Ketoconazole (Shampoo)

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[edit] BRAND NAMES

[edit] STRUCTURE

Ketoconazole.jpg

[edit] MECHANISM OF ACTION

Ketoconazole is a synthetic antifungal agent of the imidazole class. It inhibits lanosterol 14α-demethylase, a cytochrome P-450 enzyme that converts lanosterol to ergosterol.

Ergosterol is an essential component of the fungal cell membrane. The inhibition of its synthesis results in accumulation of toxic 14α-methylated sterols and the production of a defective cell membrane with altered permeability and leakage of cellular contents.

Ketoconazole Shampoo relieves also scaling and pruritus, which are usually associated with seborrhoeic dermatitis, pityriasis capitis (dandruff) and pityriasis versicolor

[edit] INDICATIONS

Fungal infections on the scalp and body such as:

  • Dandruff from proven fungal infection (pityriasis capitis)
  • Dry or greasy scaling of the scalp and other parts of the body called seborrhoeic dermatitis, from proven fungal infection.
  • White to brown patches on the body that sometimes appear after being in the sun called tinea versicolor or pityriasis versicolor. It is a non-contagious infection of the skin caused by Pityrosporum orbiculare (Malassezia furfur). This commensal organism is part of the normal skin flora. In susceptible individuals the condition is often recurrent and may give rise to hyperpigmented or hypopigmented patches on the trunk which may extend to the neck, arms and upper thighs. Treatment of the infection may not immediately result in restoration of pigment to the affected sites. Normalization of pigment following successful therapy is variable and may take months, depending on individual skin type and incidental skin exposure. The rate of recurrence of infection is variable.

[edit] DOSAGE

Apply to the affected area and a wide margin surrounding this area twice weekly for 2-4 weeks. Wash affected areas of skin (not just the hair), using a palmfull of shampoo and leave for 3-5 minutes before rinsing.

[edit] CONTRAINDICATIONS

Hypersensitivity to the active ingredient or excipients of this formulation

[edit] PRECAUTIONS

  • Avoid contact with the eyes. If the shampoo should get into the eyes, they should be bathed with water.

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category C (US). Ketoconazole is not detected in plasma after chronic shampooing. Ketoconazole has been shown to be teratogenic (syndactylia and oligodactylia) in the rat when given orally in the diet at 80 mg/kg/day (10 times the maximum recommended human oral dose). However, these effects may be related to maternal toxicity, which was seen at this and higher dose levels. There are no adequate and well-controlled studies in pregnant women. Ketoconazole should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • Nursing mothers: Ketoconazole is not detected in plasma after chronic shampooing. Nevertheless, caution should be exercised when Ketaconazole shampoo is administered to a nursing woman.

[edit] SIDE EFFECTS

Ketoconazole shampoo is generally well tolerated. Reported adverse events included allergic reaction, itchy, irritated or greasy skin and scalp, rash and erythema. As with other shampoos, a local burning sensation, oiliness and dryness of the hair and scalp have also been reported. In rare instances, mainly in patients with chemically damaged hair or grey hair, a discolouration of the hair has been observed

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

http://www.janssenpharmaceuticalsinc.com/assets/nizoral_shampoo.pdf

[edit] REFERENCES

Antifungals
Ergosterol target : Cell membrane target Azoles (lanosterol 14 alpha-demethylase inhibitors) : Ergosterol inhibitors Imidazoles Topical: Bifonazole   Clotrimazole   Econazole   Fenticonazole   Ketoconazole   Isoconazole   Miconazole   Sertaconazole   Tioconazole
Triazoles Topical: Fluconazole   Terconazole
Systemic: Fluconazole   Itraconazole   Posaconazole   Voriconazole
Polyene antimycotics (ergosterol binding; they form pores in the membrane) Topical: Nystatin
Systemic: Amphotericin B
Allylamines (squalene epoxidase inhibitors) : Ergosterol inhibitors Topical: Amorolfine   Naftifine   Terbinafine
Systemic: Terbinafine
Echinocandins (β-glucan synthase inhibitors) : Cell wall target Anidulafungin   Caspofungin   Micafungin
Pyrimidine analogues / Thymidylate synthase inhibitors : Nucleic acid inhibitors Flucytosine
Mitotic inhibitors Griseofulvin
Others Ciclopirox