Ketoconazole Liver Risk: What You Need to Know About This Medication's Side Effects

When you take ketoconazole, an antifungal medication once commonly used for skin and systemic infections. Also known as Nizoral, it was once a go-to for fungal infections—but its use has sharply declined because of a well-documented risk: drug-induced liver injury. This isn’t a rare side effect. Studies show ketoconazole can cause severe liver damage in up to 1 in 10,000 users, and in some cases, it’s led to liver failure requiring transplants. The FDA restricted its oral use in 2013 for this very reason.

The liver processes ketoconazole, and in some people, that process goes wrong. It doesn’t just cause mild enzyme spikes—it can trigger inflammation, cell death, and even scarring. People over 65, those with existing liver conditions, or anyone taking other meds that affect the liver (like statins or certain antibiotics) are at higher risk. Even short courses can be dangerous. Unlike many drugs where side effects fade after stopping, liver damage from ketoconazole can linger for months—or become permanent. That’s why doctors now avoid prescribing it orally unless no other option exists. Topical versions (creams, shampoos) carry far less risk because very little enters the bloodstream.

If you’ve ever taken ketoconazole and felt unusually tired, had yellow eyes or skin, dark urine, or pain in your upper right belly, those aren’t normal. They’re red flags for hepatotoxicity. Don’t wait for symptoms to get worse. Get your liver checked immediately. Many people assume side effects mean "just a bad reaction," but with ketoconazole, it’s not about tolerance—it’s about irreversible harm. Alternatives like fluconazole or itraconazole are safer and just as effective for most fungal infections. You don’t need to risk your liver when better options exist.

Below, you’ll find real patient experiences, clinical data, and comparisons with other antifungals that help explain why ketoconazole is no longer first-line treatment. These posts break down what the science says, how to spot trouble early, and what to ask your doctor if you’re still prescribed this drug.