Ketoconazole

Pharmacokinetics
Ketoconazole requires an acidic environment for dissolution
and systemic absorption. It does not enter the central nervous
system. Ketoconazole is a potent inhibitor of hepatic P450 enzymes;
thus dosage adjustments may be necessary to prevent
adverse drug interactions. Table 4-22 contains a partial listing
of potentially serious drug interactions.
Clinical use
Ketoconazole is used to treat severe recalcitrant infections
such as mucocutaneous candidiasis, histoplasmosis, coccidioidomycosis,
and chromomycosis. It is not active against Aspergillus.
In addition to systemic formulations, ketoconazole is
available as a topical cream and shampoo.
Adverse effects
Ketoconazole may cause hepatotoxicity. Because of the risk
of liver toxicity, liver function test results should be monitored.
Gynecomastia and impotence may occur in men