Nizoder 2% Shampoo

✔️ Uses of Nizoder 2% Shampoo

• Treatment of Fungal infections, Dandruff

✔️ How does Nizoder 2% Shampoo work?

Nizoder 2% Shampoo exerts its antifungal effects by binding to fungal p450 enzymes, thereby inhibiting their activity. These enzymes are involved in the synthesis of ergosterol, a vital component of the fungal cell wall. By inhibiting the production of ergosterol, Nizoder 2% Shampoo prevents the growth and replication of fungal cells. As a result, the fungi responsible for causing dandruff are unable to thrive and sustain their growth. This mechanism of action helps control fungal overgrowth, reducing dandruff and its associated symptoms.

✔️ Side Effects of Nizoder 2% Shampoo

• Dry hair
• Skin burning sensation
• Thinning of the hair
• Change of hair texture

✔️ Quick Suggestions:

• Nizoder 2% Shampoo is used to treat dandruff and to control flaking, scaling, and itching due to dandruff. It contains ketoconazole as the active ingredient. Do not use this shampoo for any other condition specified by your doctor.
• This medicine is meant for external application and should not be swallowed.
• Nizoder 2% Shampoo should not be used on a broken or inflamed scalp.
• If your eyes come in contact with this shampoo, then rinse your eyes with clean water immediately.
• Dry hair and burning may occur in some individuals with the use of this medicine. These symptoms, however, are usually mild and resolve on their own. Furthermore, not everyone may get this side effect.

✔️ Indication of Nizoder 2% Shampoo

Ketoconazole 2% Shampoo is primarily used to treat and prevent infections caused by the yeast Malassezia (previously known as Pityrosporum). It is specifically indicated for the following conditions:

Tinea Versicolor (Focal): Ketoconazole shampoo is effective in treating tinea versicolor, a fungal infection that causes discolored patches on the skin. The shampoo helps control the growth of Malassezia yeast, thereby reducing the symptoms of tinea versicolor.

Seborrheic Dermatitis: This shampoo is also used for the treatment of seborrheic dermatitis, a common skin condition characterized by redness, itching, and flaking of the scalp, face, and other areas. Ketoconazole shampoo helps to alleviate the symptoms associated with seborrheic dermatitis by targeting the underlying fungal infection caused by Malassezia.

Dandruff (Hair Disease): Ketoconazole shampoo is an effective option for treating dandruff, a common scalp condition characterized by flaking and itching. It helps to control the overgrowth of Malassezia yeast on the scalp, reducing flaking and relieving itching associated with dandruff.

✔️ Pharmacology

Ketoconazole 2% shampoo is a synthetic antifungal agent belonging to the imidazole dioxolan class. It exhibits broad-spectrum activity against various dermatophytes (filamentous fungi) and yeasts commonly found on the skin. Ketoconazole works by altering the permeability of the cell membrane in these fungi, leading to their suppression and inhibition of growth.

The dermatophytes targeted by ketoconazole 2% shampoo include Trichophyton rubrum, T. mentagrophytes, T. tonsurans, Microsporum canis, M. audouini, M. gypseum, and Epidermophyton floccosum. It is also effective against yeast species such as Candida albicans, Pityrosporum ovale (also known as Malassezia ovale), and C. tropics. Additionally, ketoconazole is effective against Malassezia furfur (formerly known as Pityrosporum orbiculare), the organism responsible for causing conditions like ringworm.

By targeting a wide range of fungi and yeasts, ketoconazole 2% shampoo helps combat various fungal skin infections, including dandruff (associated with Pityrosporum ovale), dermatophytosis (ringworm), and candidiasis. Its ability to modify the cell membrane permeability of these organisms contributes to its antifungal activity and effectiveness in treating these conditions.

✔️ Dosage and Administration of Nizoder 2% Shampoo

For the treatment of seborrheic dermatitis, the cream should be applied twice daily (every 12 hours) for a duration of 4 weeks or until the condition clears. The shampoo should be applied twice weekly, with at least 3 days between each application, for a total of 4 weeks.

To treat tinea versicolor using the shampoo, wet your hair and massage the shampoo into the scalp for 1 minute. Rinse it off and repeat the process, leaving the shampoo on the scalp for an additional 3 minutes. This should be done twice weekly for 4 weeks, with at least 3 days between each shampoo application.

For tinea corporis, tinea cruris, and tinea pedis, the cream should be applied once daily to the affected area for a duration of 2 weeks (6 weeks for tinea pedis). Ensure that the affected area is adequately covered with the cream.

When using the Ketoconazole shampoo, follow these steps:

1. Wet the area where the shampoo will be applied with a small amount of water.
2. Apply the shampoo to the affected skin or scalp and the surrounding area.
3. Use your fingers to rub the shampoo until it lathers.
4. Leave the shampoo on the skin or scalp for 5 minutes.
5. Rinse off the shampoo with water.

Please note that the dosing and administration instructions for children with seborrheic dermatitis are not established, while for those above 12 years, the shampoo should be applied twice weekly with at least 3 days between each shampoo, and the cream should be applied to the affected area every 12 hours for 4 weeks.

✔️ Interaction

• The absorption of Ketoconazole may be reduced when used concomitantly with antimuscarinics, antacids, H2-blockers, proton pump inhibitors (PPIs), and sucralfate.
• The plasma concentrations of Ketoconazole may be reduced when used together with rifampicin, isoniazid, efavirenz, nevirapine, and phenytoin. Additionally, Ketoconazole may also decrease the concentrations of isoniazid and rifampicin.
• There is a potential for reduced efficacy of oral contraceptives when used concurrently with Ketoconazole.
• Ketoconazole may increase the serum levels of CYP3A4 substrates such as digoxin, oral anticoagulants, sildenafil, and tacrolimus.
• There is a potentially fatal interaction between Ketoconazole and midazolam or triazolam, where Ketoconazole can potentiate and prolong the sedative and hypnotic effects of these drugs.
• Ketoconazole can increase the plasma levels and prolong the QT intervals of astemizole, cisapride, dofetilide, pimozide, quinidine, and terfenadine, which may lead to a dangerous heart rhythm disorder known as torsade de pointes.
• There is an increased risk of myopathy when Ketoconazole is used concomitantly with HMG-CoA reductase inhibitors (e.g., lovastatin, simvastatin).
• Ketoconazole can markedly increase the plasma levels of nisoldipine.
• There is an increased risk of hyperkalemia and hypotension when Ketoconazole is used together with eplerenone.
• The concomitant use of Ketoconazole with ergot alkaloids (e.g., ergotamine, dihydroergotamine) can increase the risk of vasospasm, potentially leading to cerebral ischemia.

✔️ Contraindications

If you are allergic to ketoconazole or any other contents of Nizoder 2% Shampoo

✔️ Pregnancy & Lactation

Since ketoconazole is not absorbed through the skin after application, pregnancy and lactation are not contraindications to the use of ketoconazole 2% shampoo.

✔️ Precautions & Warnings

• For patients who have been using topical corticosteroids for an extended period of time, it is advisable to gradually discontinue the steroid therapy over a period of 2 to 3 weeks while using Ketoconazole 2% shampoo. This approach helps prevent any potential rebound effects that may occur when stopping corticosteroid treatment abruptly.
• It is important to avoid contact between the shampoo and the eyes. In case the shampoo accidentally enters the eyes, it should be rinsed out immediately with plenty of water.
• Regarding lactation, it is not known if Ketoconazole is distributed in breast milk. Therefore, caution should be exercised when using shampoo during breastfeeding. It is recommended to consult a healthcare professional for guidance in such situations.

✔️ Storage Conditions

• Store the Nizoder 2% Shampoo in a closed container at room temperature, away from heat, moisture, and direct light.
• Keep out of the reach of children and pets.