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Generic: ketoconazole,miconazole nitrate is used for the treatment of Aspergillosis Candidiasis, Cutaneous Candidiasis, Vulvovaginal Tinea Pedis Tinea Versicolor


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Description


Ketoconazole cream, 2% contains the broad-spectrum synthetic antifungal agent, ketoconazole 2%, formulated in an aqueous cream vehicle consisting of butylated hydroxyanisole (BHA), cetyl alcohol, isopropyl myristate, polysorbate 60, polysorbate 80, propylene glycol, purified water, sorbitan monostearate and stearyl alcohol.

Ketoconazole is cis-1-acetyl-4-[4-[[2-(2,4-dichlorophenyl)-2-(1 H-imidazol-1-ylmethyl)-1,3-dioxolan-4-yl]methoxy]phenyl] piperazine and has the following structural formula:

Molecular Formula: C 26H 28Cl 2N 4O 4

Molecular Weight: 531.43

Clinical Pharmacology


When ketoconazole cream, 2% was applied dermally to intact or abraded skin of beagle dogs for 28 consecutive days at a dose of 80 mg, there were no detectable plasma levels using an assay method having a lower detection limit of 2 ng/mL.

After a single topical application to the chest, back and arms of normal volunteers, systemic absorption of ketoconazole was not detected at the 5 ng/mL level in blood over a 72-hour period.

Two dermal irritancy studies, a human sensitization test, a phototoxicity study and a photoallergy study conducted in 38 male and 62 female volunteers showed no contact sensitization of the delayed hypersensitivity type, no irritation, no phototoxicity and no photoallergenic potential due to ketoconazole cream, 2%.

Microbiology


Ketoconazole is a broad spectrum synthetic antifungal agent which inhibits the in vitro growth of the following common dermatophytes and yeasts by altering the permeability of the cell membrane: dermatophytes: Trichophyton rubrum, T. mentagrophytes, T. tonsurans, Microsporum canis, M. audouini, M. gypseum and Epidermophyton floccosum; yeasts: Candida albicans, Malassezia ovale (Pityrosporum ovale) and C. tropicalis; and the organism responsible for tinea versicolor, Malassezia furfur (Pityrosporum orbiculare). Only those organisms uled in the INDICATIONS AND USAGE section have been proven to be clinically affected. Development of resistance to ketoconazole has not been reported.

Mode of Action


In vitro studies suggest that ketoconazole impairs the synthesis of ergosterol, which is a vital component of fungal cell membranes. It is postulated that the therapeutic effect of ketoconazole in seborrheic dermatitis is due to the reduction of M. ovale, but this has not been proven.

Indications And Usage


Ketoconazole cream, 2% is indicated for the topical treatment of tinea corporis, tinea cruris and tinea pedis caused by Trichophyton rubrum, T. mentagrophytes and Epidermophyton floccosum; in the treatment of tinea (pityriasis) versicolor caused by Malassezia furfur (Pityrosporum orbiculare); in the treatment of cutaneous candidiasis caused by Candida spp. and in the treatment of seborrheic dermatitis.

Contraindications


Ketoconazole cream, 2% is contraindicated in persons who have shown hypersensitivity to the active or excipient ingredients of this formulation.

Warnings


Ketoconazole cream, 2% is not for ophthalmic use.

Precautions


General


If a reaction suggesting sensitivity or chemical irritation should occur, use of the medication should be discontinued. Hepatitis (1:10,000 reported incidence) and, at high doses, lowered testosterone and ACTH induced corticosteroid serum levels have been seen with orally administered ketoconazole; these effects have not been seen with topical ketoconazole.

Carcinogenesis, Mutagenesis, Impairment of Fertility


A long-term feeding study in Swiss Albino mice and in Wistar rats showed no evidence of oncogenic activity. The dominant lethal mutation test in male and female mice revealed that single oral doses of ketoconazole as high as 80 mg/kg produced no mutation in any stage of germ cell development. The Ames' salmonella microsomal activator assay was also negative.

Pregnancy


Teratogenic effects
Pregnancy Category C

Ketoconazole has been shown to be teratogenic (syndactylia and oligodactylia) in the rat when given orally in the diet at 80 mg/kg/day, (10 times the maximum recommended human oral dose). However, these effects may be related to maternal toxicity, which was seen at this and higher dose levels.

There are no adequate and well-controlled studies in pregnant women. Ketoconazole should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers


It is not known whether Ketoconazole cream, 2% administered topically could result in sufficient systemic absorption to produce detectable quantities in breast milk. Nevertheless, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use


Safety and effectiveness in children have not been established.

Adverse Reactions


During clinical trials 45 (5.0%) of 905 patients treated with ketoconazole cream, 2% and 5 (2.4%) of 208 patients treated with placebo reported side effects consisting mainly of severe irritation, pruritus and stinging. One of the patients treated with ketoconazole cream developed a painful allergic reaction.

In worldwide postmarketing experience, rare reports of contact dermatitis have been associated with ketoconazole cream or one of its excipients, namely propylene glycol.

Dosage And Administration


Cutaneous candidiasis, tinea corporis, tinea cruris, tinea pedis, and tinea (pityriasis) versicolor


It is recommended that ketoconazole cream, 2% be applied once daily to cover the affected and immediate surrounding area. Clinical improvement may be seen fairly soon after treatment is begun; however, candidal infections and tinea cruris and corporis should be treated for two weeks in order to reduce the possibility of recurrence.

Patients with tinea versicolor usually require two weeks of treatment. Patients with tinea pedis require six weeks of treatment.

Seborrheic dermatitis


Ketoconazole cream, 2% should be applied to the affected area twice daily for four weeks or until clinical clearing.

If a patient shows no clinical improvement after the treatment period, the diagnosis should be redetermined.

How Supplied


Ketoconazole cream, 2% is supplied in 15 g (NDC 51672-1298-1).

STORAGE AND HANDLING SECTION


Store at 20°-25°C (68°-77°F) [see USP Controlled Room Temperature].


Mfd. by: Taro Pharmaceuticals Inc., Brampton, Ontario, Canada L6T 1C1 Dist. by: Taro Pharmaceuticals U.S.A., Inc., Hawthorne, NY 10532

Revised: March, 2014

PK-2925-4 354


Drug Facts

Active Ingredient


Miconazole Nitrate 2% USP

Purpose


Antifungal

Uses


Cures most athlete's foot ( tinea pedis) and ringworm (tinea corporis)

for effective relief of itchy,scaly skin between the toes.

Warnings


For extenal use only

WHEN USING THIS PRODUCT


Avoid contact with the eyes.

If irritation occurs or if there is no improvement within 4 weeks, discontinue use and consult a doctor.

Flammable


Do not use while smoking or near heat or flame

DO NOT USE


On children under 2 years of age unless directed by a doctor

KEEP OUT OF REACH OF CHILDREN


If swallowed, get medical help or contact a Poison Control Center right away .

Directions


clean the affected area and dry thoroughly apply a thin layer of the product over affected area twice daily (morning and night) or as directed by a doctor supervise children in the use of this product for athlete’s foot: pay special attention to spaces between toes; wear well-fitting, ventilated shoes and change shoes and socks at least once daily for athlete’s foot and ringworm, use daily for 4 weeks if condition persists longer, consult a doctor this product is not effective on scalp or nails.

Other Information


store at controlled room temperature 15 o-30 oC (59 o-86 oF)

Inactive Ingredients


acetic acid, benzyl alcohol, isopropyl alcohol (30%), laureth-4, water

Questions Or Comments


1-800-321-4576 or visit www.pedinol.com

Pedizolpak


Contents:

NDC 0884-0293-01

1- Pedinol Topical Antifungal 1 fl. oz. (29.57 mL)

NDC 51672-1298-1

1- Ketoconazole Cream 2% 15g

1- Foot File (with extra pads)

6- Nail Files

Ketoconazole 15g Ndc 51672-1298-1


NDC 51672-1298-1

15 g

Ketoconazole Cream 2%

FOR DERMATOLOGIC USE ONLY. NOT FOR OPHTHALMIC USE.

Rx only

Keep this and all medications out of the reach of children.

TARO



Fungoid Tincture 1 Fl. Oz. (29.57 Ml) Carton Ndc 0884-0293-01




Pedizolpak Ndc 70859-053-01




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