Generic name: Ketoconazole

Why is this medication prescribed?
Ketoconazole is used to treat skin infections such as jock itch, athlete's foot, and ringworm; and fungal infections of the fingernails, toenails, mouth (thrush), lungs, vagina, and blood.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medication be used?
Ketoconazole comes as a tablet to take by mouth, in skin cream and shampoo. The tablet is usually taken once a day for 1 week or longer. The cream is used once or twice a day for 2 to 4 weeks. The shampoo is used two times a week, about every 3 days, for 4 weeks. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ketoconazole exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

To use the cream, thoroughly clean the infected area, allow it to dry and then gently rub the medication in until most of it disappears. Use enough medication to cover the affected area. You should wash your hands after applying the medication.

To use the shampoo, wet the hair and put enough shampoo on the hair so you can wash hair and scalp. Gently rub entire scalp and leave shampoo on for 1 minute. Rinse all the shampoo off. Then put on the shampoo again, rub gently into hair and scalp, let it stay on for 3 minutes, and then rinse to finish.

Continue to take or use ketoconazole even if you feel well. Do not stop taking ketoconazole without talking to your doctor.

What special precautions should I follow?
Before taking Nizoral ketoconazole,

• tell your doctor and pharmacist if you are allergic to ketoconazole, sulfites, or any other drugs.
• in addtion to the drugs listed in the IMPORTANT WARNING section, also tell your doctor and pharmacist what other prescription and nonprescription medications you are taking, especially anticoagulants ('blood thinners') such as warfarin (Coumadin), cyclosporine (Neoral, Sandimmune), hydrocortisone (Cortisone), isoniazid (INH), oral medication for diabetes or asthma, phenytoin (Dilantin), rifampin (Rifadin, Rimactane), and vitamins.
• tell your doctor and pharmacist if you take any kind of medication for your stomach such as antacids (Mylanta, Maalox), cimetidine (Tagamet), or glycopyrrolate (Robinul). Ketoconazole must be taken at least 2 hours after these medications.
• tell your doctor if you have or have ever had liver disease, achlorhydria (stomach does not produce acid), or a history of alcohol abuse.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking ketoconazole, call your doctor.
• be careful when driving or doing things that need alertness and physical skills; ketoconazole may cause headache, dizziness, and drowsiness.
• tell your doctor if you drink alcohol.

What special dietary instructions should I follow?
Ketoconazole may cause upset stomach. Take ketoconazole with food or milk. If you are on the tablets and have achlorhydria (stomach does not produce acid), take ketoconazole with a cola beverage.

What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?
Although side effects from ketoconazole are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:

• diarrhea or loose stools
• headache
• dizziness or lightheadedness
• drowsiness

If you experience any of the following symptoms, or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• fainting
• seizures
• skin rash
• itching
• increased breast size or breast tenderness in men

What storage conditions are needed for this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Keep the shampoo away from light. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose
In case of overdose, call your local poison controlcenter at 1-800-222-1222. If the victim has collapsedor is not breathing, call local emergency services at911.

What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to ketoconazole. Do not let the cream or shampoo get into your eyes or mouth, and do not swallow it. The shampoo may remove the curl from a permanent wave (perm).

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. If you still have symptoms of infection after you finish the ketoconazole, call your doctor.