Infectious Disease Compendium

Ketoconazole (Nizoril®)

Dosing

CrCl Formula

CrCl > 80: 200-400 mg po q 12 - 24 h.

CrCl 80-50: 200-400 mg po q 12 - 24 h.

CrCl 50-10: 200-400 mg po q 12 - 24 h.

CrCl < 10: 200-400 mg po q 12 - 24 h.

Hemodialysis: 200-400 mg po q 12 - 24 h.

Peritoneal dialysis: 200-400 mg po q 12 - 24 h.

Important side effects

Abdominal pain, anaphylaxis (rare), hepatotoxicity (rare), irritation, pruritus and stinging (cream), nausea, vomiting, pruritus, reduced testosterone (po doses of 800 mg/day or more).

Important drug interactions

Acenocoumarol, alfuzosin, alosetron, aluminum carbonate, basic, aluminum hydroxide, aluminum phosphate, amlodipine, amprenavir, anisindione, aprepitant, aripiprazole, astemizole, atorvastatin, benzodiazepines, bexarotene, budesonide, calcium, carbamazepine, cerivastatin, cilostazol, cimetidine, cinacalcet, cisapride, conjugated estrogens, cyclosporine, darifenacin, delavirdine, dicumarol, didanosine, dihydroxyaluminum aminoacetate, dihydroxyaluminum sodium carbonate, dofetilide, donepezil, dutasteride, eletriptan, ergot derivatives, erlotinib, erythromycin, esomeprazole, esterified estrogens, estradiol, estriol, estrone, estropipate, eszopiclone, famotidine, felodipine, fentanyl, gefitinib, imatinib, indinavir, irinotecan, isoniazid, isradipine, lansoprazole, levomethadyl, lovastatin, magaldrate, magnesium carbonate, magnesium hydroxide, magnesium oxide, magnesium trisilicate, methylprednisolone, nevirapine, nicardipine, nifedipine, nisoldipine, nizatidine, omeprazole, pantoprazole, phenindione, phenprocoumon, pimozide, pioglitazone, prednisolone, prednisone, quetiapine, quinidine, rabeprazole, ranitidine, reboxetine, rifampin, rifapentine, ritonavir, roxatidine, saquinavir, sildenafil, simvastatin, sirolimus, sodium bicarbonate, solifenacin, tacrolimus, tadalafil, terfenadine, tolbutamide, tolterodine, trazodone, tretinoin, trimetrexate, vardenafil, warfarin, zolpidem.

Rants and Screeds

Pearls

Acid dependent absorption.

Treatment of choice

Paracoccidiodes brasiliensis.

Use for

For many of these, the indications occurred before the newer and often better agents. Acne, Blastomyces dermatiditus, blepharitis, Candida - chronic mucocutaneous/ cutaneous/disseminated/esophageal/oral/urinary/vaginal, Chromomycosis systemic infections, Coccidiodes immitis, Cryptococcus neoformans, cutaneous dermatophyte infections, dermatitis - seborrheic, Histoplasma, Leishmaniasis, Paracoccidiodes, prostatic carcinoma, Pseudallescheria boydii, Sporothrix.

Don't use for

Class

Imidazole.