{"id":53706,"date":"2023-09-20T09:49:35","date_gmt":"2023-09-20T09:49:35","guid":{"rendered":"https:\/\/medsname.com\/ketocip\/"},"modified":"2026-04-30T10:25:10","modified_gmt":"2026-04-30T10:25:10","slug":"ketocip","status":"publish","type":"product","link":"https:\/\/medsbase.com\/el\/ketocip\/","title":{"rendered":"Ketocip"},"content":{"rendered":"<p><!-- medsbase-tldr-answer --><\/p>\n<div style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:14px 20px;margin:18px 0;border-radius:6px;\">\n<h3 style=\"margin-top:0;\">\ud83d\udca1 \u0393\u03c1\u03ae\u03b3\u03bf\u03c1\u03b7 \u0391\u03c0\u03ac\u03bd\u03c4\u03b7\u03c3\u03b7<\/h3>\n<p style=\"margin-bottom:0;\">Ketocip is ketoconazole 200 mg oral tablet \u2014 an older imidazole antifungal. <strong>FDA, EMA, MHRA, Health Canada have all restricted oral ketoconazole because of severe hepatotoxicity, adrenal insufficiency, and drug-interaction risk.<\/strong> Should NOT be used as first-line for skin, vaginal, or nail fungal infections \u2014 fluconazole \/ itraconazole \/ terbinafine are safer. Remaining narrow indications: endemic mycoses (blastomycosis, paracoccidioidomycosis) where alternatives have failed, and Cushing&#8217;s syndrome (off-label cortisol-suppression). Topical ketoconazole (cream, lotion, shampoo) is unaffected by these warnings.<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f5f5f5;border:1px solid #e1e1e1;padding:18px 22px;margin:24px 0;border-radius:8px;display:flex;flex-wrap:wrap;justify-content:space-around;gap:16px;align-items:center;font-size:0.95em;\">\n<div style=\"text-align:center;flex:1;min-width:140px;\">\ud83c\udfed<br \/><strong>WHO-GMP<\/strong><br \/>\u03c0\u03b9\u03c3\u03c4\u03bf\u03c0\u03bf\u03b9\u03b7\u03bc\u03ad\u03bd\u03bf\u03c2 \u03ba\u03b1\u03c4\u03b1\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03c4\u03ae\u03c2<\/div>\n<p class=\"medsbase-reship-line\" style=\"font-size:14px;color:#444;margin:8px 0 18px;\">\ud83d\udce6 \u039a\u03ac\u03b8\u03b5 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03b5\u03bb\u03af\u03b1 \u03ba\u03b1\u03bb\u03cd\u03c0\u03c4\u03b5\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c4\u03b7\u03bd <a href=\"https:\/\/medsbase.com\/el\/medsbase-re-shipment-assurance-policy\/\"><strong>\u03a0\u03bf\u03bb\u03b9\u03c4\u03b9\u03ba\u03ae \u0395\u03b3\u03b3\u03cd\u03b7\u03c3\u03b7\u03c2 \u0395\u03c0\u03b1\u03bd\u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae\u03c2<\/strong><\/a> \u2014 \u03b5\u03ac\u03bd \u03c4\u03bf \u03b4\u03ad\u03bc\u03b1 \u03c3\u03b1\u03c2 \u03b4\u03b5\u03bd \u03c6\u03c4\u03ac\u03c3\u03b5\u03b9 \u03b5\u03bd\u03c4\u03cc\u03c2 20 \u03b5\u03c1\u03b3\u03ac\u03c3\u03b9\u03bc\u03c9\u03bd \u03b7\u03bc\u03b5\u03c1\u03ce\u03bd, \u03c4\u03bf \u03b5\u03c0\u03b1\u03bd\u03b1\u03c0\u03bf\u03c3\u03c4\u03ad\u03bb\u03bb\u03bf\u03c5\u03bc\u03b5.<\/p>\n<h3>\u0393\u03b9\u03b1\u03c4\u03af \u03bd\u03b1 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03b5\u03af\u03bb\u03b5\u03c4\u03b5 \u03b1\u03c0\u03cc \u03c4\u03b7 MedsBase<\/h3>\n<p>\u03a4\u03b1 \u03b3\u03b5\u03bd\u03cc\u03c3\u03b7\u03bc\u03b1 \u03c6\u03ac\u03c1\u03bc\u03b1\u03ba\u03ac \u03bc\u03b1\u03c2 \u03c0\u03c1\u03bf\u03ad\u03c1\u03c7\u03bf\u03bd\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03ba\u03b1\u03c4\u03b1\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03c4\u03ad\u03c2 \u03c0\u03bf\u03c5 \u03c0\u03b9\u03c3\u03c4\u03bf\u03c0\u03bf\u03b9\u03bf\u03cd\u03bd\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c4\u03b7\u03bd WHO-GMP \u03ba\u03b1\u03b9 \u03b1\u03c0\u03bf\u03c3\u03c4\u03ad\u03bb\u03bb\u03bf\u03bd\u03c4\u03b1\u03b9 \u03c0\u03b1\u03b3\u03ba\u03bf\u03c3\u03bc\u03af\u03c9\u03c2 \u03c3\u03b5 \u03b4\u03b9\u03b1\u03ba\u03c1\u03b9\u03c4\u03b9\u03ba\u03ae, \u03b1\u03c0\u03bb\u03ae \u03c3\u03c5\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03af\u03b1 \u2014 \u03c7\u03c9\u03c1\u03af\u03c2 \u03cc\u03bd\u03bf\u03bc\u03b1 \u03c6\u03b1\u03c1\u03bc\u03ac\u03ba\u03bf\u03c5 \u03c3\u03c4\u03bf \u03b5\u03be\u03c9\u03c4\u03b5\u03c1\u03b9\u03ba\u03cc \u03c4\u03bf\u03c5 \u03b4\u03ad\u03bc\u03b1\u03c4\u03bf\u03c2. \u039f\u03b9 \u03c0\u03bb\u03b7\u03c1\u03c9\u03bc\u03ad\u03c2 \u03bc\u03b5 \u03ba\u03ac\u03c1\u03c4\u03b1 \u03b4\u03c1\u03bf\u03bc\u03bf\u03bb\u03bf\u03b3\u03bf\u03cd\u03bd\u03c4\u03b1\u03b9 \u03bc\u03ad\u03c3\u03c9 \u03c1\u03c5\u03b8\u03bc\u03b9\u03c3\u03bc\u03ad\u03bd\u03bf\u03c5 \u03b5\u03c0\u03b5\u03be\u03b5\u03c1\u03b3\u03b1\u03c3\u03c4\u03ae (\u03bf\u03b9 \u03c0\u03b5\u03c1\u03b9\u03b3\u03c1\u03b1\u03c6\u03ad\u03c2 \u03b5\u03ba\u03ba\u03b1\u03b8\u03ac\u03c1\u03b9\u03c3\u03b7\u03c2 \u03c0\u03b5\u03c1\u03b9\u03bb\u03b1\u03bc\u03b2\u03ac\u03bd\u03bf\u03c5\u03bd \u03c1\u03c5\u03b8\u03bc\u03b9\u03c3\u03bc\u03ad\u03bd\u03bf \u03b5\u03c0\u03b5\u03be\u03b5\u03c1\u03b3\u03b1\u03c3\u03c4\u03ae \u03c0\u03bb\u03b7\u03c1\u03c9\u03bc\u03ce\u03bd \u03bc\u03b5 \u03ba\u03ac\u03c1\u03c4\u03b1 \u2014 \u03c0\u03bf\u03c4\u03ad \u201cMedsBase\u201d \u03ae \u03bf\u03c0\u03bf\u03b9\u03bf\u03b4\u03ae\u03c0\u03bf\u03c4\u03b5 \u03cc\u03bd\u03bf\u03bc\u03b1 \u03c6\u03b1\u03c1\u03bc\u03ac\u03ba\u03bf\u03c5). \u0393\u03af\u03bd\u03bf\u03bd\u03c4\u03b1\u03b9 \u03b4\u03b5\u03ba\u03c4\u03ad\u03c2 \u03ba\u03b1\u03b9 \u03c0\u03bb\u03b7\u03c1\u03c9\u03bc\u03ad\u03c2 \u03bc\u03b5 \u03ba\u03c1\u03c5\u03c0\u03c4\u03bf\u03bd\u03bf\u03bc\u03af\u03c3\u03bc\u03b1\u03c4\u03b1 \u03ba\u03b1\u03b9 \u03c4\u03c1\u03b1\u03c0\u03b5\u03b6\u03b9\u03ba\u03ae \u03bc\u03b5\u03c4\u03b1\u03c6\u03bf\u03c1\u03ac SEPA. \u039a\u03ac\u03b8\u03b5 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03b5\u03bb\u03af\u03b1 \u03ba\u03b1\u03bb\u03cd\u03c0\u03c4\u03b5\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c4\u03b7\u03bd \u03a0\u03bf\u03bb\u03b9\u03c4\u03b9\u03ba\u03ae \u0395\u03c0\u03b1\u03bd\u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae\u03c2 \u0395\u03be\u03b1\u03c3\u03c6\u03b1\u03bb\u03af\u03c3\u03b5\u03ce\u03c2 \u03bc\u03b1\u03c2.<\/p>\n<div style=\"text-align:center;flex:1;min-width:140px;\">\ud83d\udce6<br \/><strong>\u0394\u03b9\u03b1\u03ba\u03c1\u03b9\u03c4\u03b9\u03ba\u03ae \u03c3\u03c5\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03af\u03b1<\/strong><br \/>\u03b1\u03c0\u03bb\u03cc \u03c6\u03ac\u03ba\u03b5\u03bb\u03bf<\/div>\n<div style=\"text-align:center;flex:1;min-width:140px;\">\ud83c\udf0d<br \/><strong>\u03a0\u03b1\u03b3\u03ba\u03cc\u03c3\u03bc\u03b9\u03b1 \u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae<\/strong><br \/>\u03c3\u03c4\u03b9\u03c2 \u03c0\u03b5\u03c1\u03b9\u03c3\u03c3\u03cc\u03c4\u03b5\u03c1\u03b5\u03c2 \u03c7\u03ce\u03c1\u03b5\u03c2<\/div>\n<div style=\"text-align:center;flex:1;min-width:140px;\">\u2b50<br \/><strong>1,400+ \u03c0\u03b5\u03bb\u03ac\u03c4\u03b5\u03c2<\/strong><br \/><a href=\"https:\/\/medsbase.com\/el\/reviews\/\">\u03b4\u03b9\u03b1\u03b2\u03ac\u03c3\u03c4\u03b5 \u03ba\u03c1\u03b9\u03c4\u03b9\u03ba\u03ad\u03c2<\/a><\/div>\n<\/div>\n<h2>\ud83d\udd12 Why order Ketocip from MedsBase<\/h2>\n<ul>\n<li><strong>\u03c0\u03b9\u03c3\u03c4\u03bf\u03c0\u03bf\u03b9\u03b7\u03bc\u03ad\u03bd\u03bf \u03b1\u03c0\u03cc \u03c4\u03b7 WHO-GMP \u03ba\u03b1\u03c4\u03b1\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03c4\u03ae<\/strong> \u2014 \u03c0\u03c1\u03bf\u03ad\u03c1\u03c7\u03b5\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c1\u03c5\u03b8\u03bc\u03b9\u03b6\u03cc\u03bc\u03b5\u03bd\u03b7 \u03b5\u03b3\u03ba\u03b1\u03c4\u03ac\u03c3\u03c4\u03b1\u03c3\u03b7, \u03bf\u03bb\u03bf\u03ba\u03bb\u03b7\u03c1\u03c9\u03bc\u03ad\u03bd\u03b7 \u03c3\u03c5\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03af\u03b1 \u03bc\u03b5 \u03b1\u03c1\u03b9\u03b8\u03bc\u03cc \u03c0\u03b1\u03c1\u03c4\u03af\u03b4\u03b1\u03c2 \u03ba\u03b1\u03b9 \u03b7\u03bc\u03b5\u03c1\u03bf\u03bc\u03b7\u03bd\u03af\u03b1 \u03bb\u03ae\u03be\u03b7\u03c2.<\/li>\n<li><strong>\u0394\u03b9\u03b1\u03ba\u03c1\u03b9\u03c4\u03b9\u03ba\u03ae \u03c3\u03c5\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03af\u03b1<\/strong> \u2014 \u03b1\u03c0\u03bb\u03cc \u03c6\u03ac\u03ba\u03b5\u03bb\u03bf, \u03c7\u03c9\u03c1\u03af\u03c2 \u03cc\u03bd\u03bf\u03bc\u03b1 \u03c6\u03b1\u03c1\u03bc\u03ac\u03ba\u03bf\u03c5 \u03c3\u03c4\u03bf \u03b5\u03be\u03c9\u03c4\u03b5\u03c1\u03b9\u03ba\u03cc.<\/li>\n<li><strong>\u03a0\u03b1\u03b3\u03ba\u03cc\u03c3\u03bc\u03b9\u03b1 \u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae<\/strong> \u03c3\u03c4\u03b9\u03c2 \u03c0\u03b5\u03c1\u03b9\u03c3\u03c3\u03cc\u03c4\u03b5\u03c1\u03b5\u03c2 \u03c7\u03ce\u03c1\u03b5\u03c2 \u03bc\u03b5 <a href=\"https:\/\/medsbase.com\/el\/medsbase-re-shipment-assurance-policy\/\">Reshipment Assurance<\/a>.<\/li>\n<li><strong>\u03a0\u03cc\u03bd\u03c4\u03bf\u03b9 \u03b1\u03c6\u03bf\u03c3\u03af\u03c9\u03c3\u03b7\u03c2<\/strong> \u2014 1 \u03c0\u03cc\u03bd\u03c4\u03bf\u03c2 \u03b1\u03bd\u03ac $1 \u03c0\u03bf\u03c5 \u03be\u03bf\u03b4\u03b5\u03cd\u03b5\u03c4\u03b5 (\u03b5\u03be\u03b1\u03b9\u03c1\u03bf\u03cd\u03bd\u03c4\u03b1\u03b9 \u03c4\u03b1 \u03c0\u03b5\u03c0\u03c4\u03af\u03b4\u03b9\u03b1\/\u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae)\u00b7 100 \u03c0\u03cc\u03bd\u03c4\u03bf\u03c5\u03c2 = $5 \u03ad\u03ba\u03c0\u03c4\u03c9\u03c3\u03b7 \u03c3\u03c4\u03b7\u03bd \u03b5\u03c0\u03cc\u03bc\u03b5\u03bd\u03b7 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03b5\u03bb\u03af\u03b1 \u03c3\u03b1\u03c2.<\/li>\n<\/ul>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:14px 20px;margin:20px 0;border-radius:6px;\"><strong>FDA black-box warning \u2014 oral ketoconazole<\/strong><\/p>\n<div>\n<p>Following 2013 reviews, regulatory agencies have largely de-licensed oral ketoconazole for routine fungal infections:<\/p>\n<ul>\n<li><strong>Severe hepatotoxicity<\/strong> \u2014 fatal liver failure has occurred even on short courses. Risk is dose-related and idiosyncratic.<\/li>\n<li><strong>Adrenal insufficiency<\/strong> \u2014 ketoconazole inhibits adrenal steroidogenesis at therapeutic doses (this is why it is used off-label for Cushing&#8217;s).<\/li>\n<li><strong>QT prolongation and torsades<\/strong> with co-administered drugs metabolised by CYP3A4.<\/li>\n<li><strong>Major drug interactions<\/strong> via potent CYP3A4 inhibition.<\/li>\n<\/ul>\n<p><strong>For vaginal candidiasis, oropharyngeal thrush, dermatophyte tinea \/ onychomycosis, or pityriasis versicolor \u2014 use fluconazole, itraconazole, or terbinafine instead.<\/strong> Topical ketoconazole cream \/ lotion \/ shampoo is unaffected \u2014 it is poorly absorbed and remains a sound choice for skin and scalp.<\/p>\n<\/div>\n<\/div>\n<h2 id=\"uses\">Remaining narrow indications<\/h2>\n<p>Ketocip (ketoconazole 200 mg, Cipla) in oral form is now used only when other antifungal agents are not tolerated or are contraindicated, or in specific indications where it remains evidence-based:<\/p>\n<ul>\n<li>Endemic mycoses \u2014 blastomycosis, paracoccidioidomycosis, histoplasmosis, chromoblastomycosis \u2014 where amphotericin B or itraconazole have failed or are not available.<\/li>\n<li>Cushing&#8217;s syndrome \u2014 second-line cortisol-lowering agent (off-label, hospital-initiated, monitored).<\/li>\n<li>Recalcitrant pityriasis versicolor that has failed topical and oral fluconazole \/ itraconazole.<\/li>\n<\/ul>\n<h2 id=\"dose\">Dose &#038; monitoring<\/h2>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;font-size:0.95em;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u0395\u03bd\u03b4\u03b5\u03af\u03be\u03b5\u03b9\u03c2<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u03a0\u03c1\u03cc\u03b3\u03c1\u03b1\u03bc\u03bc\u03b1 \u03b8\u03b5\u03c1\u03b1\u03c0\u03b5\u03af\u03b1\u03c2<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Endemic mycoses<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">200\u2013400 mg daily with food; duration as advised by infectious-diseases specialist (often 6\u201312 months)<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Cushing&#8217;s syndrome (off-label)<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">200 mg twice daily, titrated to 400\u20131200 mg\/day in divided doses<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Monitoring is non-negotiable:<\/strong><\/p>\n<ul>\n<li>Baseline LFTs, then every 2 weeks for first 2 months, then monthly.<\/li>\n<li>Discontinue immediately if AST\/ALT &gt; 3\u00d7 ULN OR jaundice, dark urine, or persistent nausea.<\/li>\n<li>Baseline ECG; repeat if QT-prolonging drugs co-prescribed.<\/li>\n<li>For Cushing&#8217;s use: morning cortisol, urinary free cortisol, and ACTH stim if symptoms suggestive of adrenal insufficiency.<\/li>\n<\/ul>\n<h2 id=\"how-to-take\">\u03a0\u03ce\u03c2 \u03bd\u03b1 \u03c0\u03ac\u03c1\u03b5\u03c4\u03b5<\/h2>\n<p>Take with a meal \u2014 gastric acid is required for capsule dissolution and absorption. Avoid concurrent PPIs \/ H2-blockers \/ antacids unless separated by \u2265 2 hours.<\/p>\n<h2 id=\"mechanism\">\u03a0\u03ce\u03c2 \u03bb\u03b5\u03b9\u03c4\u03bf\u03c5\u03c1\u03b3\u03b5\u03af<\/h2>\n<p>Ketoconazole inhibits fungal CYP51 (lanosterol 14-\u03b1-demethylase) \u2014 the same target as fluconazole and itraconazole. It is less selective than the newer triazoles, also inhibiting human steroidogenesis enzymes (CYP17, CYP11B1, CYP11B2) \u2014 the basis both for Cushing&#8217;s use and for adrenal insufficiency as a side effect.<\/p>\n<h2 id=\"side-effects\">\u03a0\u03b1\u03c1\u03b5\u03bd\u03ad\u03c1\u03b3\u03b5\u03b9\u03b5\u03c2<\/h2>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;font-size:0.95em;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u03a3\u03c5\u03c7\u03bd\u03cc\u03c4\u03b7\u03c4\u03b1<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">Effects<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u03a3\u03c5\u03c7\u03bd\u03ac<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Nausea, abdominal pain, headache, dizziness, gynaecomastia (men, dose-related)<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03c3\u03c5\u03bd\u03ae\u03b8\u03b9\u03c3\u03c4\u03b5\u03c2<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Loss of libido, oligospermia, photophobia<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u03a3\u03c0\u03ac\u03bd\u03b9\u03b1 \u03b1\u03bb\u03bb\u03ac \u03c3\u03bf\u03b2\u03b1\u03c1\u03ae<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\"><strong>Fatal hepatotoxicity<\/strong> (1 in ~10 000 \u2014 idiosyncratic, can occur within first month), adrenal insufficiency, QT prolongation, anaphylaxis, severe skin reactions<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 id=\"interactions\">\u0391\u03bb\u03bb\u03b7\u03bb\u03b5\u03c0\u03b9\u03b4\u03c1\u03ac\u03c3\u03b5\u03b9\u03c2 \u03c6\u03b1\u03c1\u03bc\u03ac\u03ba\u03c9\u03bd<\/h2>\n<p>Ketoconazole is among the most potent CYP3A4 inhibitors known \u2014 it raises levels of any drug metabolised by CYP3A4. Selected major interactions:<\/p>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;font-size:0.95em;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u03a6\u03ac\u03c1\u03bc\u03b1\u03ba\u03bf<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u0391\u03c0\u03bf\u03c4\u03ad\u03bb\u03b5\u03c3\u03bc\u03b1<\/th>\n<th style=\"padding:8px;text-align:left;border:1px solid #ccc;\">\u0394\u03c1\u03ac\u03c3\u03b7<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Pimozide, terfenadine, astemizole, cisapride, dofetilide, quinidine<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">QT prolongation \u2192 torsades<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03bd\u03c4\u03b5\u03bd\u03b4\u03b5\u03b9\u03ba\u03bd\u03cd\u03b5\u03c4\u03b1\u03b9<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Triazolam, midazolam, alprazolam (oral)<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Severe sedation<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03bd\u03c4\u03b5\u03bd\u03b4\u03b5\u03b9\u03ba\u03bd\u03cd\u03b5\u03c4\u03b1\u03b9<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Statins (simvastatin, atorvastatin, lovastatin)<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u03a1\u03b1\u03b2\u03b4\u03bf\u03bc\u03c5\u03cc\u03bb\u03c5\u03c3\u03b7<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Contraindicated; switch to pravastatin \/ rosuvastatin<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0395\u03c1\u03b3\u03bf\u03c4\u03b1\u03bb\u03b9\u03ba\u03ac \u03b1\u03bb\u03ba\u03b1\u03bb\u03bf\u03b5\u03b9\u03b4\u03ae<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Vasoconstriction, ergotism<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03bd\u03c4\u03b5\u03bd\u03b4\u03b5\u03b9\u03ba\u03bd\u03cd\u03b5\u03c4\u03b1\u03b9<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Tacrolimus, ciclosporin, sirolimus<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Toxicity<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Reduce dose substantially; trough monitoring<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0392\u03b1\u03c1\u03c6\u03b1\u03c1\u03af\u03bd\u03b7<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">INR rises<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u03a0\u03b1\u03c1\u03b1\u03ba\u03bf\u03bb\u03bf\u03c5\u03b8\u03ae\u03c3\u03c4\u03b5 \u03c3\u03c4\u03b5\u03bd\u03ac<\/td>\n<\/tr>\n<tr style=\"background:#fff;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Apixaban, rivaroxaban<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">Bleeding<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03c0\u03bf\u03c6\u03cd\u03b3\u03b5\u03c4\u03b5<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:8px;border:1px solid #ccc;\">Methadone<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">QT prolongation, sedation<\/td>\n<td style=\"padding:8px;border:1px solid #ccc;\">\u0391\u03c0\u03bf\u03c6\u03cd\u03b3\u03b5\u03c4\u03b5<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 id=\"contraindications\">\u0391\u03bd\u03c4\u03b5\u03bd\u03b4\u03b5\u03af\u03be\u03b5\u03b9\u03c2<\/h2>\n<ul>\n<li>Acute or chronic liver disease.<\/li>\n<li>Concurrent QT-prolonging drugs above.<\/li>\n<li>Concurrent simvastatin \/ atorvastatin \/ lovastatin \/ triazolam \/ midazolam (oral) \/ ergot alkaloids.<\/li>\n<li>\u0395\u03b3\u03ba\u03c5\u03bc\u03bf\u03c3\u03cd\u03bd\u03b7 \u03ba\u03b1\u03b9 \u03b8\u03b7\u03bb\u03b1\u03c3\u03bc\u03cc\u03c2.<\/li>\n<li>Hypersensitivity to azoles.<\/li>\n<\/ul>\n<h2 id=\"faqs\">\u03a3\u03c5\u03c7\u03bd\u03ad\u03c2 \u0395\u03c1\u03c9\u03c4\u03ae\u03c3\u03b5\u03b9\u03c2<\/h2>\n<h3>Why is oral ketoconazole &#8216;restricted&#8217;?<\/h3>\n<p>FDA, EMA, MHRA, and Health Canada concluded between 2013 and 2014 that fatal hepatotoxicity made oral ketoconazole unsuitable for routine fungal infections when safer alternatives exist (fluconazole, itraconazole, terbinafine). Topical ketoconazole shampoo \/ cream is unaffected \u2014 it is poorly absorbed.<\/p>\n<h3>Should I be on this for athlete&#8217;s foot or thrush?<\/h3>\n<p>Almost certainly not. Standard care for vaginal candidiasis is fluconazole 150 mg single dose; for tinea pedis a 4-week topical antifungal or oral terbinafine; for oral thrush fluconazole or itraconazole oral solution. Discuss switching with your clinician.<\/p>\n<h3>Is topical ketoconazole still safe?<\/h3>\n<p>Yes \u2014 ketoconazole shampoo (for seborrhoeic dermatitis, dandruff) and cream \/ lotion (for tinea, candidiasis, pityriasis versicolor) are not affected by these regulatory restrictions. Topical absorption is minimal.<\/p>\n<h3>What does ketoconazole do to my hormones?<\/h3>\n<p>It inhibits adrenal cortisol synthesis (this is why it&#8217;s used off-label for Cushing&#8217;s) and testicular testosterone synthesis. Chronic high-dose oral therapy can cause adrenal insufficiency, gynaecomastia in men, oligospermia, loss of libido, and menstrual irregularity in women.<\/p>\n<h3>What are the symptoms of liver damage?<\/h3>\n<p>Yellowing of skin or eyes, dark urine, pale stools, persistent nausea, right-upper-quadrant pain, severe fatigue, confusion. Stop the drug immediately and seek medical advice. Hepatotoxicity can be sudden and fatal \u2014 early recognition matters.<\/p>\n<h3>What if I have already finished a short course of ketoconazole?<\/h3>\n<p>If you completed a short course (e.g. 1\u20132 weeks for blastomycosis or refractory pityriasis versicolor) without symptoms, you are unlikely to develop delayed hepatotoxicity now. If you have any symptoms (jaundice, dark urine), seek medical advice. Future fungal infections \u2014 discuss safer alternatives.<\/p>\n<h3>Why is ketoconazole sometimes still used for Cushing&#8217;s syndrome?<\/h3>\n<p>Because it inhibits adrenal cortisol synthesis. In Cushing&#8217;s, this is the desired effect \u2014 to lower an excess. Specialist endocrinology supervision; metyrapone, mifepristone, osilodrostat, or bilateral adrenalectomy are alternatives.<\/p>\n<h3>Can ketoconazole be used in cancer (prostate, etc.)?<\/h3>\n<p>Historically used at high doses (1200 mg\/day) to suppress testicular and adrenal androgen synthesis in advanced prostate cancer. Now largely replaced by abiraterone, enzalutamide, etc. Not first-line oncology therapy.<\/p>\n<h3>Is Ketocip the same as Nizoral?<\/h3>\n<p>Yes \u2014 Nizoral is the original Janssen brand of ketoconazole. Ketocip is the same active ingredient, manufactured by Cipla under WHO-GMP. The regulatory restrictions apply equally to all brands of oral ketoconazole.<\/p>\n<h3>What antifungal should I be on instead?<\/h3>\n<p>Depends on the infection. Vaginal candidiasis \u2192 fluconazole 150 mg single dose. Oral thrush \u2192 fluconazole 100 mg\/day \u00d7 7 days. Tinea pedis \/ cruris \u2192 topical terbinafine cream \u00d7 1\u20134 weeks. Onychomycosis \u2192 oral terbinafine 250 mg\/day \u00d7 6 weeks (fingernails) or 12 weeks (toenails). Pityriasis versicolor \u2192 topical ketoconazole shampoo or oral fluconazole.<\/p>\n<h2 id=\"storage\">\u0391\u03c0\u03bf\u03b8\u03ae\u03ba\u03b5\u03c5\u03c3\u03b7<\/h2>\n<p>Store tablets at 15\u201325 \u00b0C, away from moisture and light. Do not use after expiry. Keep out of reach of children.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h2>\u0386\u03bb\u03bb\u03b1 \u0391\u03bd\u03c4\u03b9\u03bc\u03c5\u03ba\u03b7\u03c4\u03b9\u03b1\u03c3\u03b9\u03ba\u03ac \u03a6\u03ac\u03c1\u03bc\u03b1\u03ba\u03b1 \u03c0\u03bf\u03c5 \u03bc\u03c0\u03bf\u03c1\u03b5\u03af \u03bd\u03b1 \u03c3\u03b1\u03c2 \u03b5\u03bd\u03b4\u03b9\u03b1\u03c6\u03ad\u03c1\u03bf\u03c5\u03bd<\/h2>\n<p>Oral ketoconazole is no longer first-line for routine fungal infections. Listed below are recommended alternatives for the common indications.<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/el\/zocon\/\"><strong>Zocon (\u03c6\u03bb\u03bf\u03c5\u03ba\u03bf\u03bd\u03b1\u03b6\u03cc\u03bb\u03b7 150 mg)<\/strong><\/a> \u2014 Oral first-line for Candida \u2014 safer than oral ketoconazole.<\/li>\n<li><a href=\"https:\/\/medsbase.com\/el\/zimig\/\"><strong>Zimig (terbinafine 250 mg)<\/strong><\/a> \u2014 First-line oral for dermatophyte nail \/ scalp \/ extensive skin.<\/li>\n<li><a href=\"https:\/\/medsbase.com\/el\/sporanox-capsule\/\"><strong>Sporanox (itraconazole 100 mg)<\/strong><\/a> \u2014 For non-dermatophyte moulds, dimorphic mycoses, mixed Candida.<\/li>\n<li><a href=\"https:\/\/medsbase.com\/el\/keto-cream\/\"><strong>Keto Cream (ketoconazole 2%)<\/strong><\/a> \u2014 Topical ketoconazole \u2014 safe even though oral is restricted.<\/li>\n<li><a href=\"https:\/\/medsbase.com\/el\/clocip\/\"><strong>Clocip (clotrimazole 1% \u03ba\u03c1\u03ad\u03bc\u03b1)<\/strong><\/a> \u2014 Topical broad-spectrum antifungal.<\/li>\n<\/ul>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:12px 18px;margin:24px 0;font-size:0.95em;\"><strong>\u0399\u03b1\u03c4\u03c1\u03b9\u03ba\u03ae \u03b1\u03c0\u03bf\u03c0\u03bf\u03af\u03b7\u03c3\u03b7 \u03b5\u03c5\u03b8\u03c5\u03bd\u03ce\u03bd.<\/strong> \u0391\u03c5\u03c4\u03ae \u03b7 \u03c3\u03b5\u03bb\u03af\u03b4\u03b1 \u03c0\u03b1\u03c1\u03ad\u03c7\u03b5\u03b9 \u03c0\u03bb\u03b7\u03c1\u03bf\u03c6\u03bf\u03c1\u03af\u03b5\u03c2 \u03c0\u03c1\u03bf\u03ca\u03cc\u03bd\u03c4\u03c9\u03bd \u03b3\u03b9\u03b1 \u03b5\u03bd\u03ae\u03bb\u03b9\u03ba\u03b5\u03c2 \u03c0\u03bf\u03c5 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03ad\u03bb\u03bd\u03bf\u03c5\u03bd \u03b1\u03bd\u03c4\u03b9\u03bc\u03c5\u03ba\u03b7\u03c4\u03b9\u03b1\u03c3\u03b9\u03ba\u03ac \u03c6\u03ac\u03c1\u03bc\u03b1\u03ba\u03b1 \u03b3\u03b9\u03b1 \u03c0\u03c1\u03bf\u03c3\u03c9\u03c0\u03b9\u03ba\u03ae \u03c7\u03c1\u03ae\u03c3\u03b7. \u0394\u03b5\u03bd \u03b1\u03c0\u03bf\u03c4\u03b5\u03bb\u03b5\u03af \u03c5\u03c0\u03bf\u03ba\u03b1\u03c4\u03ac\u03c3\u03c4\u03b1\u03c4\u03bf \u03b5\u03be\u03b1\u03c4\u03bf\u03bc\u03b9\u03ba\u03b5\u03c5\u03bc\u03ad\u03bd\u03b7\u03c2 \u03b9\u03b1\u03c4\u03c1\u03b9\u03ba\u03ae\u03c2 \u03c3\u03c5\u03bc\u03b2\u03bf\u03c5\u03bb\u03ae\u03c2. \u03a3\u03c5\u03b6\u03b7\u03c4\u03ae\u03c3\u03c4\u03b5 \u03c4\u03bf \u03ba\u03b1\u03c4\u03ac\u03bb\u03bb\u03b7\u03bb\u03bf \u03b1\u03bd\u03c4\u03b9\u03bc\u03c5\u03ba\u03b7\u03c4\u03b9\u03b1\u03c3\u03b9\u03ba\u03cc, \u03c4\u03b7 \u03b4\u03cc\u03c3\u03b7 \u03ba\u03b1\u03b9 \u03c4\u03b7 \u03b4\u03b9\u03ac\u03c1\u03ba\u03b5\u03b9\u03b1 \u03b8\u03b5\u03c1\u03b1\u03c0\u03b5\u03af\u03b1\u03c2 \u03bc\u03b5 \u03ad\u03bd\u03b1\u03bd \u03b5\u03b9\u03b4\u03b9\u03ba\u03b5\u03c5\u03bc\u03ad\u03bd\u03bf \u03ba\u03bb\u03b9\u03bd\u03b9\u03ba\u03cc \u2014 \u03b5\u03b9\u03b4\u03b9\u03ba\u03ac \u03b5\u03ac\u03bd \u03ad\u03c7\u03b5\u03c4\u03b5 \u03b7\u03c0\u03b1\u03c4\u03b9\u03ba\u03ae \u03bd\u03cc\u03c3\u03bf, \u03b5\u03af\u03c3\u03c4\u03b5 \u03ad\u03b3\u03ba\u03c5\u03bf\u03c2 \u03ae \u03b8\u03b7\u03bb\u03ac\u03b6\u03b5\u03c4\u03b5, \u03c0\u03b1\u03af\u03c1\u03bd\u03b5\u03c4\u03b5 warfarin, \u03c0\u03b1\u03af\u03c1\u03bd\u03b5\u03c4\u03b5 \u03c3\u03c4\u03b1\u03c4\u03af\u03bd\u03b7, \u03c0\u03b1\u03af\u03c1\u03bd\u03b5\u03c4\u03b5 \u03b1\u03bd\u03bf\u03c3\u03bf\u03ba\u03b1\u03c4\u03b1\u03c3\u03c4\u03b1\u03bb\u03c4\u03b9\u03ba\u03ac \u03ae \u03ad\u03c7\u03b5\u03c4\u03b5 \u03bc\u03c5\u03ba\u03b7\u03c4\u03b9\u03b1\u03c3\u03b9\u03ba\u03ae \u03bc\u03cc\u03bb\u03c5\u03bd\u03c3\u03b7 \u03bd\u03c5\u03c7\u03b9\u03ce\u03bd \u03c0\u03bf\u03c5 \u03bc\u03c0\u03bf\u03c1\u03b5\u03af \u03bd\u03b1 \u03b5\u03af\u03bd\u03b1\u03b9 \u03b4\u03b9\u03b1\u03c6\u03bf\u03c1\u03b5\u03c4\u03b9\u03ba\u03ae \u03b4\u03b9\u03ac\u03b3\u03bd\u03c9\u03c3\u03b7 (\u03c8\u03c9\u03c1\u03af\u03b1\u03c3\u03b7, \u03b5\u03c1\u03c5\u03b8\u03b7\u03bc\u03b1\u03c4\u03ce\u03b4\u03b7\u03c2 \u03bb\u03b5\u03b9\u03c7\u03ae\u03bd\u03b1\u03c2, \u03c4\u03c1\u03b1\u03c5\u03bc\u03b1\u03c4\u03b9\u03c3\u03bc\u03cc\u03c2).<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<h5>\u2705 Treats broad fungal infections<br \/>\n\u2705 Targets resistant strains<br \/>\n\u2705 Easy to use<\/h5>\n<p><span style=\"color: #999999;\">Ketocip contains Ketoconazole<\/span><\/p>","protected":false},"featured_media":53707,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3501,3141,3504,3342],"product_tag":[3625,3623],"class_list":{"0":"post-53706","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-anti-fungal","7":"product_cat-category-overview","8":"product_cat-fungal-infection-treatment","9":"product_cat-general-health","10":"product_tag-ketocip","11":"product_tag-ketoconazole","13":"first","14":"outofstock","15":"shipping-taxable","16":"purchasable","17":"product-type-variable","18":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/product\/53706","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/comments?post=53706"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/media\/53707"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/media?parent=53706"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/product_brand?post=53706"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/product_cat?post=53706"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/el\/wp-json\/wp\/v2\/product_tag?post=53706"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}