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Ketoconazole has the potential to cause severe, potentially life-threatening side effects and interactions with other medications. It is recommended for use only when alternative treatments are ineffective, unavailable, or unsuitable for you. It is essential to have a thorough discussion with your doctor about the risks and benefits of ketoconazole, as well as other treatment options for fungal infections that may be more effective or safer.

• Liver Concerns: In rare instances, ketoconazole has been linked to severe, potentially fatal liver issues. Immediate medical attention is crucial if you notice signs of liver problems, such as persistent nausea or vomiting, abdominal pain, dark urine, yellowing of the skin or eyes, loss of appetite, or pale stools. To minimize liver risk, your doctor should conduct weekly liver function tests during your treatment with ketoconazole. Avoid consuming alcohol, as it can increase the likelihood of serious liver complications.

• Drug Interactions: Ketoconazole should not be taken with certain medications, including disopyramide, dofetilide, dronedarone, methadone, pimozide, quinidine, and ranolazine, among others, due to the risk of serious, potentially life-threatening drug interactions. These interactions can lead to a condition known as QT prolongation, which affects heart rhythm and may cause severe, sometimes fatal, rapid or irregular heartbeat, dizziness, or fainting. If you experience these symptoms, seek medical help immediately. Inform your doctor and pharmacist about all medications and products you use before starting ketoconazole treatment.

It is important to adhere to these guidelines to ensure safe use of ketoconazole and to prevent any adverse effects or interactions.

You might experience mild stinging, swelling, irritation, or redness on the treated skin. These effects are generally not serious, but if they persist or worsen, it's important to speak with a healthcare professional. Most individuals using this medication do not experience serious side effects. However, if you notice blistering or open sores, contact a healthcare provider immediately for guidance.

While allergic reactions to this medication are very rare, they can be severe. Seek urgent medical attention if you experience symptoms such as a rash, itching, swelling (especially of the face, tongue, or throat), severe dizziness, or difficulty breathing. This summary does not cover all possible side effects. If you observe any unusual symptoms not mentioned here, consult your healthcare provider for advice.

While using ketoconazole, it is crucial to inform your healthcare provider about any other medications you are taking. This is because ketoconazole can interact with various prescription and over-the-counter drugs.

Certain medications, like acetaminophen, may increase the risk of liver problems when taken with ketoconazole. Additionally, some drugs can affect how ketoconazole is eliminated from your body, potentially altering its effectiveness. These include isoniazid, nevirapine, rifamycins (such as rifabutin and rifampin), and St. John's wort.

Ketoconazole may also reduce the body's ability to clear other medications, which could influence how they work. This includes certain benzodiazepines (like alprazolam, midazolam, and triazolam), domperidone, eletriptan, eplerenone, ergot drugs (such as ergotamine), nisoldipine, medications for erectile dysfunction or pulmonary hypertension (such as sildenafil and tadalafil), some seizure medications (like phenytoin), and certain statins (such as lovastatin and simvastatin).

For ketoconazole to be properly absorbed, stomach acid is necessary. If you're taking medications that decrease stomach acid, such as antacids, H2 blockers (like cimetidine, famotidine, and ranitidine), or sucralfate, it's advised to take ketoconazole at least two hours before these drugs. If you're on proton pump inhibitors (PPIs like lansoprazole and omeprazole), consult your doctor or pharmacist for guidance on minimizing this interaction.

Lastly, avoid using levoketoconazole-containing products with ketoconazole, as they are very similar.