Xolegel, Extina

Written by Sarah Lewis, PharmD
Medically reviewed by Melissa Badowski, PharmD, MPH, FCCP on May 18, 2023

These approved uses differ based on the form of ketoconazole your doctor prescribes.

This article describes ketoconazole’s uses, side effects, and more. Below you’ll find some coupon options to help save on the cost of ketoconazole.

Ketoconazole comes in several forms. This article doesn’t provide coupons for all forms of ketoconazole. To find coupons for other forms of ketoconazole, see the following articles:

• ketoconazole tablet
• ketoconazole powder

Boxed warnings for ketoconazole oral tablet

Ketoconazole oral tablet has boxed warnings about the risks of serious liver problems and long QT syndrome. It also has a boxed warning stating the drug should only be prescribed for specific purposes. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

For details, see the “Interactions and warnings for ketoconazole” section below.

The Food and Drug Administration (FDA) approves prescription drugs such as ketoconazole for certain conditions. Approved uses for ketoconazole are described below. These uses differ based on the form of ketoconazole prescribed.

Use for certain fungal infections

Doctors may prescribe ketoconazole oral tablet, topical cream, topical foam, and topical shampoo for treating fungal infections. It’s used for this purpose in adults and some children.

For ketoconazole oral tablet, this includes children ages 2 years or older. For ketoconazole foam, this includes children ages 12 years or older. The shampoo and cream are for use in adults. Depending on the condition, it can be prescribed as a short-term or long-term treatment.

Examples of infections the topical cream and shampoo can treat include a skin or scalp yeast infection and ringworm. Doctors usually prescribe the tablet when other treatments haven’t worked or have caused harmful side effects.

Doctors may not prescribe ketoconazole oral tablet in some situations. This includes prescribing them to people who have liver disease or take certain other medications.

Use for seborrheic dermatitis

Doctors may prescribe ketoconazole topical cream, topical foam, and topical shampoo for treating seborrheic dermatitis. This is a common skin condition primarily affecting the scalp.

The cream and shampoo are for use in adults. The ketoconazole foam may be used in children ages 12 years or older. It’s usually prescribed as a short-term treatment and for long-term maintenance.

The exact cause of seborrheic dermatitis isn’t clear. The condition causes itchy, flaky skin on the scalp, eyebrows, and mustache or beard area. It looks like dandruff. The condition is often long lasting and can go away and come back.

Ketoconazole may cause mild or serious side effects. More common mild side effects of ketoconazole and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about ketoconazole’s side effects, ask your doctor or pharmacist. You can also read the prescribing information* for ketoconazole.  

* To view ketoconazole’s prescribing information, see the “Article resources” section below.

Mild side effects

More common mild side effects reported with some forms of ketoconazole are listed below. These side effects may differ based on the form of ketoconazole you take or use.

This article doesn’t include all possible mild side effects of the drug. To learn more about ketoconazole’s side effects based on the form, see the prescribing information* for ketoconazole.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Ketoconazole shampoo’s mild side effects include:

• changes in hair texture
• scalp dryness
• scalp irritation
• scalp itching
• mild allergic reaction†

Ketoconazole oral tablet’s mild side effects include:

• abdominal pain
• diarrhea
• headache
• nausea
• mild allergic reaction†

* To view ketoconazole’s prescribing information, see the “Article resources” section below.
† For details about this side effect, see the “Interactions and warnings for ketoconazole” section below.

Serious side effects

Serious side effects of ketoconazole are listed below. These side effects may differ based on the form of ketoconazole you take or use.

This article doesn’t include all possible serious side effects of the drug. To learn more about ketoconazole’s side effects based on the form, see the prescribing information* for ketoconazole.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, ketoconazole’s serious side effects for oral tablet only include:

• adrenal gland problems
• low testosterone level
• boxed warnings: risks of serious liver problems and long QT syndrome, and caution about treatment with the drug for specific purposes†
• severe allergic reaction†

* To view ketoconazole’s prescribing information, see the “Article resources” section below.
† For details about this side effect, see the “Interaction and warnings for ketoconazole” section below.

The dosage of ketoconazole your doctor prescribes may vary based on your condition and certain other factors. Talk with your doctor about the dosage you should follow.

Taking or applying ketoconazole

Ketoconazole oral tablet is swallowed. You can take it with or without food, but taking it with food will help it work best.

Ketoconazole topical foam or topical cream is applied to the affected area.

Ketoconazole topical shampoo is applied to damp skin in the affected area. You lather it, leave it in place for 5 minutes, and then rinse it off.

Your doctor will talk with you about how to take or use ketoconazole. They’ll explain how much to take or apply and how often. Always follow your doctor’s recommendation.

Overdose of ketoconazole

You should not take or use more ketoconazole than your doctor prescribes. For some drugs, doing so may lead to serious side effects or overdose.

The topical forms of ketoconazole should not be swallowed or used in the eyes or vagina.

If you think you’ve taken or used too much ketoconazole, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Below you’ll find answers to a few commonly asked questions about ketoconazole.

Can ketoconazole be prescribed for hair loss?

Possibly. Doctors can prescribe topical forms of ketoconazole to treat seborrheic dermatitis. Hair loss can be a symptom of seborrheic dermatitis. Treating the condition with ketoconazole may help stop the hair loss and allow hair to regrow.

Also, doctors may prescribe this drug for hair loss as an off-label use. Off-label means doctors are prescribing a drug for a condition other than its approved uses.

To learn more about ketoconazole for hair loss, talk with your doctor.

How does ketoconazole compare with similar drugs, such as miconazole and climbazole?

Ketoconazole is an antifungal. There are many similar drugs, such as climbazole (which is not available in the United States), miconazole, and fluconazole. Some of them work better topically, when applied to the skin and scalp. Others work better when swallowed.

Ketoconazole can work as a tablet that’s swallowed or as a topical treatment applied to the skin. But doctors usually don’t prescribe the tablet as a first treatment option. Instead, they tend to prescribe the tablet only when other treatments haven’t worked or have caused harmful side effects.

Talk with your doctor or pharmacist to find out more about other antifungals.

Is ketoconazole a steroid?

No, ketoconazole is an antifungal drug. But doctors may prescribe topical ketoconazole forms along with a steroid, such as hydrocortisone. The steroid can help relieve some of the symptoms of a fungal infection.

The combination of ketoconazole tablet and a steroid should be used with caution. Using these medications together could cause serious side effects.

Ask your doctor or pharmacist before using a steroid along with ketoconazole.

How does ketoconazole work? And how long does it take to start working?

Ketoconazole is an antifungal drug. It works by stopping fungi from growing. This helps your body clear a fungal infection.

Ketoconazole will start working as soon as you take or use it. But it can take a few days to weeks for symptoms to ease, depending on the form of ketoconazole prescribed. For some skin infections, it can take 1–2 months before symptoms clear.

To learn more about what to expect with your form of ketoconazole, talk with your doctor or pharmacist.

Can ketoconazole be used with hydrocortisone?

Yes, topical forms of ketoconazole can be used with hydrocortisone.

Hydrocortisone is a corticosteroid. It can help relieve symptoms of a fungal infection, such as itching or inflammation. This can help you feel better while ketoconazole works to clear the infection.

Topical hydrocortisone doesn’t interact with topical ketoconazole or ketoconazole oral tablet. But hydrocortisone that is swallowed can interact with ketoconazole.

The combination of ketoconazole tablet and a steroid should be used with caution. Using these medications together can cause serious side effects.

Ask your doctor or pharmacist before using a steroid along with ketoconazole.

Below, you’ll find information about ketoconazole’s possible interactions and warnings.

Interactions of ketoconazole

For some medications, certain things may affect how the drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you take ketoconazole, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription drugs
• over-the-counter medications
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for ketoconazole” section below.

Warnings for ketoconazole

Ketoconazole should not be taken or used by certain people.

Boxed warnings

Ketoconazole oral tablet has boxed warnings about the risks of serious liver problems and long QT syndrome. It also has a boxed warning stating the drug should only be used for specific purposes. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

To learn more about these warnings, read below. You can also talk with your doctor or pharmacist.

Risk of serious liver problems. Some people taking ketoconazole have had serious liver problems. This includes liver failure that required a liver transplant. Some liver problems have also been fatal.

This has happened in people taking high doses of ketoconazole tablet for short periods of time. It has also happened in people taking low doses of the tablet for long periods of time. Due to this risk, doctors will monitor your liver function while you’re taking ketoconazole oral tablet.

Symptoms of serious liver problems may include:

• nausea or vomiting
• loss of appetite
• abdominal pain
• dark urine
• light-colored stools
• jaundice (yellowing of the skin or whites of the eyes)

If you have any of these symptoms, tell your doctor. They’ll likely recommend stopping ketoconazole oral tablet.

Risk of long QT syndrome. With long QT syndrome, changes in the heart’s electrical signals occur. This can lead to serious and life threatening heart rhythm problems.

Ketoconazole oral tablet can cause this, as can other drugs. When ketoconazole oral tablet is taken with these drugs, the risk is even higher. Due to this risk, ketoconazole oral tablet shouldn’t be taken with other drugs that can cause long QT syndrome.

Symptoms of long QT syndrome include:

• lightheadedness
• fluttering feeling in the chest
• chest pain
• shortness of breath
• fainting

Cardiac arrest (when the heart stops beating) may also occur with long QT syndrome.

If you have any of these symptoms, tell your doctor. They’ll likely recommend stopping ketoconazole oral tablet. However, if your symptoms feel serious or life threatening, seek emergency medical care.

Prescribing the drug for specific purposes. Due to the risk of serious liver problems and long QT syndrome, ketoconazole oral tablet should only be prescribed for specific purposes.

This means doctors should prescribe other treatments first. They should only prescribe ketoconazole oral tablet if these treatments don’t work or cause harmful side effects.

Ketoconazole oral tablet shouldn’t be used to treat fungal infections of the skin or nails. It also shouldn’t be used to treat Candida infections.

Other warnings

Ketoconazole could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether ketoconazole is a safe option for you. These warnings may differ based on the form of ketoconazole you take or use.

Ask your doctor about specific warnings for ketoconazole, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Ketoconazole can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to ketoconazole or any of its ingredients, your doctor will likely not prescribe ketoconazole. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to ketoconazole, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Pregnancy or breastfeeding and ketoconazole

Information about ketoconazole and pregnancy and breastfeeding is described below.

Ketoconazole and pregnancy

It’s not known whether ketoconazole should be taken or used during pregnancy. If you’re planning a pregnancy or can become pregnant, talk with your doctor before taking or using this medication.

Ketoconazole and breastfeeding

It’s not known whether topical forms of ketoconazole should be used while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before using this medication.

Ketoconazole oral tablet should not be taken while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before taking this medication. Your doctor may recommend other ways to feed your child during treatment with ketoconazole oral tablet.

You may be able to save money on your prescription for ketoconazole by using our Perks discount coupons. They can be found at the end of this article.

If you have questions about how to pay for ketoconazole, talk with your doctor or pharmacist.

Note: Optum Perks coupons cannot be used with insurance copays or benefits.

This article describes ketoconazole’s uses and side effects, ways to save on cost, and more. Let your doctor know if you have questions about ketoconazole or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• Am I at a higher risk of side effects than others?
• Are there drug interactions I should be aware of with ketoconazole?
• How does ketoconazole compare with other drugs that could treat my condition?
• Is there an over-the-counter version of ketoconazole?

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Ketoconazole cream 2%. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/cafecac3-20d7-4f9d-8be8-521db8bfb6f1/spl-doc
• Ketoconazole foam, 2%. (2022). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/77989858-9f7a-45d6-97fb-deba1cba8fe8/spl-doc
• Ketoconazole shampoo, 2%. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/b200ef76-5ea1-4253-bea5-1e8db0294510/spl-doc
• Ketoconazole tablets USP. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/f162e616-21b4-49b1-b437-15e21001a6f0/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.