Ketoconazole Shampoo

Class

Antifungal

Schedule

POM

Route

ORAL / TOPICAL / IV

Onset

Days for clinical response (varies)

Duration

Days–weeks per indication

Pregnancy

Systemic azoles often av...

Renal

Fluconazole dose-adjust...

High-alert

No

Kenya market

Wholesale / list prices where loaded

From

—

Median

—

Brands

2

Risk first

Contraindications

• Hypersensitivity.
• Many systemic azoles contraindicated with certain CYP3A4 substrates (e.g. some statins, quinidine) — check labels.
• Terfenadine/astemizole historical QT combinations.

Precautions

• Hepatotoxicity monitoring for systemic azoles.
• QT prolongation (some azoles).
• Voriconazole: visual disturbances, photosensitivity, skin cancer risk long-term.
• Confirm species for invasive disease.

Point of care

Dosing

Adult

Wet hair and scalp apply sufficient shampoo to produce enough lather. Massage for one minute and rinse with warm water. Repeat procedure for an additional 3 minutes. Rinse with warm water and dry hair. Shampoo twice a week for 4 weeks at least 3 days between uses

Paediatric

See label paediatric section if present; otherwise use paediatric formulary — do not extrapolate adult doses.

Renal

Fluconazole dose-adjust in CKD; amphotericin nephrotoxicity high-alert.

• CrCl 0–120: Confirm renal dosing in product SmPC / primary label.

Hepatic

Monitor LFTs for courses >14 days or higher-risk patients.

Safety

Drug interactions

Open checker →

• Match agent to site and species.
• For tinea, continue topical beyond clearance.
• Invasive fungal disease needs ID/specialist input and source control.

Safety

Adverse effects

• GI upset, rash, raised LFTs.
• Serious: hepatitis, severe skin reactions, arrhythmias, infusion reactions (amphotericin).

Use

Indications

• Therapeutic use is agent- and indication-specific within the class (Antifungal).
• Use according to culture results, national guidelines (Kenya STG/EML where applicable) and the current product SmPC.
• Dandruff

Pharmacology

Mode of action

Azoles inhibit fungal CYP51 (lanosterol 14α-demethylase), depleting ergosterol and disrupting membrane integrity.

Azoles inhibit fungal CYP51 (lanosterol 14… → Terbinafine inhibits squalene epoxidase. → Polyenes bind ergosterol creating membrane…

Full mechanism text

Azoles inhibit fungal CYP51 (lanosterol 14α-demethylase), depleting ergosterol and disrupting membrane integrity. Terbinafine inhibits squalene epoxidase. Polyenes bind ergosterol creating membrane pores. Echinocandins inhibit β-glucan synthase (cell wall).

ADME

Pharmacokinetics & PD

Onset	Days for clinical response (varies)
Duration	Days–weeks per indication
Route	ORAL / TOPICAL / IV
Metabolism	with major interactions. Topicals: minimal systemic

Full PK/PD text

Fluconazole: excellent bioavailability, renal excretion, CSF penetration. Itraconazole/voriconazole: complex absorption and CYP metabolism with major interactions. Topicals: minimal systemic absorption when intact skin.

Kenya

Brands & prices

2 listed

Brand	Company	Pack	KES
Conaz. Shampoo	Globe Pharmacy Ltd.,	Standard Commercial Pack	—
Phytoral shampoo	Micro-labs Limited	Standard Commercial Pack	—

Special populations

Pregnancy & lactation

Pregnancy

Systemic azoles often avoided in pregnancy (fluconazole high-dose teratogenicity signal); topical clotrimazole commonly used for VVC.

Lactation

Topicals usually fine; systemic — agent-specific.

Diet

Food & alcohol

• Food
• Food

Trust

Sources & disclaimer

Source: Local active-ingredient clinical extract; Professional class pharmacology (Antifungal)

Last reviewed: 01 Aug 2026

Decision support only — not a substitute for clinical judgment, product SmPC, or Kenya STG/EML.