Antimicrobials
Ketoconazole

Ketoconazole

General Information

Pediatric: Perform periodic liver function tests and use with caution in patients with impaired hepatic function

Neonatal: Perform periodic liver function tests and monitor patient for evidence of adrenal insufficiency

  • Hepatotoxicity
  • GI symptoms
  • Rash
  • Anaphylaxis
  • Thrombocytopenia
  • Hemolytic anemia
  • Gynecomastia
  • Adrenal insufficiency

Neonatal:

  • Hepatotoxicity
  • Nausea/vomiting
  • Adrenal cortical insufficiency (reported with high doses in adults)

A potent inhibitor of the CYP450 enzyme system.

Check for drug interactions:

  • Concomitant use with cisapride, domperidone may cause cardiac arrhythmias
  • Concomitant use with midazolam may cause excessive sedation and respiratory depression

Neonatal:

  • Increases serum levels of the following drugs:
    • Phenytoin
    • Theophylline
    • Cyclosporine
    • Warfarin
  • Decreases serum levels of the following drugs:
    • Rifampin
    • Isoniazid
  • Decreased GI absorption when administered with H₂ blocker or antacid
  • Tablet: 200mg

Neonatal:

  • Topical: 2% topical cream
  • Oral suspension: 20 mg/mL compounded
  • Tablets require adequate gastric acidity for dissolution
    • In patients receiving H₂-antagonists (e.g. ranitidine) or proton pump inhibitors (e.g. omeprazole) administer ketoconazole with a cola beverage
  • Do not administer with antacids (space doses by 2 hrs)