgen synthesis in castration-resistant prostate cancer (CRPC) (off-label use, limited due to toxicity and inferiority compared to abiraterone acetate)yeast keratitis and endophthalmitisAcanthamoeba keratitis (adjunctive, oral, off-label)Dermatophytosis (oral, alternative to griseofulvin)Seborrhoea of scalp (topical lotion/shampoo)Dandruff (topical lotion/shampoo)Monilial vaginitis (oral, reserved for recurrent/non-responsive cases)Systemic mycosis (though triazoles largely preferred now)Dermal leishmaniasis (occasionally)Kala azar (occasionally)Cushing’s syndrome (high-dose to decrease corticosteroid production)SeborrhoeaSeborrheic dermatitisHypercortisolism associated with Cushing’s Syndrome Caused by Ectopic ACTH ProductionTopical treatment for common cutaneous mycosesTopical treatment for oropharyngeal candidiasisTopical treatment for vaginal candidiasis

Dosing

Adult: ▶ Adult (body-weight 61 kg and above): 60 mg once daily, duration of treatment adjusted according to risk ▶ factors—consult product literature), treatment should follow initial use of parenteral anticoagulant for at least 5 days DOSE ADJUSTMENTS DUE TO INTERACTIONS ▶ Manufacturer advises max. dose of 30 mg once daily with concurrent ciclosporin, dronedarone, erythromycin, or ketoconazole.…

Contraindications

Pregnant women
Nursing women

Side effects

Common

gynaecomastialoss of libido in menNauseaVomitingLoss of appetiteHeadacheParesthesiaRashesHair lossMild and asymptomatic elevation of serum transaminases (~5% patients)

Serious

liver toxicity
hepatic dysfunction
severe hepatic injury
Toxicity (general statement, refers to Chapter 61 for details)
Hormonal effects (decreased androgen production, displacement of testosterone, gynaecomastia, loss of hair/libido, oligozoospermia)
Menstrual irregularities (due to suppression of estradiol synthesis)
Dose-dependent decrease in serum hydrocortisone
Serious hepatotoxicity (infrequent)
hepatotoxicity
exfoliative skin disorders
anaphylaxis

Pregnancy & lactation

Pregnancy

Manufacturer advises avoid—toxicity in

Drug interactions

Astemizole

Contraindicated

Textbook-cited

Dangerous ventricular arrhythmia (QT prolongation, torsades de pointes)

Concurrent use is contraindicated

Source: KDT 7e · p948

Cisapride

Contraindicated

Textbook-cited

QT prolongation and ventricular arrhythmia

Concurrent use is contraindicated

Source: KDT 7e · p948

Terfenadine

Contraindicated

Textbook-cited

Dangerous ventricular arrhythmia (QT prolongation, torsades de pointes)

Concurrent use is contraindicated

Source: KDT 7e · p948

Cilostazole

Contraindicated

Textbook

Increased plasma levels and toxicity of cilostazole.

Should not be administered along with inhibitors of CYP3A4.

Source: KDT 7e · p555

Finerenone

Contraindicated

Textbook

Increased plasma levels of finerenone.

These drugs should not be administered concomitantly.

Source: G&G 14e · p570

Domperidone

Contraindicated

Database

Potent CYP3A4 inhibition increases domperidone levels and QT prolongation risk

Avoid combination

Source: Kimi deep-research + Cla

Midazolam (oral)

Contraindicated

Database

Markedly increased and prolonged sedative effects, respiratory depression

Concomitant use of oral midazolam is contraindicated. If a benzodiazepine is needed, consider one not metabolized by CYP3A4 or use parenteral midazolam with extreme caution and dose reduction.

Pimozide

Contraindicated

Database

Fatal cardiac arrhythmia

Contraindicated.

Source: DDInter

Ranolazine

Contraindicated

Database

Increased plasma levels and toxicity of ranolazine, including QT prolongation.

Should not be given to patients taking CYP3A4 inhibitors.

Source: DDInter