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May Be Prescribed by Vets for:
Susceptible fungal and yeast infections and hyperadrenocorticism in dog
Ketoconazole is commercially available as an oral
tablet 200mg, topical cream/foam/gel/shampoo in 2%.
Search for Available Dosage Forms
Ketoconazole is an oral azole antifungal-drug. It is used to treat a number of superficial and systemic yeast and fungal infections in dogs. Although ketoconazole has been used in cats, its use is controversial due to the risk of hepatic toxicity. There are other anti-fungal drugs that may be better options in the cat.
Ketoconazole’s mechanism of action is thought to be through a direct effect on cellular membrane permeability, and decreased cellular metabolism and growth. Azole anti-fungal drugs inhibit the fungal P-450 enzyme system and, to a lesser degree, inhibit the mammalian P-450 enzyme system. Blocking of mammalian P-450 enzymes is the mechanism behind the reduction in steroid synthesis (cortisol and testosterone). Ketoconazole has some anti-inflammatory properties and may suppress T-lymphocyte production.
Ketoconazole is generally fungistatic, although it may become fungicidal with prolonged use or at higher dosages. Susceptible fungi and yeast include:
Blastomyces, Coccidioides, Cryptococcus, Histoplasma, Microsporum, Trichophyton, Malassezia, Candidia, Sporotichosis,
Ketoconazole is metabolized by the liver and primarily excreted in the feces. It is well-distributed through most tissues of the body, including skin and subcutaneous tissue, liver, kidneys, adrenal gland, pituitary gland, lungs, bladder, bone marrow, and myocardium. It does not adequately penetrate
cerebrospinal fluid, ocular fluid, or seminal fluid. Ketoconazole is relatively poorly absorbed except in an acid environment, and there is wide inter-patient variation in absorption.
Ketoconazole is used to treat systemic coccidiomycosis, blastomycosis, histoplasmosis, aspergillosis, cryptococcosis, sporotrichosis, and fungal myocarditis. The duration of treatment for these serious, systemic fungal diseases can be quite long, in some cases up to a year. In some animals, suppressive treatment may continue for life. Absorption of ketoconazole is improved by administration with food. Clinical response may not occur until after 10 to 14 days of therapy. In animals that are critically ill, intravenous amphoteracin B may be used with ketoconazole as a means of increasing the efficacy and speed of response. When ketoconazole is used in combination with amphoteracin B, the dose of amphoteracin B is reduced or given at an increased interval.
When ketoconazole is used to treat dermatitis due to Malassezia pachydermatis it is generally used with topical anti-mycotic shampoos. Two to four weeks of treatment may be necessary for chronic cases.
Ketoconazole may be used to treat adrenal hypercorticism in dogs that do not tolerate mitotane. Ketoconazole and mitotane should not be used together, as ketoconazole interferes with the mechanism of action of mitotane. Clinical response to ketoconazole is about 50% of cases.
Ketoconazole interferes with the metabolism of cyclosporine and may be used to reduce the therapeutic dose and cost of treatment with cyclosporine
There are numerous potential drug interactions with
Dr. Barbara Forney is a veterinary practitioner in Chester County, Pennsylvania. She has a master's degree in animal science from the University of Delaware and graduated from the University of Pennsylvania School of Veterinary Medicine in 1982.
She began to develop her interest in client education and medical writing in 1997. Recent publications include portions of The Pill Book Guide to Medication for Your Dog and Cat, and most recently Understanding Equine Medications published by the Bloodhorse.
Dr. Forney is an FEI veterinarian and an active member of the AAEP, AVMA, and AMWA.
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