In the prevention and treatment of the scalp conditions dandruff and seborrhoeic dermatitis.

For topical administration.

Ketoconazole shampoo 2% is for use in adolescents and adults:

Wash affected areas and leave for 3-5 minutes before rinsing. Usually, a palmful of shampoo suffices for one wash.

Treatment:

Dandruff and seborrhoeic dermatitis: Wash hair twice weekly for 2-4 weeks.

Tinea versicolor: Once daily for a maximum of 5 days.

Prophylaxis:

Dandruff and seborrhoeic dermatitis: Use once every 1-2 weeks.

Tinea versicolor: Once daily for a maximum of 3 days before exposure to sunshine.

Known hypersensitivity to the active substance(s) or to any of the excipients listed in section 6.1.

Keep out of the eyes. If the shampoo should get into the eyes, they should be bathed with water.

In patients who have been on prolonged treatment with topical corticosteroids, it is recommended that the steroid therapy be gradually withdrawn over a period of 2 to 3 weeks, while using Nizoral Dandruff Treatment 2%w/w Shampoo, to prevent any potential rebound effect.

If the scalp has not cleared within 4 weeks, a doctor or pharmacist should be consulted.

Excipient warnings:

This medicine contains 24% w/w sodium lauryl ether sulfate in each application. Sodium lauryl ether sulfate may cause local skin reactions (such as stinging or burning sensation) or increase skin reactions caused by other products when applied on the same area.

None Known

There are no adequate and well-controlled studies in pregnant or lactating women. Data on a limited number of exposed pregnancies indicate no adverse effects of topical ketoconazole on pregnancy or on the health of the foetus/newborn child. Animal studies have shown reproductive toxicity at doses that are not relevant to the topical administration of ketoconazole. No effects on the breastfed newborn/infant are anticipated. See Pharmacokinetic properties, section 5.2.

Plasma concentrations of ketoconazole were not detectable after topical administration of Nizoral Dandruff Treatment 2%w/w Shampoo to the scalp of non-pregnant humans. Plasma levels were detected after topical administration of Nizoral Dandruff Treatment 2%w/w Shampoo on the whole body. There are no known risks associated with the use of Nizoral Dandruff Treatment 2%w/w Shampoo in pregnancy or lactation.

None likely

The safety of ketoconazole 2% shampoo was evaluated in 2890 subjects who participated in 22 clinical trials. Ketoconazole 2% shampoo was administered topically to the scalp and/or skin. Based on pooled safety data from these clinical trials, there were no ADRs reported with an incidence ≥ 1%.

The following table displays ADRs that have been reported with the use of Ketoconazole 2% Shampoo from either clinical trial or postmarketing experiences.

The displayed frequency categories use the following convention:

Very common (≥ 1/10)

Common (≥ 1/100 to <1/10)

Uncommon (≥ 1/1,000 to <1/100)

Rare (≥ 1/10,000 to <1/1,000)

Very rare (<1/10,000)

Not known (cannot be estimated form the available clinical trial data).

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

In the event of accidental ingestion, supportive and symptomatic measures should be carried out. In order to avoid aspiration, neither emesis nor gastric lavage should be instigated.

Pharmacotherapeutic group: Imidazole and triazole derivatives, ATC code: D01AC08

Ketoconazole is a synthetic imidazole dioxolane antimycotic active against yeasts, including Malassezia, and dermatophytes. Its broad spectrum of activity is already well known.

Ketoconazole also has a direct anti-inflammatory action independent from its antifungal activity which may contribute to symptom relief in dandruff and seborrhoeic dermatitis.

Plasma concentrations of ketoconazole were not detectable after topical administration of Nizoral Dandruff Treatment 2%w/w Shampoo on the scalp. Plasma levels were detected after topical administration of Nizoral Dandruff Treatment 2%w/w Shampoo on the whole body.

Effects in non-clinical studies were observed only at exposures considered sufficiently in excess of the maximum human exposure indicating little relevance to clinical use.

Sodium lauryl ether sulfate

Disodium monolauryl ether sulphosuccinate

Coconut fatty acid diethanolamide

Laurdimonium hydrolysed animal collagen

Macrogol 120 methyl glucose dioleate

Sodium chloride

Concentrated hydrochloric acid

Imidurea

Sodium hydroxide

Erythrosine sodium (E127)

Purified water

None known

3 years

Store below 25° C

High-density polyethylene bottle containing 60ml, 100ml or 120ml Nizoral Dandruff Treatment 2%w/w Shampoo

Not all pack sizes may be marketed

Not applicable