Nizral 2%: Uses, How It Works, Side Effects
Also known as: Nizral, Nizral shampoo, Nizral 2% shampoo, Ketoconazole 2% shampoo, Ketoconazole shampoo
Nizral 2% is a medicated shampoo containing 2% ketoconazole, an antifungal medicine used to treat dandruff, seborrhoeic dermatitis and pityriasis versicolor. These conditions are linked to yeast on the skin. It is lathered on the scalp or skin and rinsed off, and very little reaches the blood.
- Active ingredient
- Ketoconazole 2%
- Type of medicine
- Antifungals
- Used for
- Fungal infections, Fungal skin infections
- Starts working in
- Flaking and itching may ease within a few washes; pityriasis versicolor can take longer, and skin colour may take months to return to normal
- Effect lasts
- It acts while it is on the skin and is used on a regular schedule as the pack or doctor advises
- With or without food
- Not applicable, it is used on the scalp and skin
- Alcohol
- No known effect when it is used on the skin
- Pregnancy
- Very little reaches the blood from the scalp; ask your doctor before using it in pregnancy or while breastfeeding
- Habit-forming
- No
- Made by
- VERIFY on pack
Pharmacist review in progress. This page is based on the sources listed below and is being checked by our registered pharmacist.
On this page
- What is Nizral 2% used for?
- How does Nizral 2% work?
- How to take Nizral 2%
- Side effects of Nizral 2%
- Who should be careful
- Medicines and things that interact with Nizral 2%
- If someone takes too much
- Storage
- Regulatory status in India
- Other brands with the same medicine
- Other strengths and forms
- Common questions
What is Nizral 2% used for?
Nizral 2% is an antifungal shampoo. It is used to treat scalp and skin conditions linked to yeast, on a doctor's or pharmacist's advice.
- Dandruff
- Seborrhoeic dermatitis, a condition with red, flaky, itchy skin on the scalp and other oily areas
- Pityriasis (tinea) versicolor, a non-contagious yeast infection that causes light or dark patches on the trunk, neck and arms
How does Nizral 2% work?
Ketoconazole stops yeasts and fungi from making a substance called ergosterol that their outer cell layer needs. Without it the yeast on the skin cannot grow, which reduces flaking, itching and patches.
What happens in your body after you take it
You lather the shampoo
The shampoo is worked into the wet scalp or the affected skin, as the pack or your doctor advises.
It stays for a few minutes
Ketoconazole acts on the skin surface while the lather is left on for the time stated on the pack.
It reaches the yeast
The medicine enters the yeast cells living on the scalp and skin, such as Malassezia.
The yeast stops growing
Blocking ergosterol damages the yeast's outer layer, so it cannot grow. Itching and flaking ease.
You rinse it off
The shampoo is rinsed away. In studies, ketoconazole was not found in the blood of people who shampooed regularly, so almost nothing enters the body.
How to take Nizral 2%
Use Nizral 2% exactly as the pack or your doctor says. Shampoo frequency and the time to leave it on are printed on the pack or set by your doctor.
- Wet the hair and skin, work the shampoo in to a lather, leave it on for the time stated on the pack, then rinse well.
- Keep it out of the eyes. If it gets in, rinse well with water.
- If you miss a wash, use it at the next planned one. Do not use extra to make up for it.
- Keep going for the full course advised, even if the flaking has settled.
- See a doctor if there is no improvement after about 4 weeks.
Side effects of Nizral 2%
Ketoconazole shampoo is usually well tolerated. When side effects happen they are mostly local.
Uncommon or mild
- Itching or a burning feeling on the skin
- Skin irritation or dryness
- Oily or dry hair and scalp
- Changes in hair texture
- Increased hair loss for a short time (uncommon)
Rare but serious: get medical help
- Hives, widespread rash, swelling of the face or lips or difficulty breathing. Stop using it and get medical help immediately
Who should be careful
Some people need to check with a doctor before using Nizral 2%, or need extra care while using it.
When the label says not to use it
- Allergy to ketoconazole or to any ingredient of the shampoo
- Do not use it if you are allergic to ketoconazole or any ingredient in the shampoo
- Keep it out of the eyes
- It may remove the curl from permed hair and can change hair colour or texture in some people
- See a doctor if the scalp is red or swollen, if there are patches on the face or body, or if there is no improvement after about 4 weeks
- Children: safety and benefit have not been established, so ask a doctor
- Pregnancy and breastfeeding: very little reaches the blood from the scalp, but ask a doctor first
Medicines and things that interact with Nizral 2%
Used as a shampoo, Nizral 2% is not known to interact with other medicines because ketoconazole is not found in the blood after scalp use. Tell your doctor about other treatments you use on your scalp.
- Other medicated scalp products used together: ask a doctor or pharmacist first
If someone takes too much
Using too much shampoo is unlikely to be serious. If it is swallowed, call 112 or go to the nearest hospital and take the bottle with you.
Storage
Store in a cool, dry place away from direct sunlight, with the cap closed tightly and out of the reach of children. Do not use after the expiry date. Check the pack for the exact storage instructions.
Regulatory status in India
Approved for sale in India as a medicated antifungal shampoo. Single-ingredient ketoconazole is not on the CDSCO list of medicines banned under section 26A of the Drugs and Cosmetics Act, but several fixed-dose combinations that contain ketoconazole with steroids, antibiotics or other ingredients are on that list. Nizral 2% contains ketoconazole only; check the ingredient list on the pack.
Other brands with the same medicine
Ketoconazole 2% shampoo is sold under other brand names. They contain the same medicine; check the label for the strength, since some anti-dandruff shampoos contain 1%. Some products also contain other ingredients, so do not switch between them without asking your doctor or pharmacist.
Other strengths and forms
Ketoconazole is also sold as a 1% shampoo, as a cream and as tablets, and in combination creams. These are different products with different uses and risks. The contents are printed on the pack, so check the label of the one you have.
Common questions
What is Nizral shampoo used for?
Nizral 2% is used to treat dandruff, seborrhoeic dermatitis and pityriasis versicolor, which are linked to yeast on the skin. It is not a general hair-growth or hair-care product. Ask a doctor if the problem does not improve.
How long should I use Nizral shampoo?
Use it for the time on the pack or advised by your doctor. The NHS suggests trying an anti-dandruff shampoo for up to 4 weeks. See a doctor if there is no improvement then, or if the scalp is red, swollen or very itchy.
Is ketoconazole in the shampoo absorbed into the body?
Very little. The US label reports that ketoconazole was not detected in the blood of people who shampooed regularly for many months. This is different from ketoconazole tablets, which are a separate medicine with different risks.
Can Nizral shampoo be used on the body?
It is used on affected skin for conditions such as pityriasis versicolor, as the pack or your doctor says. Keep it away from the eyes and rinse well. Ask a doctor or pharmacist before using it on broken skin or large areas.
Will Nizral cause hair loss?
Hair loss is uncommon, and in trials extra hair loss and irritation happened in fewer than 1 in 100 people. Dandruff itself and many other things can also affect hair. Tell your doctor if hair loss continues or bothers you.
Will the patches of pityriasis versicolor go away straight away?
Not always. Even after the yeast is treated, the skin colour can take months to return to normal. The condition is not contagious, but it can come back because the yeast is part of normal skin.
Can I use Nizral 2% for a child?
Ask a doctor first. Safety and effectiveness in children have not been established in the US label. Do not use adult shampoo on a child unless a doctor advises it.
What is the difference between Nizral 2% and ketoconazole shampoo?
Nizral is a brand name and ketoconazole is the antifungal inside it. Other brands of ketoconazole 2% shampoo contain the same medicine. Check the strength on the pack, as some shampoos contain 1%, and ask a doctor or pharmacist before switching.
Sources
- Ketoconazole shampoo, 2%: prescribing information (ANI Pharmaceuticals). DailyMed, US National Library of Medicine
- Ketoconazole: a medicine for fungal skin infections and dandruff. NHS (UK)
- Dandruff. NHS (UK)
- ATC/DDD Index: D01AC08 ketoconazole. WHO Collaborating Centre for Drug Statistics Methodology
- List of drugs prohibited for manufacture and sale through gazette notifications under section 26A of the Drugs & Cosmetics Act 1940. Central Drugs Standard Control Organisation (CDSCO)