Drug Index

Ketoconazole

 
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Mechanism :

Ketoconazole impairs the synthesis of ergosterol, which is a vital component of fungal cell membranes.


Indication :

• Patients of systemic fungal infections who have failed other therapy or are intolerant.

• Histoplasmosis

• Blastomycosis

• Paracoccidioidomycosis

• Coccidioidomycosis

• Chromomycosis


Contraindications :

Ketoconazole is contraindicated in patients who have shown hypersensitivity to the drug or excipients of the formulation. Keep out of eyes. It is contraindicated in children below 2 years of age.


Dosing :

Under years: Safety and efficacy not established.

Above 2 years: 3.3-6.6 mg/kg/day given orally.


Adverse Effect :

Nausea and vomiting, abdominal pain, pruritus, alopecia, headache, hyperlipidemia, dizziness, diarrhea, impotence, thrombocytopenia erythema multiforme, gynecomastia, hepatotoxicity, xeroderma, fever and chills, somnolence, depression, bulging fontanelles, jaundice, dysgeusia, decreased platelet count, dyspepsia, photophobia, hemolytic anemia, leukopenia, orthostatic hypotension.


Interaction :

Terfenadine: Has led to elevated plasma concentrations of terfenadine, resulting in rare instances of life-threatening cardiac dysrhythmias.
Astemizole: Inhibits the metabolism of astemizole, resulting in elevated plasma concentrations of astemizole which may prolong QT intervals.



Renal Dose :

Dose in Renal Impairment GFR (mL/min)
20-50Dose as in normal renal function
10-20Dose as in normal renal function
<10Dose as in normal renal function

Dose in Patients undergoing Renal Replacement Therapies
CAPDNot dialysed. Dose as in normal renal function
HDNot dialysed. Dose as in normal renal function
HDF/High fluxUnknown dialysability. Dose as in normal renal function
CAV/VVHDUnknown dialysability. Dose as in normal renal function

Hepatic Dose :

Oral use is contraindicated in patients with acute or chronic hepatic disease. Monitor liver function weekly for one month after initiation of the treatment, then monthly for 6 months and then weekly for one month whenever the dose is increased.
ALT or AST >3 times the ULN: Discontinue the drug and do not restart.
ALT or AST < 3 times the ULN: more frequent monitoring of liver function tests and the daily dose should be decreased.
Use of shampoo or cream in patients with liver disease is not contraindicated.
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05/22/2020 18:48:51 Ketoconazole
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