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Ketoconazole

Ketoconazole by Taro Pharmaceuticals

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Ketoconazole

Trade Names:
Nizoral®

General Description:

Ketoconazole is an antifungal agent used to treat fungal infections (ex. ringworm, bone, lung, central nervous system infections). It may also be prescribed for Cushing's disease or for other reasons. Give ketoconazole with a fatty meal to reduce stomach upset and increase absorption. This medication is available as a tablet or in various topical preparations.

What is this drug?
• Antifungal
• Given by mouth; some forms are used topically

Reasons for prescribing:
• Treatment of fungal infections, whether limited to the skin (ex. ringworm, Malassezia dermatitis), or more serious infections affecting organ systems (bone, lungs, nervous system)
• Treatment of Cushing's disease
• Sometimes used at the same time as the drug Cyclosporine. Ketoconazole reduces the amount of cyclosporine needed.

What dogs/cats should not take this medication?
• Some believe ketoconazole should not be used in cats
• Pets known to have had an allergic reaction to ketoconazole or like products before
• Pets with liver disease or clotting disorders
• Breeding, pregnant or nursing animals

Directions:

To reduce the incidence of stomach upset, divide the dose and give with meals.

Give medication as directed by your veterinarian. Depending upon the condition, this medication may be given once, twice or three times daily. Your veterinarian may suggest tablets be given with a fatty food (ex. butter or cheese).

Give the exact amount prescribed and only as often as directed. Missed doses reduce the effectiveness of therapy. Ideally, give the medication at the same time daily.

Call ahead for refills. Long term-therapy (from a few weeks up until a year) is usually necessary for successful results.

If for some reason your pet needs antacids while on ketoconazole, give them two hours after ketoconazole is administered.

It may take one or two weeks before effects of the medication are noted.

What if dose is missed?

If a dose is missed, give it as soon as you can. If it is time already for the next dose, skip the missed dose and go back to the normal schedule. Do not give two doses at the same time.

What to tell/ask veterinarian before giving medication?

Talk to your veterinarian about:
• When will your pet need to be rechecked
• What tests may need to be performed prior to and during treatment with this drug
• Risks and benefits of using this drug

Tell your veterinarian about:
• If your pet has experienced side-effects on other drugs/products
• If your pet has experienced digestive upset now or ever
• If your pet has experienced liver or kidney disease now or ever
• If your pet has experienced any other medical problems or allergies now or ever
• All medicines and supplements that you are giving your pet or plan to give your pet, including those you can get without a prescription. Your veterinarian may want to check that all of your pet's medicines can be given together.
• If your pet is pregnant or nursing or if you plan to breed your pet

Storage and Warnings:

Store in a tight, light resistant, childproof container in a cool, dry place at room temperature away from heat and direct sunlight.

Refrigerate suspension if directed.

When administering the topical cream, the owner should wear gloves and wash hands after use.

Keep this and all medication out of reach of children and pets. Call your physician immediately if you accidentally take this product.

Potential side effects:
• Nausea, decrease in appetite, vomiting, diarrhea (especially cats)
• High doses may cause liver disease (jaundice - yellowing of gums, skin or eyes), but are resolved when medication is discontinued. This has been found more often in cats and some dogs. Monitoring liver enzymes and blood counts during long-term therapy is advised.
• Some individuals will have a lightened hair coat while undergoing therapy. Reverses when medication is discontinued.
• May cause bleeding problems
• Some individuals may need prednisone administered along with ketoconazole
• Testicular secretion of testosterone is reduced; may produce a feminizing effect or infertility in males.
• If you notice anything unusual, contact your veterinarian

Can this drug be given with other drugs?
• Yes, but possible interactions may occur with acyclovir, antacids, anticholinergics (ex. propantheline), cyclosporine, digoxin, ethanol, H2 blockers (cimetidine, ranitidine), isoniazid, mitotane, methylprednisolone, phenytoin, rifampin, theophylline and warfarin.
• These drugs should not be given with ketoconazole: astemizole, cisapride and terfenadine.
• If your pet experiences any unusual reactions when taking multiple medications, contact your veterinarian.

Overdosing?

Contact your veterinarian immediately if pet eats more than the prescribed amount.

What else should I know?

Notify your veterinarian if your animal's condition does not improve or worsens despite this treatment.

As with all prescribed medicines, ketoconazole should only be given to the dog/cat for which it was prescribed. It should be given only for the condition for which it was prescribed.

This is just a summary of information about ketoconazole. If you have any questions or concerns about ketoconazole or for the condition it was prescribed, contact your veterinarian.

Ketoconazole
(Nizoral)

Common Drug Name
Ketoconazole 

Common Brand Names
Nizoral (human form) 
Generic products are available.

Storage
Store at room temperature in a tight, light resistant, childproofed container.

Uses
Dogs and Cats: Ketoconazole is used for the treatment of serious fungal infections. It may also be used against some yeast and dermatophyte (ringworm) infections. It suppresses the adrenal gland, so is used for the treatment of hyperadrenocorticism (Cushing?s disease) in dogs. May be used to maximize the effects of cyclosporine. 
Ferrets, Reptiles, Rabbits, Chinchillas, Gerbils, Hamsters, Guinea Pigs, Rats, and Mice: It is common to use ketoconazole for the treatment of fungal infections.
Birds: It is common to use ketoconazole for the treatment of Candida infections.

Dose and Administration
Always follow the dosage instructions provided by your veterinarian. If you have difficulty giving the medication, contact your veterinarian.
Dose and frequency of administration depends upon the disease and response to treatment. It may be necessary to treat several months, and may take one or two weeks to start seeing improvement.
Tablets are given by mouth, and should be given with food, preferably a fatty meal. However, contact your veterinarian prior to adding fat to your pet's diet.
Birds: May be added to the food or drinking water at different concentrations.
If you miss a dose, give it as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to the regular schedule. Do not give 2 doses at once. 
This medication should only be given to the pet for whom it was prescribed. 

Possible Side Effects
May see lack of appetite, vomiting, diarrhea, or liver toxicity (jaundice - yellowing of gums, skin or eyes) or bleeding problems. Consult your veterinarian if you notice any of these.
May see a reversible lightening of the haircoat.
Signs of an allergic reaction may include facial swelling, hives, scratching, sudden onset of diarrhea, vomiting, shock, seizures, pale gums, cold limbs, or coma. If you observe any of these signs, contact your veterinarian immediately.

Precautions
Not for use in animals hypersensitive (allergic) to it or to similar products.
Not for use in pregnant or lactating animals (female animals nursing their young). May cause infertility in males.
Not for use in animals with liver disease or clotting problems.
If on high oral doses of ketoconazole, may need corticosteroid therapy during periods of acute stress.
Consult with your veterinarian regarding the physical examinations and laboratory testing (especially monitoring liver enzymes) necessary prior to and during treatment with ketoconazole.

Drug and Food Interactions
Consult your veterinarian before using ketoconazole with any other medications, including vitamins and supplements, Mitotane, cisapride, astemizole, terfenadine, warfarin, or other anticoagulants, other hypoglycemic agents, theophylline, cyclosporine, and methylprednisolone, since interactions may occur. 
Do not give with antacids or other products that alkalinize the stomach pH level. If needed, these products may be given 2 hours after the ketoconazole dose.
Blood levels of ketoconazole, phenytoin, and rifampin may be altered when these medications are used together.
May increase digoxin levels; they should be monitored while giving ketoconazole.
May behave synergistically with acyclovir.
Use cautiously with other medications that can also cause liver damage.

Signs of Toxicity/Overdose
May see signs similar to those under side effects.
If you know or suspect your pet has had an overdose, or if you observe any of these signs in your pet, contact your veterinarian immediately.
Keep this and all other medications out of the reach of children and pets.

This information may not cover all possible uses, directions, side effects, precautions, allergic reactions, drug interactions, or withdrawal times. Always consult your own veterinarian for specific advice concerning the treatment of your pet.
 

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