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Oral Ketoconazole Shouldn't Be First Choice for Fungal Infections — Physician’s First Watch

Medical News |
July 29, 2013

Oral Ketoconazole Shouldn't Be First Choice for Fungal Infections

By Kristin J. Kelley

The oral antifungal ketoconazole (marketed as Nizoral) should not be used as a first-line treatment for any fungal infection because it may pose a risk for adrenal gland problems and potentially fatal liver injury, the FDA notified clinicians late last week.

Additionally, interactions with other drugs — including dofetilide, quinidine, pimozide, and cisapride — could cause heart rhythm problems.

Ketoconazole's label will now note that the tablets:

  • are no longer indicated for Candida and dermatophyte infections or for skin and nail infections;

  • should not be used in patients with acute or chronic liver disease; and

  • should only be used to treat endemic mycoses infections when patients don't respond to or can't tolerate other antifungal therapies.

Reader Comments (2)

Jay H Edwards, BS,JD Other

This statement from the FDA has no medical basis.
No new information about the risks of ketoconazole has emerged recently and severe side effects are very rare. It is an effective and very inexpensive drug with manageable side effects.
The only alternative is the vastly more expensive itraconazole, a derivative of ketoconazole.
This action reflects an agenda other than patient welfare...

Phillip Kirkland, MSPAS, PA-C Other Healthcare Professional, Family Medicine/General Practice

I appreciate the article on ketoconazole, however, no other drugs were mentioned to use in its place.

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