Ketoconazole (Nizoral) (The James)

Ketoconazole (Nizoral) (The James)


Taking Your Treatment Home

What you need to know about your Anti-Cancer Medicine


Here is important information on how to use, handle, and store your medicine, what side effects to look for and how to manage them. If you have questions about this medicine, call your doctor.


How to handle and store:

  • It is safe to handle Ketoconazole as a whole tablet.
  • Store in a closed container in a dry place such as a cabinet, away from light, heat, and moisture.
  • Do not store in your bathroom or refrigerator.
  • Keep this medicine away from children and do not share it with anyone.


How does it work:

  • High-dose ketoconazole is used along with hydrocortisone to treat prostate cancer.
  • Ketoconazole stops your adrenal glands from making the hormone, testosterone.
  • Your adrenal glands make other hormones, such as hydrocortisone. You will be given hydrocortisone while you are taking Ketoconazole to replace what your adrenal glands normally make.


How to take:

  • Take by mouth.
  • Do not take more tablets than ordered by your doctor.
  • Take with orange juice or cola, with or without food.
  • Do not take within 2 hours of taking an antacid (TUMS, Alka-Seltzer, Gaviscon, Maalox, Mylanta, Rolaids).
  • Do not take this medicine within 2 hours of taking a product with calcium.
  • If you miss a dose, wait until it is time for your next dose. Skip the missed dose. Do not double up on the dose.



  • Tell your doctor if you have or had liver disease.
  • Ketoconazole has many drug interactions. Tell your doctor or pharmacist about any medicines you are taking, including prescription and over-the-counter medicines, vitamins and herbal products.
  • Ask your doctor or pharmacist before you take any new medicines or herbal supplements.


Possible Side Effects

You can find more information on side effects in the Patient Education booklet, Treatment with Chemotherapy and Anti-Cancer Medicines.


Nervous System Changes

What this means: Ketoconazole may cause hearing loss, ringing in your ears, dizziness or weak muscles.

What to do:

  • Call your doctor if you notice any of these changes.
  • Walk slowly and use handrails.
  • Wear sturdy shoes or slippers that fit well to protect your feet.



What to do:

  • Call your doctor if you have any unusual fatigue or extreme weakness.


Decreased Appetite

What to do:

  • Call your doctor if you have a loss of appetite.


Nausea and Vomiting

What to do:

  • Call your doctor if you are unable to keep fluids down for more than 24 hours or if you are unable to eat.
  • Call your doctor if you feel lightheaded or dizzy.



What to do:

  • Keep the area around your rash clean and dry.
  • Talk to your doctor before you put anything on your rash.


Change in Liver Function Tests

What this means: It is rare, but this medicine can cause severe liver injury. Signs of liver damage are dark colored urine, yellowing of your skin, abdominal pain or tenderness, "flu-like" symptoms, or nausea and vomiting.

What to do:

  • Call your doctor immediately if have any of these symptoms.


Other Side Effects

  • Call your doctor if you have any changes in your heartbeat, difficulty breathing or any new symptoms.



  • Talk with your doctor or pharmacist about how to get rid of prescription medicines safely.


This is not a complete list of all possible side effects. Tell your doctor if you have these or any other side effects that you think are caused by this medicine. Your James health care team can give you other tips for how to manage your side effects.



© 11/5/2021. The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.