stools yellowing of your skin or the whites of your eyes, fever, rash.
Ketoconazole belongs to a group of azole antifungal drugs. Ketoconazole was the first oral Azole introduced into clinical use.it is distinguished from Triazoles by its greater propensity to inhibit mammalian cytochrome p450 enzyme; that is, it is less selective for fungal p450 than are the newer azole. It is potent and rather nonselective inhibitor of adrenal and gonadal steroid synthesis. Inhibition of steroid biosynthesis is seen only at high doses. It penetrates poorly into cerebrospinal fluid. Ketoconazole elimination is hepatic and excreted through bile. It is therefore necessary to adjust the dose in patients with liver problems.
It is used in the treatment of the following infections:
Infections, including candidiasis, oral thrush, blastomycosis, histoplasmosis, paracoccidioidomycosis, coccidioidomycosis, chromomycosis, candiduria, chronic mucocutaneous candidiasis, as well as certain recalcitrant cutaneous dermatophytoses
Use - Unlabeled Treatment of prostate cancer (androgen synthesis inhibitor)
Used off-label to inhibit steroidogenesis in patients with Cushing syndrome
Ketoconazole is also used to prevent fungal infections caused by candida in patients undergoing bone marrow transplantation and receive cytotoxic/radiation therapy.
Precautions:
Ketoconazole should not be used in patients who are allergic /hypersensitive to the active substance ketoconazole or other azoles (e.g., floconazol, itraconazol, voriconazol, and others).
Ketoconazole inhibits enzyme that participate in the metabolism of many drugs, and therefore may enter a large number of major, clinically significant interactions, some of which may endanger your life; it is very important to inform your doctor about all medicines as well as the herbal preparations you are taking.
Fatal cases of liver injury have also been reported. Damage occurs on the hepatocellular level and is often associated with symptoms of an allergic reaction (e.g., fever and skin rash).
The risk of torsades de pointes is higher in patients receiving other drugs that may also cause QT prolongation, such as:
Erythromycin and clarithromycin,( macrolide antibiotics), Moxifloxacin (fluoroquinolon antibiotic), Astemizole and Terfenadine(H2 antihistamines used in the treatment of allergic reactions), Cisapride (medication used to treat heartburn in patient with gastro esophageal reflux disease, Pimozide (medication used to treat motor tics), GERD,antiarrhythmic drugs such as:Jbutilide, amiodarone, procainamide, dronedarone, quinidine, Sotalol, Bepridil (a calcium blocker used to treat angina) .
Thioridazine (muscle relaxant), mezoridazine (a phenothiazine antipsychotic used to treat schizophrenia), Halophantrine and lumefantrine (medication used to treat malaria), Methadone (opioid analgesic), Tricyclic antidepressants (Amitriptyline and Nortriptyline)
Concomitant use with these drugs therefore absolutely contraindicated.

Ketoconazole, pregnancy and breastfeeding:
FDA pregnancy category: D. this means that use during pregnancy is absolutely contraindicated.
Ketoconazole should not be used during pregnancy and breastfeeding unless advised by your doctor.
Dosage:
The dose and duration of therapy will be determined by your doctor based on the type of fungus that caused the infection and clinical response to the therapy. . Ketoconazole is used for short term treatment.
Fungal infections:
Indicated for the treatment of the following systemic fungal infections in patients who have failed or who are intolerant to other therapies: blastomycosis, coccidiodomycosis, histoplasmosis, chromomycosis, and paracoccidioidomycosis.
Fungal infections: Oral: 200-400 mg/day as a single daily dose
Prostate cancer (unlabeled use): Oral: 400 mg 3 times/day
Recurrent Tinea Veriscolor (off-label):
400mg PO monthly
Used off-label to inhibit steroidogenesis in patients with Cushing syndrome
600-800 mg/day PO
Fungal infections in children:
<2 years old: safety and efficacy not established
≥2 years old: 3.3-6.6 mg/kg/day PO
Used rarely and often toxic at doses required to reduce cortisol secretion
Dosage modifications:
Renal impairment: No dosage modifications provided in manufacturer’s labeling
Hepatic impairment: No dosage modifications provided in manufacturer’s labeling.
If hepatotoxicity occurs during treatment (ALT level above UNL or ALT30% above baseline):
Interrupt dosing and order a full set of liver tests.


Dosing considerations:
Do not use tablets as first- line treatment; should be used only when other effective antifungal therapy is not available or tolerated and the potential benefits are considered to outweigh the potential of hepatotoxicity.
Avoid prescribing tablets to treat skin and nail fungal infections owing to risk of serious liver damage, adrenal gland problems, and harmful interaction with other medicines that outweigh its benefit in treating these conditions, which are not approved uses of the drug.
Interactions:
Ozole should not be administered concurrently with the following medicines:
Fentanyl and alfentanil (opioid analgesics) ozol increase the concentration of these drugs in the blood which increase the risk of side effects (e.g. confusion, excess drowsiness, vertigo, bradycardia, and slow breathing)
Midazolam and Triazolam (benzodiazepines) ozol increase the concentration of these drugs in the blood which increase the risk of side effect (e.g. excessive sedation) ,Vincristine and vinblastine, Nifedipin, Felodipin, Amlodipine, and Nicardipin (dihydropiridine calcium antagonists used in .the treatment of cardiovascular disease). Ozole increases the concentration of these drugs in the blood and increase the risk of side effect, Statins-medicines used to lower cholesterol, administration increases the risk of hepatotoxicity and myopathy, Antiepileptic medication, such as: Carbamazepine, and Phenytoin, Warfarin (anticoagulant drug) simultaneous administration increases the risk of bleeding , Non –steroidal anti-inflammatory drugs, Zidovudin (medication used to treat HIV), Oral contraceptive, Oral hypoglycemic, Corticosteroids (e.g. prednisolone),Medication used to treat asthma (e.g. theophylline)
Side effect:
As a group the Azoles are relatively nontoxic. The most common adverse reaction is relatively minor gastrointestinal upset. All Azoles have been reported to cause abnormalities in liver enzyme and very rarely clinical hepatitis. Ketoconazole is generally well tolerated. Most common side effect reported include: nausea, headache, diarrhea, stomach pain liver function test results. If these effects are mild, they go away within a few days or a couple of weeks. If they are more severe or don’t go away, talk to your doctor or pharmacist .Serious side effects, call your doctor right away if you have serious side effect and their symptoms can include the following: liver problems (hepatotoxicity). Symptoms can include: loss of appetite, or weight loss (anorexia), nausea or vomiting, tiredness, stomach pain or tenderness, dark-colored urine or light –colored