Indications:

Shampoo: Treatment and prophylaxis of infections involving Malassezia (formerly Pityrosporum), such as pityriasis versicolor, seborrhoeic dermatitis, and pityriasis capitis (dandruff).
Cream: Treatment of dermatophyte infections (tinea corporis, tinea cruris, tinea manus, tinea pedis), cutaneous candidosis (including vulvitis, candidal intertrigo), pityriasis versicolor, and seborrhoeic dermatitis caused by Malassezia.
Tablet: Treatment of superficial and deep mycoses (dermatomycosis, onychomycosis, mucocutaneous candidiasis, oral thrush, vaginal candidiasis, systemic mycoses such as candidiasis, histoplasmosis, coccidioidomycosis). Also used prophylactically in immunocompromised patients (cancer, transplant, burns).
Medicated Bar: Indicated for all kinds of body fungus.

Pharmacology: Ketoconazole inhibits 14-α-sterol demethylase, a cytochrome P-450 enzyme essential for ergosterol synthesis. This leads to impaired fungal cell membrane integrity, accumulation of toxic metabolites, and disruption of membrane-bound enzyme systems.

Dosage & Administration:

Shampoo:
- Shake well, apply to wet scalp/skin, lather, leave for 5 minutes, rinse.
- Seborrhoeic dermatitis/dandruff: twice weekly for 2–4 weeks.
- Pityriasis versicolor: once daily for 5 days.
- Prophylaxis: once every 1–2 weeks (seborrhoeic dermatitis/dandruff); once daily for 3 days before summer (pityriasis versicolor).
Cream:
- Apply once or twice daily depending on severity.
- Tinea pedis: twice daily, usually 1 week (longer for severe cases).
- Tinea versicolor: 2–3 weeks.
- Tinea corporis: 3–4 weeks.
- Continue until a few days after symptoms resolve.
Tablet:
- Vaginal candidiasis: 1 tablet twice daily for 5 days.
- Other indications: Adults 200 mg once daily; Children 3–5 mg/kg/day.
- Duration varies: pityriasis versicolor (1–6 weeks), dermatomycoses (2–8 weeks), onychomycoses (1–12 months), mucocutaneous candidiasis (1–12 months), oral mycoses (5–10 days).

Interactions:

Shampoo/Cream: No significant drug interactions.
Tablet: Absorption impaired by acid-neutralizing agents, H2 antagonists, proton pump inhibitors.

Contraindications:

Hypersensitivity to ketoconazole.

Side Effects:

Shampoo: Local burning, itching, contact dermatitis; rarely oily/dry hair.
Cream: Burning, erythema, pruritus; uncommon reactions include dryness, irritation, rash, bullous eruption.
Tablet: Nausea, headache, diarrhea, abdominal pain, vomiting.

Pregnancy & Lactation:

Category C. Not contraindicated for topical use in pregnancy/lactation.
Oral ketoconazole excreted in breast milk; avoid breastfeeding during tablet therapy.

Precautions & Warnings:

Shampoo: Gradual withdrawal of corticosteroids recommended. Avoid eye contact.
Cream: Not for ophthalmic use; allow recovery period after potent corticosteroid use.
Tablet: Monitor liver function; discontinue if signs of hepatotoxicity appear.

Overdose Effects:

Shampoo: Supportive measures only if ingested.
Cream: Excess use may cause erythema, edema, burning.
Tablet: Symptomatic management required.