ケトコナゾール

使用用途

• Coccidioidomycosis
• Coccidioidomycosis
• Blastomycosis
• Cryptococcosis
• Aspergillosis
• Dermatophytosis
• Sporotrichosis
• Susceptible yeasts and Aspergillus spp
• Scopulariopsis pneumonia
• Severe refractory candidiasis in Psittacines
• Susceptible fungal infections (most species)
• Susceptible fungal infections (most species)
• Susceptible fungal infections (Moluccan Cockatoos)
• Susceptible fungal infections (Ratites)
• Susceptible infections (Rabbits)
• Systemic mycoses/candidiasis (Hamsters, Gerbils, Mice, Rats, Guinea pigs, Chinchillas)
• Coccidioidomycosis (systemic form)
• Coccidioidomycosis (CNS form)
• Coccidioidomycosis (bony lesions or relapses)
• Coccidioidomycosis
• Blastomycosis
• Blastomycosis
• Histoplasmosis
• Histoplasmosis
• Aspergillosis
• Nasal aspergillosis
• Cryptococcosis
• Fungal myocarditis
• Candidiasis
• Sporotrichosis
• Malassezia dermatitis (severe)
• Malassezia dermatitis
• Malassezia dermatitis
• Malassezia dermatitis
• Malassezia dermatitis
• Hyperadrenocorticism
• Hyperadrenocorticism
• Hyperadrenocorticism (palliative)
• Reduce cyclosporine dosage
• Perianal fistula (with cyclosporine)
• Atopic dermatitis (with cyclosporine)
• IMHA (with cyclosporine)
• Susceptible infections (most species)
• Fungal shell diseases in turtles/tortoises

投与方法

考えられる副作用

• Anorexia (most common, especially in cats)
• Vomiting
• Diarrhea
• Hepatic toxicity (cholangiohepatitis, increased liver enzymes)
• Thrombocytopenia (rare)
• Reversible lightening of haircoat
• Transient suppression of gonadal and adrenal steroid synthesis
• Infertility in male dogs (reversible)
• Hepatotoxicity
• Anorexia
• Alterations in hair-coat colour
• Thrombocytopenia (at high doses)
• Adrenal insufficiency (at high doses)
• Cataract development (in dogs)
• Teratogenic effects

注意事項と禁忌

• Known hypersensitivity to ketoconazole
• Controversial/Contraindicated in cats (due to toxicity risks)
• Concurrent use with cisapride or ivermectin (in dogs)
• Hepatic insufficiency
• Pregnancy (due to possible teratogenic effects)
• Use with caution in patients with **hepatic disease** or **thrombocytopenia**. Ketoconazole is a known **teratogen and embryotoxin**; weigh risks vs. benefits in pregnant animals. It may cause reversible infertility in male dogs by decreasing testosterone synthesis. Dogs undergoing high-dose antifungal therapy may need additional glucocorticoid support during periods of acute stress due to adrenal suppression.

薬物相互作用

• Alcohol: May produce a disulfiram-like reaction (vomiting)
• Antacids: May reduce oral absorption of ketoconazole; administer at least 1 hour before or 2 hours after
• Tricyclic Antidepressants (amitriptyline, clomipramine): Ketoconazole may reduce metabolism and increase adverse effects
• Benzodiazepines (midazolam, triazolam): Ketoconazole may increase levels
• Buspirone: Plasma concentrations may be elevated
• Busulfan: Ketoconazole may increase levels
• Calcium-channel blockers (amlodipine, verapamil): Ketoconazole may increase levels
• Cisapride: Ketoconazole may increase cisapride levels and possibility for toxicity; use together contraindicated
• Corticosteroids: Ketoconazole may inhibit metabolism; potential for increased adverse effects
• Cyclophosphamide: Ketoconazole may inhibit metabolism; potential for increased toxicity
• Cyclosporine: Increased cyclosporine levels (often used therapeutically to reduce cyclosporine dose)
• Digoxin: Ketoconazole may increase digoxin levels
• Fentanyl/Alfentanil: Ketoconazole may increase fentanyl or alfentanil levels
• H2-blockers (ranitidine, famotidine): Increased gastric pH may reduce ketoconazole absorption
• Hepatotoxic drugs: Should be used cautiously together due to additive hepatotoxicity risk
• Isoniazid: May affect ketoconazole levels; concomitant use not recommended
• Ivermectin: Ketoconazole may increase risk for neurotoxicity; should never be used together in dogs
• Macrolide antibiotics (erythromycin, clarithromycin): May increase ketoconazole concentrations
• Mitotane: Not recommended together; adrenolytic effects of mitotane may be inhibited by ketoconazole
• Phenytoin: May decrease ketoconazole levels
• Proton-pump inhibitors (omeprazole): Increased gastric pH may reduce ketoconazole absorption
• Quinidine: Ketoconazole may increase quinidine levels
• Rifampin: May decrease ketoconazole levels; ketoconazole may increase rifampin levels
• Sucralfate: May reduce absorption of ketoconazole
• Sulfonylurea antidiabetic agents (glipizide, glyburide): Ketoconazole may increase levels; hypoglycemia possible
• Theophylline: Ketoconazole may decrease serum theophylline concentrations; monitor levels
• Vincristine/Vinblastine: Ketoconazole may inhibit vinca alkaloid metabolism and increase levels
• Warfarin: Ketoconazole may cause increased prothrombin times
• Ciclosporin: Ketoconazole increases blood levels of ciclosporin (used therapeutically to reduce ciclosporin dose requirements)
• Amphotericin B: Used synergistically in systemic fungal disease, allowing for a reduced dose of amphotericin B
• Proton-pump inhibitors (PPIs): Increases gastric pH, which impairs the absorption of ketoconazole; stagger dosing
• H2 blockers: Increases gastric pH, which impairs the absorption of ketoconazole; stagger dosing
• Antimuscarinics: Increases gastric pH, which impairs the absorption of ketoconazole; stagger dosing
• Methylprednisolone: Ketoconazole extends the activity of methylprednisolone
• Antihistamines: Inhibits the metabolism of antihistamines (extrapolated from human data)
• Oral hypoglycaemics: Inhibits the metabolism of oral hypoglycaemics (extrapolated from human data)
• Antiepileptics: Inhibits the metabolism of antiepileptics (extrapolated from human data)

よくある質問