Tiara 20 mg/ml Shampoo

Imidazole antifungal, now mainly used topically:

• Shampoo 2%: dandruff, seborrhoeic dermatitis of the scalp, pityriasis versicolor
• Cream 2%: ringworm (body, groin, feet), cutaneous candidiasis, seborrhoeic dermatitis, pityriasis versicolor
• Tablets (restricted): Cushing's syndrome (specialist); oral use for fungal infections is no longer recommended because of liver toxicity

Shampoo 2%: dandruff/seborrhoeic dermatitis — leave on scalp 3–5 minutes, rinse; twice weekly for 2–4 weeks, then once every 1–2 weeks to prevent relapse. Pityriasis versicolor — apply to affected skin, leave 5 minutes, rinse; daily for up to 5 days.

Cream 2%: apply once or twice daily; ringworm 2–4 weeks, candidiasis 2–3 weeks, continue a few days after clearing.

Tablets (specialist only, Cushing's): 400–1,200 mg daily with liver monitoring.

• Allergy to ketoconazole or imidazoles
• Tablets: liver disease, pregnancy, use with many interacting drugs (simvastatin, lovastatin, midazolam, triazolam, pimozide, quinidine, dofetilide, ergot alkaloids, colchicine, etc.), QT prolongation

Topical: local irritation, burning, itching, dry or oily hair, change in hair texture/colour (rare).

Tablets: nausea, abdominal pain; serious liver injury, adrenal insufficiency, QT prolongation, gynaecomastia.

• Keep shampoo out of the eyes; rinse if contact occurs.
• Topical steroids used before: taper over 2–3 weeks when starting cream (to avoid rebound).
• Tablets: liver tests before and frequently during treatment.

Shampoo/cream: may be used in pregnancy and breastfeeding (minimal absorption). Tablets: contraindicated in pregnancy; avoid while breastfeeding.

Tablets (strong CYP3A4 inhibitor): many serious interactions — statins, benzodiazepines, calcium-channel blockers, ciclosporin, tacrolimus, warfarin, QT drugs; absorption reduced by antacids/PPIs.

Topical: no significant interactions.

Topical: not expected. Tablets: supportive care; liver monitoring.

Store below 30°C.