Systemic Antifungal Agents For Cutaneous Fungal Infections
- David Ellis, Alan Watson
SummaryCutaneous fungal infections are usually treated topically, but nail and hair infections, widespread dermatophytosis and chronic non-responsive yeast infections are best treated with oral antifungal drugs. The oral drugs currently available in Australia for the treatment of cutaneous fungal infections include griseofulvin, ketoconazole, fluconazole, itraconazole and terbinafine.
IntroductionThe cutaneous mycoses are superficial fungal infections of the skin, hair or nails. Essentially no living tissue is invaded however, a variety of pathological changes occur in the host because of the presence of the fungus and/or its metabolic products. The principal aetiological organisms are:
- dermatophytic moulds belonging to the genera Microsporum, Trichophyton and Epidermophyton which cause ringworm or tinea of the scalp, glabrous skin and nails
- Malassezia furfur, a lipophilic yeast responsible for pityriasis versicolor, follicular pityriasis, seborrhoeic dermatitis and pityriasis capitis
- Candida albicans and related species, causing candidiasis of skin, mucous membranes and nails
The usual approach to the management of cutaneous infections in immuno competent patients is to treat with topical agents. However, nail and hair infections, widespread dermatophytosis and chronic non-responsive yeast infections are best treated with oral antifungal drugs.
When to use systemic therapy
Oral antifungal drugs
How To Use Ketoconazole Shampoo
Ketoconazole May Interact With Other Medications
Ketoconazole can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.
Below is a list of medications that can interact with ketoconazole. This list does not contain all drugs that may interact with ketoconazole.
Before taking ketoconazole, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
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How Is Ketoconazole Given
Ketoconazole is given by mouth in the form of a tablet. It should be given with food, and ideally with high fat foods such as cheese, butter, or cream cheese. This medication may also be compounded into an oral liquid. Follow the instructions on the label and measure doses carefully.
This medication can take a few weeks before full effects are observed, but gradual improvements are usually noticed after a few days.
Interactions Between Ketoconazole Cream And Other Medications
Ketoconazole cream may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements that you are currently taking. The list below does not include all possible drug interactions with ketoconazole cream. Please note that only the generic name of each medication is listed below.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription medicine.
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Contraindications And Interactions With Other Drugs
Pregnant dogs must not follow a treatment based on Ketoconazole, as the drug causes the death of the fetus. Apart from this, there are no other contraindications, with the mention that the side effects listed above can occur in any dog.
Interactions between Ketoconazole and other drugs are possible. Some of the types of drugs with which this yeast infection medicine can interact include:
What Other Drugs Interact With Ketoconazole
If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.
- Ketoconazole has severe interactions with at least 33 different drugs.
- Ketoconazole has serious interactions with at least 202 different drugs.
- Ketoconazole has moderate interactions with at least 241 different drugs.
- Ketoconazole has mild interactions with at least 105 different drugs.
This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more information about this medicine.
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What Is Ketoconazole Toxicity
Derived from imidazole, ketoconazole or nizoral as it can be known, works to inhibit the growth of fungus but if given in too large a dose, it can start destroying the cells by boring through the cell membrane causing essential elements to ooze out. It can also be used for the treatment of some yeast and ringworm infections. When your dog is being treated with ketoconazole either internally via a pill or topically through a cream, watch out for signs of a yellow tint to the whites of the eyes or gums as this can indicate liver damage.
Ketoconazole inhibits the process vital for fungal growth and as such can be an effective treatment for your dog, but needs careful monitoring by a veterinarian.
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What Is Ketoconazole Topical
Ketoconazole topical is an antifungal medicine used to treat infections such as athlete’s foot, jock itch, ringworm, and seborrhea .
Ketoconazole topical is also used to treat a fungal infection called pityriasis, which causes scaly discolored patches on the skin of the neck, chest, arms, or legs.
Ketoconazole topical may also be used for purposes not listed in this medication guide.
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What Is Ketoconazole Cream What Is Miconazole
Ketoconazole cream is an antifungal medication in the same family of drugs as fluconazole , itraconazole , and miconazole . It prevents growth of several types of fungi by preventing production of the membranes that surround fungal cells. Ketoconazole cream is prescribed to treat fungal infections such as ringworm, jock itch, athlete’s foot, dandruff, and tinea versicolor.
Miconazole is an antifungal medication related to fluconazole , ketoconazole , itraconazole , and clotrimazole . It is used either on the skin or in the to treat vaginal infections and other infections , and severe fungal infections.
What Are The Possible Side Effects Of Ketoconazole Topical
Get emergency medical help if you have signs of an allergic reaction: hives difficult breathing swelling of your face, lips, tongue, or throat.
- burning, stinging, or severe irritation after using this medicine
- redness, pain, or oozing of treated skin or
- shortness of breath.
Common side effects may include:
- changes in the color or texture of your hair
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
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Recovery Of Ketoconazole Toxicity In Dogs
Once therapy has begun, following at home support consisting of a quiet, comfortable bed for your dog to rest and recover is advisable. Fresh clean water and small bland meals will help your dogs appetite to return to normal. Dogs are amazing healers, and will soon have forgotten all about their illness and return to their former bouncing furry ball of energy, but do follow up with specialist visits to monitor progress.
Causes Of Ketoconazole Toxicity In Dogs
The need for use for Ketoconazole is for the relief of fungal infections on your dog. These infections may manifest on your dog in the following way
- You may notice an unpleasant odor on the skin
- If there are patches of skin without hair it could be ringworm
- Your dog may experience breathing problems
- Your dogs eyes may have watery discharges
The use of Ketoconazole will be very effective for fungal infections, but if you notice any of the following signs affecting your dog, the dose may be too strong or your pet may be allergic to the medication and you will need to inform your veterinary care provider immediately.
- If your dog exhibits anorexia and shows signs of diarrhea and vomiting
- Liver toxicity, which shows as yellowing of the eyes or gums of your dog
- Another observation you may notice is a reversible lightening of the hair coat
- An allergic reaction may show as swelling around the face, scratching, and seizures, or he may go into a coma
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Ketoconazole Topical Side Effects
Get emergency medical help if you have signs of an allergic reaction: hives difficult breathing swelling of your face, lips, tongue, or throat.
Ketoconazole topical may cause serious side effects. Call your doctor at once if you have:
-
burning, stinging, or severe irritation after using this medicine
-
redness, pain, or oozing of treated skin or
-
shortness of breath.
Common side effects of ketoconazole topical may include:
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What Are Side Effects Associated With Using Ketoconazole
Common side effects of Ketoconazole include:
Less common side effects of ketoconazole include:
- High levels of fat in the blood
- Swollen breast tissue in males
- Loss of interest in sex
Serious side effects of ketoconazole include:
- Mental/mood changes
This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.
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What Is This Medication
KETOCONAZOLE treats fungal or yeast infections of the skin. It may also be used to treat seborrheic dermatitis, a condition that causes dry, flaky, and itchy skin. It belongs to a group of medications called antifungals. It will not treat infections caused by bacteria or viruses.
This medicine may be used for other purposes ask your health care provider or pharmacist if you have questions.
COMMON BRAND NAME: Kuric, Nizoral
What Is The Dosage Of Ketoconazole Vs Miconazole
Ketoconazole
Ketoconazole may be taken with or without food. The oral dose range is 200-400 mg daily. Recurrent tinea versicolor is treated with 400 mg monthly. Topical formulations are administered to affected areas once or twice daily.
Miconazole
Miconazole usually is used once daily at bedtime. The 200 mg suppositories are inserted once nightly for 3 nights. The 100 mg suppositories and intravaginal cream are inserted once nightly for 7 nights. The 1200 mg formulation is applied once for one night.
For fungal skin infections, the topical cream is applied as a thin layer to cover the affected skin and surrounding area, usually once or twice daily for 2-4 weeks. The hands should be washed before and after application.
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How To Use Ketoconazole Cream
If you’re using any other creams, ointments or lotions on the same area of skin, do not put them on at the same time as ketoconazole cream. After putting on the ketoconazole cream, wait 30 minutes before you use different products on the same area. This gives the ketoconazole time to be absorbed into your skin.
How Should I Use This Medication
This medication is for external use only. Do not take by mouth. Wash your hands before and after use. If you are treating your hands, only wash your hands before use. Do not use on healthy skin or over large areas of skin. Do not get this medication in your eyes. If you do, rinse it out with plenty of cool tap water. Use it as directed on the label at the same time every day. Do not use it more often than directed or for a longer time period than prescribed by your care team. Keep taking it unless your care team tells you to stop.
Apply a thin film to the affected area and rub gently. Do not bandage or wrap the skin being treated unless directed to do so by your care team.
Talk to your care team about the use of this medication in children. Special care may be needed.
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.
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What May Interact With This Medication
Interactions are not expected. Do not use any other skin products without telling your care team.
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
Symptoms Of Ketoconazole Toxicity In Dogs
- Toxicity is shown by a yellow tint to the whites of your dogs eyes and gums
- Extreme drowsiness can indicate too high a dose
- Your dog may suffer from skin irritation and keep scratching himself
- Nausea and vomiting
- Allergic reactions, dont use nizoral if your dog has a very sensitive system that reacts to many things
- Liver damage, if your dog has liver problems then you would be wise not to use this product to prevent further damage
- Diarrhea may be a side effect of the treatment and reaction to toxicity
Types
Fungal types requiring the use of ketoconazole on your dog are:
- Yeast infections around the skin, ears, mouth or the reproductive system
- Ringworm can also be treated
- Severe fungal infections often need the use of ketoconazole
- Blastomycosis which is disease from parasitic fungi affecting the internal organs
- Coccidioidomycosis which a fungal disease of the lungs and other tissue
- Cryptococcosis which is a yeast like fungus that results in tumors that affect the lungs and sometimes the brain
Your veterinarian is the person to help your dog if he is suffering from a fungal infection and she will help you to monitor your dog while he is on a course of ketoconazole as dosage is dependent on the size of the dog, the age, and the condition of your pet.
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What Are Warnings And Precautions For Ketoconazole
Warnings
- Tablets should be used only when other effective antifungal therapy is not available or tolerated and the potential benefits are considered to outweigh the potential risks
- Liver damage has occurred with oral use, including some fatalities or requiring liver transplantation reported with oral administration of the drug some patients had no obvious risk factors for liver disease
- May cause QT prolongation coadministration with dofetilide, quinidine, pimozide, cisapride, methadone, disopyramide, dronedarone, and ranolazine is contraindicated ketoconazole can cause elevated plasma concentrations of these drugs and may prolong QT intervals, sometimes resulting in life-threatening ventricular dysrhythmias such as torsades de pointes
- This medication contains ketoconazole. Do not take Nizoral if you are allergic to ketoconazole or any ingredients contained in this drug
- Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately
Contraindications
- See âWhat Are Side Effects Associated with Using Ketoconazole?â
Long-Term Effects
- See âWhat Are Side Effects Associated with Using Ketoconazole?â
Cautions
Pregnancy and Lactation
- Use ketoconazole with caution during pregnancy if benefits outweigh risks
- Animal studies show risk and human studies are not available or neither animal nor human studies were done
- Ketoconazole enters breast milk consult your doctor before breastfeeding
Do Home Remedies Work
Perhaps youd prefer to try home remedies? According to the National Center for Complementary and Integrative Health , some research shows that applied to the skin, bitter orange oil may help with athletes foot, jock itch and ringworm infections. There is also some evidence that tea tree oil may be helpful for athletes foot or nail fungus, according to the NCCIH.
There is limited evidence that apple cider vinegar can help treat vaginal yeast infections and thrush, a fungal infection in the mouth. When used on the skin, apple cider vinegar should be used with caution because it can lead to a chemical burn due to its acid content.
Garlic has shown anti fungal properties against a yeast in the Candida family, as well as fungal infections of the scalp. And an early study showed that a cream containing a component of garlic relieved athletes foot in all 34 study participants. Some research has shown that garlic is active against toenail fungus. However applying garlic directly to the skin can result in burns and blistering, so do it with caution if you decide to try it.
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