Toenail fungus, also known as onychomycosis, is a common infection that can affect anyone. It’s not usually a serious condition, but it can be unsightly and uncomfortable. Symptoms can include discoloration, thickening, and even crumbling of the affected nails.
Ketoconazole is an antifungal medication used to treat a variety of fungal infections. You can find it in several forms, including creams, shampoos, and oral medications.
So, can ketoconazole be used for toenail fungus? That’s what we’ll explore in this article. We’ll clarify how ketoconazole works, its typical uses, and whether it’s an appropriate treatment for toenail fungus. We’ll also look at its limitations and potential side effects, so you can make an informed decision about your treatment options.
What is ketoconazole?
Ketoconazole is a manufactured (synthetic) antifungal medication used to treat several fungal infections.
It comes in two forms:
- Topical
- Oral
Topical ketoconazole comes as a cream, foam, gel, and shampoo, but for targeted application, consider an antifungal foot spray. Oral ketoconazole is usually prescribed only for serious infections because it can have significant side effects.
Brand names
You may recognize ketoconazole by one of its brand names:
- Extina (U.S.)
- Ketodan (Canada)
- Nizoral (U.S. and Canada)
- Xolegel (U.S.)
How it works
Ketoconazole belongs to a class of medications called antifungals, and it works by preventing fungi from producing a substance called ergosterol. Ergosterol is an essential component of fungal cell membranes. When ketoconazole blocks ergosterol production, the fungal cell membrane becomes unstable, which inhibits fungal growth and treats the infection.
Topical vs. oral ketoconazole: Which is used for toenail fungus?
Ketoconazole is an antifungal medication that can be used topically (on the skin) or orally (taken by mouth). But which form is used to treat toenail fungus?
Limitations of topical ketoconazole for toenail fungus
If you have toenail fungus, your doctor probably won’t prescribe topical ketoconazole as the first treatment. That’s because toenail fungus lives deep inside the nail. It’s hard for topical medications to reach it.
Topical medications in general aren’t as effective as oral medications when it comes to treating toenail fungus.
Use of oral ketoconazole
Oral ketoconazole may be used to treat severe cases of toenail fungus, but it’s not a first-line treatment. It’s mainly used for serious fungal infections.
There are some significant risks and side effects associated with oral ketoconazole.
Some of those side effects include:
- liver damage
- allergic reactions
- heart rhythm changes
Also, oral ketoconazole interacts with many other medications, so it’s important to discuss your current medications with your doctor before starting treatment.
Alternative treatments for toenail fungus
There are other, more common treatments for toenail fungus that your doctor may recommend, such as, and possibly even a nail repair solution:
- oral antifungal medications like terbinafine or itraconazole
- topical antifungal medications that can penetrate the nail better, such as ciclopirox
- laser therapy
- surgical removal of the nail
What is ketoconazole used for?
Ketoconazole is an antifungal medication. It’s available as a cream, gel, foam, and shampoo that you put on your skin, and it’s also available in pill form.
FDA-approved uses
The Food and Drug Administration (FDA) has approved ketoconazole for the following uses:
- Athlete’s foot
- Ringworm
- Seborrheic dermatitis
- Dandruff
The pill form is approved for serious fungal infections.
Off-label uses
Sometimes, doctors prescribe a medication for a purpose other than what it’s approved for. This is called “off-label” use.
Ketoconazole is not usually the first choice for toenail fungus. Doctors only prescribe it if other treatments haven’t worked because of the risk of serious side effects.
There are many effective ways to deal with toenail fungus, so talk with your doctor about which one is right for you.
Dosage and administration
Ketoconazole comes in both topical and oral forms. The dosage and directions vary based on the type of infection it’s treating and the formulation you’re using.
Topical ketoconazole
Topical ketoconazole comes as a cream, foam, gel, and shampoo, but for targeted application, consider an antifungal foot spray.
To use any of these forms:
- Wash your hands before and after applying the medication.
- Apply the cream to the affected area and surrounding skin, gently rubbing it in.
- For the foam, spray the medicine into your hand or onto a clean surface, and then apply it to the affected area.
- For the gel, don’t wash the treated area for at least three hours after application.
- For the shampoo, follow the directions on the label, as they can vary depending on the strength of the shampoo.
Your doctor will tell you how often to use the topical medication.
Oral ketoconazole
Your doctor will give you specific instructions about the dose you should take and whether to take it with food or on an empty stomach.
It’s very important to follow your doctor’s directions carefully.
Don’t stop taking the medication without talking to your doctor first. Also, keep all your appointments for bloodwork while you’re taking oral ketoconazole.
What are the side effects and risks of ketoconazole?
Like all medications, ketoconazole carries the risk of side effects and other complications.
Topical ketoconazole
Common side effects of topical ketoconazole include:
- Itching
- Redness
- Burning sensation
Rarely, people have allergic reactions to topical ketoconazole.
Oral ketoconazole
Common side effects of oral ketoconazole include:
- Nausea and vomiting
- Stomach pain
- Headache
- Diarrhea
- Itching
More serious side effects of oral ketoconazole include:
- Liver damage
- Allergic reactions
- Changes in heart rhythm
- Reduced adrenal function
Warnings and precautions
Oral ketoconazole can cause liver damage. If you’re taking it, you’ll need to keep all appointments for bloodwork so your doctor can monitor your liver function.
Ketoconazole interacts with many other medications, including statins, antibiotics, and some heart medications. Because of these interactions, you’ll want to discuss all medications, supplements, and over-the-counter drugs you’re taking with your doctor before using ketoconazole.
If you’re pregnant or breastfeeding, talk with your doctor about whether ketoconazole is right for you.
Your doctor can tell you more about whether ketoconazole is contraindicated for you, meaning that you shouldn’t use it because of the risk of serious health consequences.
Drug interactions
Before you start using ketoconazole, it’s important to know that this medication can interact with other drugs you may be taking. It’s always a good idea to give your healthcare provider a complete list of all the medications and supplements you take.
Topical ketoconazole has few known interactions, but oral ketoconazole has a number of interactions.
These are some of the medications that are known to interact with oral ketoconazole:
- Statins (cholesterol medications)
- Antacids
- Certain antibiotics
- Some medications for heart conditions
Also, you should avoid grapefruit and grapefruit juice if you’re taking ketoconazole. Grapefruit can interfere with the way the medication is processed in your body, and that can lead to side effects.
It’s also important not to drink alcohol while taking ketoconazole. Combining alcohol and ketoconazole can increase the risk of liver damage and other side effects.
Precautions and contraindications
Ketoconazole is an antifungal medication, and like all medications, it may not be right for everyone.
Topical ketoconazole
When using topical ketoconazole, avoid getting the medication in your eyes, nose, or mouth. Also, do not apply it to open wounds.
Oral ketoconazole
Oral ketoconazole carries more contraindications than the topical version. You should not take oral ketoconazole if you have:
- liver disease
- adrenal insufficiency
- QT prolongation
- hypochlorhydria
- congenital long QT syndrome
Special populations
Here’s what we know about how ketoconazole affects specific groups of people:
Children
The NIH says, “Appropriate studies have not been performed on the relationship of age to the effects of ketoconazole topical in children younger than 12 years of age. Safety and efficacy have not been established.”
Older adults
The NIH says, “Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of ketoconazole topical in the elderly. However, some elderly patients may be more sensitive to the side effects of this medicine.”
Breastfeeding
The NIH says, “There are no adequate studies in women for determining infant risk when using this medication during breastfeeding.”
What else can you use for toenail fungus?
If ketoconazole cream isn’t the right choice for your toenail fungus, you have other options.
Oral antifungal medications
These prescription medications are taken by mouth to kill the fungus. Because they are absorbed into the bloodstream, oral medications tend to work more quickly than topical medications. However, they may also come with more side effects.
Common oral antifungals include:
- Terbinafine
- Itraconazole
- Griseofulvin
Topical antifungal medications
These prescription medications are applied directly to the nail. They may take longer to work than oral medications, but they also have fewer side effects.
Common topical antifungals include:
- Ciclopirox
- Efinaconazole
- Tavaborole
Non-pharmacological treatments
Sometimes, medications are not enough to get rid of a stubborn toenail fungus infection; in these cases, laser treatment for nail fungus might be considered. In these cases, your doctor may recommend one of these procedures:
- Laser therapy
- Surgical nail removal
Wrapping Up
Ketoconazole is an antifungal medication that’s sometimes used to treat fungal infections. However, it’s not usually the first choice for toenail fungus, and oral ketoconazole comes with some serious risks. Because of the potential for liver damage and drug interactions, doctors usually prescribe other medications first.
If you think you have toenail fungus, it’s important to see a healthcare provider for an accurate diagnosis and treatment plan. Before you start taking ketoconazole, tell your doctor about any other medications, supplements, or health conditions you have, as ketoconazole can interact with other drugs and may not be safe for everyone.
Keep in mind that there are often safer and more effective alternatives available for treating toenail fungus. Your doctor can help you explore all your options and choose the best course of action for your specific situation.
Ultimately, your health and safety are what matters most, so always prioritize getting professional medical advice and following your doctor’s recommendations.