Ketoconazole
Znana też jako: Nizoral, Fungiconazole
- **Administration:** Give this medication with food to increase absorption and reduce stomach upset. If your pet develops vomiting or loss of appetite, dividing the daily dose may help. - **Side Effects:** Watch for loss of appetite, vomiting, or diarrhea. If these occur, contact your veterinarian. In cats, these side effects are more common. - **Coat Changes:** You might notice a reversible lightening of your pet's haircoat during treatment. - **Commitment:** Fungal infections often require months of continuous treatment. Do not stop the medication early even if your pet looks better, as the infection can easily return. - **Warning:** Inform your vet of *all* other medications your pet is taking, as ketoconazole interacts with many drugs.
Dosage must be set by your veterinarian for your specific pet. Never give human medication or another pet’s prescription without veterinary guidance.
Veterinary professional? See the full dosing-by-species reference on VetSheet →
What it is used for
- 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
How it is given
Possible side effects
- 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
Cautions & contraindications
- 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.
Drug interactions
- 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)
Częste pytania
What is Ketoconazole used for in pets?
- Administration: Give this medication with food to increase absorption and reduce stomach upset. If your pet develops vomiting or loss of appetite, dividing the daily dose may help. - Side Effects: Watch for loss of appetite, vomiting, or diarrhea. If these occur, contact your veterinarian. In cats, these side effects are more common. - Coat Changes: You might notice a reversible lightening of your pet's haircoat during treatment. - Commitment: Fungal infections often require months of continuous treatment. Do not stop the medication early even if your pet looks better, as the infection can easily return. - Warning: Inform your vet of *all* other medications your pet is taking, as ketoconazole interacts with many drugs.
Is Ketoconazole safe for my pet?
Dosage must be set by your veterinarian for your specific pet. Never give human medication or another pet’s prescription without veterinary guidance.
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