Comprehensive medication guide to Ketoconazole including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$20 copay for generic formulations on most commercial and Medicare Part D plans; generic ketoconazole is typically Tier 1–2. Branded topical products (Extina, Ketodan) may be Tier 3–4 and require prior authorization.
Estimated Cash Pricing
$78–$101 retail for generic 200 mg tablets (30 count); as low as $23 with a free GoodRx coupon or ~$9 with GoodRx Companion membership. Generic 2% cream starts from $10–$30 for 15g.
Medfinder Findability Score
82/100
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Ketoconazole is a broad-spectrum azole antifungal medication that has been used clinically since the early 1980s. It is available in multiple forms: oral tablets (200 mg) for serious systemic fungal infections, and topical formulations — including 2% cream, 2% shampoo, 2% foam (Extina), and 2% gel (Xolegel/Ketodan) — for skin and scalp conditions. An over-the-counter 1% shampoo (Nizoral A-D) is also available without a prescription for dandruff control.
Topical ketoconazole treats seborrheic dermatitis, tinea versicolor (pityriasis versicolor), ringworm, athlete's foot, jock itch, and cutaneous candidiasis. Oral ketoconazole is a last-resort treatment, reserved by the FDA for serious systemic infections — including blastomycosis, histoplasmosis, coccidioidomycosis (Valley Fever), chromomycosis, and paracoccidioidomycosis — only when preferred antifungals have failed or are not tolerated.
Brand names include Nizoral (tablet and shampoo), Extina (foam), Xolegel and Ketodan (gel), and Kuric (cream). Generic ketoconazole is widely available at most major pharmacies.
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Ketoconazole works by inhibiting the fungal enzyme 14-alpha-demethylase (CYP51), a cytochrome P450 enzyme that is essential for converting lanosterol into ergosterol — the primary structural lipid in fungal cell membranes. Without ergosterol, the fungal cell membrane loses its integrity and the cell can no longer properly regulate its internal environment. At lower concentrations, ketoconazole stops fungal growth (fungistatic); at higher concentrations, it kills fungal cells outright (fungicidal).
Topical ketoconazole acts locally on fungi living on or just below the skin surface, with minimal systemic absorption. This is why topical forms are generally safe with few systemic side effects. Oral ketoconazole reaches systemic concentrations in the bloodstream — necessary for treating deep tissue fungal infections, but also responsible for its many drug interactions through potent inhibition of the human CYP3A4 enzyme.
At high oral doses, ketoconazole also inhibits human steroid synthesis enzymes, reducing production of cortisol and testosterone. This antiandrogen/antiglucocorticoid effect is exploited therapeutically for Cushing's syndrome (off-label) but also causes adrenal insufficiency as a potential adverse effect.
200 mg — oral tablet
Standard oral dose for systemic fungal infections. Typically 200–400 mg once daily with food.
2% — topical cream
Apply to affected area once daily for 2–6 weeks depending on condition.
2% — shampoo (prescription)
Used for tinea versicolor (one-time application) and seborrheic dermatitis (twice weekly x 4 weeks, then maintenance).
1% — shampoo (OTC)
Nizoral A-D available without prescription for dandruff control. Use every 3–4 days.
2% — foam (Extina)
Apply to affected scalp areas twice daily for 4 weeks for seborrheic dermatitis.
2% — gel (Xolegel/Ketodan)
Apply to affected scalp areas once daily for 2 weeks for seborrheic dermatitis.
As of 2026, ketoconazole is not on the FDA's national drug shortage list. Generic ketoconazole 200 mg tablets and 2% topical cream are produced by multiple manufacturers and are generally available at major retail chain pharmacies (CVS, Walgreens, Walmart, Rite Aid, Kroger). The findability score of 82/100 reflects that generic formulations are broadly accessible with occasional localized gaps.
However, branded topical formulations — Extina foam, Xolegel gel, and Ketodan gel — have historically had more sporadic availability. These specialty products are stocked by fewer pharmacies and are more commonly ordered on demand rather than kept on the shelf. Oral ketoconazole tablets may also be harder to find at smaller independent pharmacies due to low stocking priority following the 2013 FDA safety restrictions.
If your pharmacy doesn't have ketoconazole in stock, medfinder can call pharmacies near you and find which ones can fill your prescription today — saving you hours of calls.
Ketoconazole is not a controlled substance and has no DEA scheduling requirements. Any licensed prescriber with prescribing authority can write a ketoconazole prescription — including nurse practitioners (NPs) and physician assistants (PAs) in all 50 states.
Common prescriber types include:
Dermatologists (most common for topical use)
Primary care physicians and family medicine doctors
Infectious disease specialists (for oral ketoconazole systemic infections)
Endocrinologists (for off-label Cushing's syndrome use)
Nurse practitioners (NPs) and physician assistants (PAs)
Urgent care providers (for straightforward skin fungal infections)
Telehealth is a practical option for topical ketoconazole prescriptions. Platforms like Teladoc, MDLive, Curology, and Apostrophe can evaluate skin conditions via video or photo-based visits and send a prescription to your pharmacy the same day. Oral ketoconazole for systemic infections requires in-person evaluation and ongoing monitoring and is not appropriate for telehealth prescribing.
No — ketoconazole is not a controlled substance and is not scheduled by the DEA. Any licensed prescriber (MD, DO, NP, or PA) with prescribing authority can write a ketoconazole prescription without any special registration or licensing requirements.
There are no refill restrictions due to controlled substance scheduling. Prescribers may set their own refill limits based on clinical judgment (e.g., requiring follow-up before refilling oral ketoconazole to monitor liver function). For topical ketoconazole used for ongoing conditions like recurrent seborrheic dermatitis, providers often write a 90-day supply to minimize refill burden. Oral ketoconazole can also be prescribed via telehealth without special in-person requirements.
Topical ketoconazole side effects (cream, shampoo, foam, gel):
Burning, itching, or stinging at the application site
Redness or skin irritation
Hair discoloration or texture changes (with shampoo use)
Photosensitivity (foam formulation)
Serious side effects (oral ketoconazole — FDA black box warning):
Hepatotoxicity: Serious liver damage, including fatal cases. Symptoms: jaundice, dark urine, fatigue, upper abdominal pain. Monitor liver enzymes.
QT prolongation / torsades de pointes: Dangerous heart rhythm changes — especially with co-administered QT-prolonging drugs. Seek emergency care for palpitations, chest flutter, or fainting.
Adrenal insufficiency: At high doses, suppresses cortisol production. Symptoms: extreme fatigue, dizziness, nausea.
Anaphylaxis: Severe allergic reaction reported after first dose. Seek emergency care immediately if it occurs.
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Fluconazole (Diflucan)
First-line azole antifungal for Candida infections, coccidioidomycosis, and tinea versicolor (oral). Better safety profile than ketoconazole with fewer drug interactions. Generic widely available.
Itraconazole (Sporanox)
Preferred oral azole for histoplasmosis and blastomycosis. Broader spectrum than fluconazole. Boxed warning for heart failure risk. Available as capsules and oral solution.
Terbinafine (Lamisil)
Allylamine antifungal — first-choice for dermatophyte infections (ringworm, athlete's foot, nail fungus). More effective than azoles for dermatophytes. Available OTC as cream and gel.
Ciclopirox (Ciclodan/Loprox)
Prescription topical with broad-spectrum activity. Used for seborrheic dermatitis, candidiasis, and tinea infections. Available as cream, shampoo, and nail solution.
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Dofetilide, quinidine, pimozide, methadone, disopyramide, dronedarone, ranolazine
majorAbsolutely contraindicated. Ketoconazole elevates plasma levels via CYP3A4 inhibition, causing potentially fatal QT prolongation and torsades de pointes.
Simvastatin, lovastatin
majorContraindicated. Elevated statin levels due to CYP3A4 inhibition can cause severe rhabdomyolysis and kidney failure.
Oral triazolam, oral midazolam, alprazolam
majorContraindicated. Extreme prolonged sedation and respiratory depression risk.
Ergot derivatives (ergotamine, dihydroergotamine)
majorContraindicated. Risk of severe vasospasm affecting blood flow to brain and extremities.
Warfarin and anticoagulants
moderateKetoconazole increases anticoagulant levels, raising bleeding risk. Monitor INR closely.
Cyclosporine, tacrolimus, sirolimus
moderateKetoconazole dramatically elevates immunosuppressant levels. Dose reduction and blood level monitoring required.
Proton pump inhibitors, H2 blockers, antacids
moderateReduce stomach acid and impair ketoconazole absorption. Take ketoconazole with non-diet cola if co-administration necessary.
Calcium channel blockers (amlodipine, verapamil)
moderateElevated CCB levels may cause excessive blood pressure lowering. Monitor BP.
Ketoconazole is a well-established antifungal that remains an important option for specific skin and scalp conditions. For the vast majority of patients, it comes in the form of a topical cream or shampoo — both generally safe, widely available, and effective. The oral tablet is a different story: powerful but with a serious safety profile that restricts its use to last-resort systemic infections under close medical supervision.
For patients taking the oral form, attending regular liver function monitoring appointments and maintaining a complete medication list to share with all providers is not optional — it's critical. The drug's CYP3A4 inhibition creates interaction risks that can be life-threatening if overlooked. Avoid alcohol and grapefruit, and never stop taking oral ketoconazole abruptly without consulting your prescriber.
If you have a ketoconazole prescription and need help finding it in stock at a pharmacy near you, medfinder calls pharmacies on your behalf and texts you the results — no hold music, no driving around.
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