Ketoconazole: how to use ointment, pills and shampoo?

Naturally, the human body is inhabited by microorganisms that assist in the proper functioning of the organism.

However, despite living harmoniously, when there is an excessive proliferation of these beings or even the entry of organisms that are not part of the human microbiota, some problems can manifest themselves.

This is the case of diseases caused by fungi, such as mycoses, chilblains, respiratory and skin infections.

For the treatment of these conditions there are some medications and, among them, Ketoconazole.

Keep reading and learn more about the drug!


What is Ketoconazole?

Ketoconazole is an antifungal substance, used as an active ingredient in medicines. It is part of the group of imidazole antifungals, that is, synthetic derivatives of Imidazole (organic compound).

It is used to treat infections and diseases, such as mycoses, lung problems and seborrheic dermatitis on the scalp, caused by fungi.

Its administration can be systemic or topical, that is, through pills or shampoo and dermatological cream. The application may vary according to the patient’s clinical condition.

In addition, in its spray version, it is used to treat fungal infections in dogs and cats.

It is worth mentioning that Ketoconazole is a drug with a risk of severe hepatotoxicity, that is, it can cause serious damage to the liver.

Thus, the drug should be used only when the potential benefits are considered to be greater than the potential risks.

What is Ketoconazole indicated for?

The drug Ketoconazole is indicated for the treatment of pathologies caused by fungi such as Tinea cruris , which causes infections in the skin in the region of the genitals, and Blastomyces dermatitidis , which causes a lung infection. It is also used in the fight against fungal infections in dogs and cats.

The specific indication of use varies according to the presentation. In general, medication can be used to:


The tablet version of Ketoconazole is used to fight fungal infections in the skin, tissues and other internal organs that may be affected.

This type of presentation is generally used when other treatments are not tolerated or effective.

According to the package leaflet, some pathologies treated with the tablet are:

  • Blastomycosis – lung infection that can reach the bloodstream and skin;
  • Coccidioidomycosis – respiratory infection that can spread to other organs;
  • Histoplasmosis – infectious disease that affects the lungs and can spread throughout the body;
  • Chromomycosis – deep mycosis that affects the skin and subcutaneous tissue;
  • Paracoccidioidomycosis – progressive mycosis that affects the skin, mucous membranes and internal organs.

It is worth mentioning that Ketoconazole tablet is not indicated for cases of fungal meningitis – inflammation of the membranes that line the brain and spinal cord – since it has a low potential for penetration into brain fluid and meninges.

Cream or ointment

The cream or ointment version, that is, for topical use, is generally recommended for the treatment of problems, caused by fungi or yeasts, that reach the skin, such as chilblains.

According to the package insert, this presentation is used to:

  • Skin mycoses – fungal infections that affect the skin, nails and hair;
  • Chilblains (athlete’s foot) – infection caused by the fungus Tricophyton , which causes blisters, cracks and flaking in the feet and between the toes, causing severe itching;
  • White cloth – infection caused by the fungus Malassezia furfur , which causes discolored spots on the skin;
  • Cutaneous candidiasis – infection of the skin and mucous membranes caused by a fungus of the genus Candida .


Ketoconazole in shampoo form is indicated for the treatment of scalp infections in adults, caused by fungi or yeasts.

In general, it is used to combat seborrheic dermatitis , also called seborrhea.

This problem consists of a chronic inflammation of the skin that causes red patches and flaking, resulting in signs such as dandruff.


Ketoconazole spray is for animal use, indicated for the treatment of fungal infections in dogs and cats.

It can be used in puppies, adults or the elderly and, in general, is administered to combat pathologies that affect the hair, nails, skin and mucous membranes.

The application should be done 1 to 2 times a day, for a period of 40 to 45 days or until there is complete elimination of the fungus.

What is Ketoconazole + Betamethasone Dipropionate for?

The drug Ketoconazole in combination with Betamethasone Dipropionate is used for the treatment of dermatoses in general, in the wet phase, which have been affected or have potential infection by fungi or yeasts.

The combination of substances promotes a product that acts as an anti-inflammatory and antimycotic.

In general, they serve to:

  • Contact dermatitis – skin rash caused by contact with any substance that causes allergy;
  • Atopic dermatitis – itchy skin inflammation;
  • Seborrheic dermatitis – inflammation of the skin that causes reddish spots and flaking;
  • Intertrigo – irritation in hot and humid areas of the skin;
  • Dyshidrosis – appearance of blisters on the palms of the hands and soles of the feet that may be filled with liquid and cause severe itching;
  • Neurodermatitis – alteration in the texture of the skin due to the act of scratching or rubbing the region;
  • Eczemas – inflammation of the skin that causes swelling, itching and redness;
  • Inflammatory dermatoses .

The Ketoconazole has antimycotic action and inhibiting the growth of fungi and yeasts.

Betamethasone dipropionate, on the other hand, acts as an anti-inflammatory, antipruritic (anti-itch) and vasoconstrictor (promotes the contraction of blood vessels), being effective in the treatment of corticosteroid-sensitive dermatoses (synthetic remedies with effects similar to the natural hormone cortisol and aldosterone) .

What does Ketoconazole do?

As soon as Ketoconazole starts to take effect, it can have two mechanisms of action:

  • Fungistatic – paralyzes the growth of fungi;
  • Fungicide – destroys fungi.

In general, when in contact with the infectious agent, the drug inhibits the synthesis of ergosterol from the fungus, a substance that makes up its cell membrane.

In this way, it alters the composition of the lipid elements of the fungal cell wall, causing its destruction.

Ketoconazole also works to relieve the itching and flaking that usually occur in some of the infections.

Milligramming: what options are available?

Milligrams are the available concentrations of a drug. The values ​​generally vary according to the presentation.

In general, the available Ketoconazole concentrations are:

  • Tablet: 200mg;
  • Cream / pomade: 20mg / g;
  • Shampoo: 20mg/mL.

This means that for each tablet, g or mL of product, there is an amount in mg of Ketoconazole.

How to use Ketoconazole ointment?

The ointment or cream version of the drug Ketoconazole is for topical use, that is, administered directly to the skin. According to the package insert, it is recommended that it is applied once a day to the affected area. In general, there are some steps for administration, such as cleaning the dermis before using the product.

Specifically, they are:

  1. Desrosqueie a tampa do creme;
  2. With the skin sanitized, gently rub the cream on the skin with your fingertip. Apply to and around the infected area;
  3. Wash your hands after administering the cream.

Dosage: how to use Ketoconazole tablet and shampoo?

The dosage and method of administration of Ketoconazole may vary according to the recommended presentation.

It is worth mentioning that despite the information presented here, the form of application may vary according to the pathology treated and the patient’s clinical condition.

Therefore, it is essential to follow the guidelines of your medical team.

In general, the mode of use is:


According to the package insert, Ketoconazole in tablet form should be taken orally, during one of the daily meals.

If the patient is using drugs that reduce stomach acid in parallel, it is recommended to take the tablet with an acidic drink, such as cola soda.

The dosage is:

  • Adults: 1 200mg tablet, once a day;
  • Children weighing more than 30kg: 1 200mg tablet, once a day;
  • Children weighing between 15 and 30kg: half of 1 tablet (100mg), once a day.

For adults and children weighing <30kg, if the responsible physician deems it necessary, the dose can be increased to 2 tablets (totaling 400mg), once a day.

In general, the treatment period can vary between 2 to 4 weeks. If there is a systemic infection, the treatment can be 6 months or until the infection is cured.


In the case of shampoo presentation, for the treatment of seborrheic dermatitis, it is recommended to wash the scalp with shampoos based on Ketoconazole at a frequency of:

  • 2 times a week, for a period of 2 to 4 weeks.

To prevent the problem from reappearing, the package insert indicates the application: 1 time every week or 1 time every 2 weeks , according to medical advice.

How long does it take for Ketoconazole to take effect?

The time for the onset of the effects of the drug Ketoconazole may vary according to the pathology treated and the chosen form of administration: tablet, cream / ointment or shampoo. In general, the tablet and shampoo versions present the improvement of symptoms more quickly. Specifically:

  • Cream / ointment : significant results begin to appear, in general, after 4 weeks of use;
  • Shampoo: after 1 week of using the product, it is usually possible to notice the first results.

The maximum absorption time, that is, the time it takes the drug to be fully absorbed by the body, in the tablet version is 1 to 2 hours after ingestion.

Despite this, it is worth mentioning that the symptoms will not necessarily disappear soon after the onset of the action.

The time for the complete elimination of the pathology can vary according to the clinical picture and response of the organism.

In addition, it is worth mentioning that even if the symptoms subside quickly, it is essential not to interrupt the treatment. Therefore, it is necessary to continue using it according to medical advice.

What are the side effects of Ketoconazole?

Like other medicines, Ketoconazole can cause side effects in some people.

However, it is worth mentioning that each organism reacts differently to the medication and, therefore, not all people will suffer the adverse effects.

The main reactions, according to each presentation, are:


The common side effects (occurring between 1 to 10% of patients) in the tablet version are:

  • Abdominal pain;
  • Flatulence;
  • Diarrhea;
  • Cold;
  • Nausea;
  • Vomiting;
  • Abnormal liver function;
  • Headache;
  • Chills;
  • Fatigue;
  • Somnolence;
  • Bad to be;
  • Fever;
  • Dizziness;
  • Epistaxis – nosebleed;
  • Myalgia – muscle pain;
  • Hyperlipidemia – increased fat in the blood;
  • Dry mouth;
  • Insomnia;
  • Nervousness;
  • Rash;
  • Menstrual disorder;
  • Gynecomastia – breast growth in men;
  • Discoloration of the tongue;
  • Alcohol intolerance;
  • Anorexia;
  • Dyspepsia – difficulty in digestion;
  • Dysgeusia – distortion or decreased taste;
  • Decrease in the number of platelets;
  • Increased appetite;
  • Hepatitis – inflammation of the liver;
  • Jaundice – yellowish color of the skin;
  • Alopecia – hair loss;
  • Dermatitis;
  • Erythema – redness;
  • Peripheral edema – swelling of the feet and ankles;
  • Urticaria;
  • Fogacho – heat waves;
  • Photophobia – sensitivity to light;
  • Astenia – muscle weakness;
  • Xeroderma – high susceptibility to skin cancer and extreme sensitivity to light;
  • Orthostatic hypotension – excessive reduction in blood pressure when upright.

Very rare reactions (occur in less than 0.01% of patients), but which can occur are:

  • Thrombocytopenia – reduced number of platelets in the blood;
  • Anaphylactic shock – severe allergic reaction;
  • Angioneurotic edema – swelling of the skin;
  • Adrenocortical insufficiency – adrenal gland disorder;
  • Cirrhosis – injury to the liver;
  • Photosensitivity;
  • Arthralgia – joint pain;
  • Liver failure;
  • Increased intracranial pressure;
  • Erectile dysfunction.

Cream or ointment

In the cream or ointment version, the common side effects (occurring between 1 and 10% of patients) are:

  • Itching at the application site – itching;
  • Burning sensation on the skin;
  • Erythema at the application site – redness.

Rare reactions (between 0.01% and 0.1% of patients), but which may occur are:

  • Bullous rash (blistering skin rash);
  • Contact dermatitis;
  • Rash;
  • Skin exfoliation
  • Sticky skin;
  • Reactions at the application site – bleeding, discomfort, dryness, inflammation, irritation;
  • Paresthesia – abnormal skin sensations.


In general, adverse reactions with the use of the shampoo version are uncommon , occurring between 0.1 and 1% of patients who apply it. But, if it does, it may include:

  • Alteration of taste;
  • Follicles;
  • Hair loss;
  • Change in hair texture;
  • Eye irritation;
  • Tearsjamento;
  • Acne;
  • Contact dermatitis;
  • Dryness of the skin;
  • Flaking;
  • Rash – rash on the skin;
  • Burning sensation on the skin;
  • Irritation at the application site;
  • Erythema – redness of the skin;
  • Hypersensitivity – allergy;
  • Itching – itching;
  • Pustule at the application site – elevations with pus on the skin.

Price: what is the average value of Ketoconazole?

The price of Ketoconazole may vary according to the geographic region, establishment of purchase, presentation indicated and brand requested in the prescription.

There are different categories for classifying drugs, and the choice may interfere with the final value: reference, generic, similar or interchangeable similar.

It is worth mentioning that, in case there is a need to compare prices and make the purchase, it is possible to use the Consulta Remédios website , which indicates the best prices in different pharmacies in each region.

The available options are:


Reference drugs are those that originated the medication formula. Its effectiveness, safety and quality are scientifically proven and approved by Anvisa.

The reference drug for Ketoconazole and its price * is from:

  • Nizoral — R$32,28.

* Price consulted in May 2020. The value may change.


Generic drugs are those that have the same active ingredient, dose, pharmaceutical form, indication and route of administration as the reference, but without the commercial nomenclature.

Thus, it is marketed by the name of the active ingredient.

Some generic options of the tablet version and their values ​​* are from:

  • Cimed Tablet Ketoconazole – R $ 7.53;
  • Prati-Donaduzzi Ketoconazole Tablet – R $ 10.89;
  • Biosynthetic Compressed Ketoconazole – R $ 19.71;

In the cream or ointment presentation , the options and prices * are:

  • Ketoconazole Neo Química – R $ 6.32;
  • Cetoconazole Creme Cimed – R $ 4.80;
  • Ketoconazole Creme Teuto – R $ 5.28.

Among the options of Generic Ketoconazole in shampoo are:

  • Ketoconazole Shampoo Cimed – R $ 9.75;
  • Ketoconazole Shampoo EMS – R $ 15.06;
  • Ketoconazole Shampoo Medley – R $ 13.29.

* Prices consulted in May 2020. Prices may change.


Similar are the drugs that have the same efficacy and effect as the reference, however, they may have, for example, different excipients, expiration date, labeling and product size.

Among Ketoconazole’s similar tablet options and their initial values ​​* are:

  • Lausanne – R $ 12.56;
  • Noriderm Tablet – R $ 38.89.

Similar in Ketoconazole ointment or cream are:

  • Cetomicoss — R$8,32;
  • Cleartop Creme — R$13,12;
  • Cetonax — R$41,19;
  • Cetonin — R$10,92.

In the shampoo version , some of the available options and their respective prices are:

  • Cetop — R$25,99;
  • Fungonazol — R$11,63;
  • Cleartop Shampoo — R$13,52.

* Prices consulted in May 2020. Prices may change.

Similar Interchangeable

Interchangeable similars are those that, as well as conventional similars, have proven efficacy and effect similar to the reference drug.

The difference is that these products can replace, at the time of purchase, the reference drugs prescribed in the medical prescription.

Among the available options of interchangeable similars in the tablet version and their prices *, are:

  • Candoral — R$34,53;
  • Cetomed — R$7,14.

In the presentation of ointment or cream , the option and average value is:

  • Izonax — R$9,06.

* Prices consulted in May 2020. Prices may change.

Fungi are microorganisms that can be harmful to humans.

In the case of infections caused by them, there are medications such as Ketoconazole, which works to fight mycoses and problems in internal organs.

Want to know more about medicines ? The Healthy Minute has other complete content for you! Read more and stay informed!