Pharmacological properties of the drug Nizoral cream
Pharmacodynamics. Ketoconazole is a synthetic derivative of imidazoledioxolane, which has a pronounced fungicidal and fungistatic effect against dermatophytes (Trichophyton spp., Epidermophyton floccosum, Microsporum spp.) and yeast (Candida spp., Malassezia furfur). Ketoconazole cream quickly reduces flaking and itching, which are caused by dermatophytes and yeasts, and are also characteristic of skin lesions of Pityrosporum spp . Pharmacokinetics. When Nizoral cream is applied topically, the level of ketoconazole in the blood is not determined.
Contraindications
Contraindications to the use of Nizoral cream and shampoo
Individual sensitivity to any of the components of the drug.
Contraindications to the use of Nizoral tablets
Contraindications include:
- liver diseases of an acute or chronic nature;
- lactose intolerance , lactase deficiency , glucose-galactose malabsorption ;
- co-administration with substrates of the 3A4 isoenzyme of the cytochrome CYP3A4 - Bepridil, Astemizole, Halofantrine, Disopyramide, Dofetilide, Cisapride, Levacetylmethadol, Terfenadine, Sertindole, Quinidine, Domperidone and Mizolastine , since increased levels of these drugs in the blood lead to an increase in the QT interval and arrhythmias ;
- combined use with oral forms of Midazolam and Triazolam ;
- co-administration with HMG-CoA reductase blockers transformed by the CYP3A4 system , for example, Simvastatin and Lovastatin ;
- combined use with ergot alkaloids , such as dihydroergotamine, ergometrine, methylergometrine, ergotamine ;
- simultaneous use with Eplerenone, Nisoldipine, Irinotecan, Everolimus ;
- age less than 3 years;
- individual sensitivity to any of the components of the drug.
Nizoral tablets are advised to be used with caution in people with reduced stomach acidity, because in this condition the absorption of the drug worsens. Patients taking antacids should take a two-hour break after taking Nizoral. Patients with achlorhydria or patients taking medications that reduce the secretion of hydrochloric acid in the stomach ( histamine H2 receptor blockers or proton pump blockers ) should take Nizoral with drinks containing cola. In persons with adrenal insufficiency or in persons exposed to severe stress (major surgery), adrenal function should be monitored when using the drug.
Nizoral is also recommended with caution to persons who abuse alcohol, because when the drug is used simultaneously with alcohol, the development of a disulfiram-like reaction , characterized by rash, redness, nausea, swelling and headache, is possible.
Patients with liver failure and those taking hepatotoxic drugs should use Nizoral with caution due to the risk of hepatotoxicity and only when strictly indicated, also taking into account the existence of other effective antifungal drugs.
Use of the drug Nizoral cream
- treatment of candidomycosis of the skin, athlete's foot, hands, feet, inguinal athlete's foot and pityriasis versicolor: the cream is applied to the affected skin and adjacent areas once a day;
- treatment of seborrheic dermatitis: Nizoral cream is applied to the affected areas of the skin 1-2 times a day, depending on the severity of the lesion. Treatment should continue for several days after all symptoms disappear. If there is no evidence of clinical recovery within 4 days, the diagnosis should be reconsidered.
Duration of treatment: pityriasis versicolor - 2-3 weeks, yeast infections - 2-3 weeks, athlete's foot - 2-4 weeks, athlete's foot - 3-4 weeks, athlete's foot - 4-6 weeks. Seborrheic dermatitis - 2-4 weeks, for maintenance therapy the cream is applied once a week.
Release form
- White flat tablets, round in shape, with beveled edges, on one side with the inscription “JANSSEN“, on the other - with a serif and the inscription “K 200“. 10 tablets in a blister, 1 or 3 blisters in a paper pack.
- Nizoral shampoo 2% is a red-orange liquid. 25, 60 or 125 ml of liquid in a polyethylene bottle, 1 bottle in a paper pack.
- Nizoral 2% cream is white in color and has a uniform consistency. 15 grams of cream in aluminum tubes, 1 tube in a paper pack.
Special instructions for the use of Nizoral cream
If Nizoral cream is applied to areas treated with corticosteroid ointments, it is recommended to apply corticosteroids in the morning, and Nizoral cream in the evening, then gradually, over 2-3 weeks, stop steroid therapy. During pregnancy and breastfeeding. Since the drug is practically not resorbed and does not enter the systemic circulation, its use is possible during pregnancy and lactation. Does not affect the ability to drive vehicles or operate equipment.
Compound
- 1 tablet of Nizoral contains approximately 200 mg of ketoconazole . Additional substances: polyvidone K90, lactose monohydrate, microcrystalline cellulose, magnesium stearate, corn starch, silicon dioxide, water.
- Nizoral shampoo contains 20 mg of ketoconazole per 1 gram of product. Additional substances: collagen hydrolyzate, sodium lauryl sulfate, coconut oil diethanolamide, disodium lauryl sulfosuccinate, macrogol methyl dextrose dioleate, hydrochloric acid, red dye, sodium chloride, imidourea, sodium hydroxide, flavoring, water.
- 1 gram of the cream of the same name includes 20 mg of ketoconazole . Additional substances: propylene glycol, sorbitan stearate, cetyl alcohol, stearyl alcohol, polysorbate 60, isopropyl myristate, polysorbate 80, sodium sulfite, water.
Nizoral price, where to buy
Nizoral cream price
The price of Nizoral ointment in Russia is close to 390-430 rubles. In Ukraine, the price of this form of release is 155-205 hryvnia.
How much does Nizoral shampoo cost?
The price of Nizoral shampoo 60 ml in Russia is 550-620 rubles. The average price of shampoo in Ukraine in a bottle of the same volume is 20-210 hryvnia.
Price of Nizoral tablets
The drug is quite rare in pharmacies in Russia and Ukraine. Buying tablets in Moscow (package No. 10) will cost an average of 750 rubles. For comparison, the same package of tablets in Ukraine costs 55-65 hryvnia.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
- Online pharmacies in KazakhstanKazakhstan
ZdravCity
- Nizoral shampoo 20 mg/g 120 mlJanssen-Pharmaceutica NV
RUB 960 order - Nizoral shampoo 20mg/g 60 mlJanssen-Pharmaceutica NV
RUR 751 order
- Nizoral cream for external use 2%, tube 15 g Janssen-Pharmaceutica NV
RUR 677 order
Pharmacy Dialogue
- Nizoral cream (tube 2% 15g)Janssen Pharmaceutica HB
RUR 677 order
- Nizoral (shampoo 60ml)Janssen Pharmaceutica
RUR 793 order
- Nizoral (shampoo 120ml)Janssen-Cilag
RUB 1,072 order
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Pharmacy24
- Nizoral 2% 15 g cream
160 UAH. order - Nizoral 60 ml shampoo Jansen, Belgium
195 UAH order
PaniPharmacy
- Nizoral cream Nizoral cream 20mg/g 15g Belgium, Janssen
184 UAH order
- Nizoral liquid Nizoral Shampoo 2% bottle 60ml No. 1 Belgium, Janssen
217 UAH. order
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Nizoral's analogs
Level 4 ATC code matches:
Daktarin
Oronazole
Isoconazole
Kandibene
Miconazole
Candide B
Kanesten
Mifungar
Ecodax
Econazole
Clotrimazole
Travogen
Bifonazole
Sebozol
Mycozolon
Mycozoral
Travocort
Mycospor
Mycospor Set
Dermazol
- Analogs of Nizoral tablets: Ketoconazole , Mycozoral .
- Analogs of Nizoral cream: Mycozoral, Sebozol, Mycoket, Dermazol, Ketodin, Ketozoral, Zalain, Onabet, Candibene, Kanesten, Fungisan .
- Analogs of Nizoral shampoo: Mycozoral, Perhotal, Sebozol, Kenazol, Ketodin, Orazol, Ebersept.
The price of analogues of shampoo and other forms of release of Nizoral is generally lower than the price of the described drug.
Interaction
Drugs that reduce gastric acidity reduce the absorption of ketoconazole .
The use of Nizoral with the following drugs is not recommended due to their high ability to reduce the bioavailability of ketoconazole : stimulants of microsomal oxidation , such as Rifabutin, Rifampicin, Carbamazepine, Nevirapine, Isoniazid and Phenytoin .
When used together with Ritonavir, it is necessary to reduce the dosage of ketoconazole , as the bioavailability of the latter may increase.
Ketoconazole is able to suppress the metabolism of drugs broken down by cytochrome P450 CYP3A . As a result, the effects of these drugs, including side effects, may be activated and prolonged.
Co-administration of Nizoral with the following drugs is contraindicated:
- Astemizole, Bepridil, Halofantrine, Disopyramide, Cisapride, Dofetilide, Levacetylmethadol, Mizolastine, Pimozide, Quinidine, Sertindole, Terfenadine and Domperidone (due to the risk of ventricular arrhythmias and prolongation of the QT interval with increasing plasma concentrations);
- oral forms of Triazolam and Midazolam ;
- metabolized by CYP3A4 blockers of HMG-CoA reductase ( Simvastatin, Lovastatin and the like);
- ergot alkaloids ( ergotamine, ergometrine, dihydroergotamine, methylergometrine );
- Irinotecan;
- Eplerenone;
- Nisoldipine;
- Everolimus.
If necessary, during combined use with ketoconazole , it is necessary to reduce the dosage of the following drugs: HIV protease inhibitors, indirect anticoagulants, some antitumor agents ( Busulfan , rose periwinkle alkaloids, Erlotinib, Docetaxel, Imatinib), dihydropyridine blockers of slow calcium channels cleaved by CYP3A4, a number of immunosuppressive agents (Tacrolimus, Cyclosporine, Sirolimus) , some glucocorticosteroids (Fluticasone, Budesonide, Dexamethasone, Methylprednisolone), Digoxin, Brotizolam, Alprazolam, Alfentanil, Buspirone, Cilostazol, Carbamazepine, Ebastine, Fentanyl, Eletriptan, Quetiapine, Midazolam, Repaglinide, Reboxe tin, Sildenafil, Rifabutin, Tolterodine, Trimetrexate, Solifenacin .
Ketoconazole increases the blood levels of sulfonylurea derivatives when taken and increases the risk of hypoglycemia .
In some cases, when taken together with alcohol, disulfiram-like reactions , manifested by rash, redness, nausea, peripheral edema and headache. These symptoms went away on their own within a few hours.
Overdose
The use of the cream in large quantities can lead to erythema , burning sensation and swelling, which disappear immediately after stopping treatment. In case of accidental ingestion, no special measures are required.
There is no data on the possibility of overdose with shampoo.
In case of an overdose of tablets, the most common symptoms were nausea, anorexia , fatigue, drowsiness, vomiting, abdominal pain, weight loss, edema, loss of appetite, flushing, increased sweating, rash, dysgeusia, gynecomastia, dermatitis, headache , diarrhea, alopecia . In this situation, it is necessary to monitor the patient's condition and take enterosorbents . Gastric lavage is performed if indicated.
