- For treatment of systemic fungal infections; Candidiasis, chronic
mucocutaneous candidiasis, oral thrush,
Blastomycosis,
coccidioidomycosis, histoplasmosis, and paracoccidioidomycosis;
- topical cream for localized fungal infections due to dermatophytes & yeast;
- Adult: 200mg PO qd; increase to 400mg PO qd for very serious infections;
- Associated with severe hepatotoxicity; monitor LFT's closely throughout
course of therapy;
- Drug interaction with any agent increasing gastric pH preventing
absorption of ketoconazole;
- Note that ketoconazole requires gastric acidity for absorption
(if patient is receiving H2 blockers, antacids, or anticholinergics,
they should be administered at least 2hrs after Ketoconazole
administration);
- may enhance effects of oral anticoagulants;
- may react with alcohol to produce disulfiram like reaction;
- Contraindicated with: fungal meningitis (poor CNS penetration);
- Use with caution in patients with a h/o liver dz, patients receiving
warfarin like drugs (increased prothrombintime), cyclosporin A
(increased serum level), phenytoin (altered metabolism), oral
hypoglycemic agents (increased risked hypoglycemia), rifampin (
decreased serum level);
- Diffusion from Blood into CSF minimal even w/ Inflammation even with high
dose >800mg/dl;
- Dosing Regimens for Patients with Renal Insufficiency: (Dose for 70 kg
Adult {gm / dosing interval inhours}): CrCl:>80:0.2-0.4/12-24;
CrCl:50-79:0.2-0.4/12-24; CrCl:30-49:0.2-0.4/12-24;
CrCl:10-29:0.2-0.4/12-24;
- 10% of drug will be excreted in to urine (w/ nl RF(x))
- Peds: >2yrs: 3.3-6.6 mg/kg/day as a single dose;
- Supplied: Tabs: 200 mg; topical cream 2%;
--------------------------------
