Key takeaways
Ketoconazole is a generic antifungal medicine used to treat certain types of fungal infections. However, it can interact with many drugs and isn’t right for everyone.
Alternatives to ketoconazole include Diflucan, Sporanox, Vfend, Lotrimin AF, Lamisil, and Ciclodan. Natural alternatives may be an option for people who are using ketoconazole for dandruff or seborrheic dermatitis.
Before switching to a ketoconazole alternative, talk to your healthcare provider.
Ketoconazole, a medication also known by the brand names Nizoral, Xolegel, and Extina, is a generic medication that is approved by the US Food and Drug Administration (FDA) to treat certain types of fungal infections. It is an azole antifungal medication that works by killing or stopping the growth of fungi causing the infection. While it is an effective medication, ketoconazole isn’t right for everyone. Some people may need a ketoconazole alternative due to drug interactions, contraindications, or allergies.
Read on to learn more about alternatives to ketoconazole.
What can I take instead of ketoconazole?
There are several other options available to treat fungal infections. However, alternatives depend on the specific type of infection, your other medications, and your medical history. These alternative medications include other types of azole antifungals and over-the-counter (OTC) topical medications or shampoos. Each of these alternatives has its unique uses, side effect profiles, and dosages.
The following table highlights the most common alternatives to ketoconazole.
Compare ketoconazole alternatives |
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|---|---|---|---|
| Drug name | Price without insurance | SingleCare price | Savings options |
| Ketodan (ketoconazole) | $831 for 1, 100 gm of 2% can | $147 for 1, 50 gm of 2% can of generic Ketodan at CVS | See latest prices |
| Diflucan (fluconazole) | $215 for 1, 35 ml of 40mg/ml bottle | $22 for 1, 35 ml of 40 mg/ml bottle of generic Diflucan at Kroger | See latest prices |
| Sporanox (itraconazole) | $1,926 for 60, 100 mg capsules | $50 for 60, 10 mg capsules of generic Sporanox at CVS | See latest prices |
| Vfend | $3,249 for 60, 200 mg tablets | $71 for 60, 200 mg tablets of generic Vfend at CVS | See latest prices |
| Lotrimin AF (clotrimazole) | $149 for 1, 90 gm of 1% bottle | $12 for 1, 30 gm of 1% tube of cream of generic Lotrimin AF at Kroger | See latest prices |
| Lamisil | $270 for 30, 250 mg tablets | $11 for 30, 250 mg tablets of generic Lamisil at Food Lion | See latest prices |
| Miconazole | $16 for 1, 30 gm of 2% tube | $12 for 1, 30 gm of 2% tube of generic miconazole at Kroger | See latest prices |
| Ciclodan | $152 for 1, 6.6 ml of 8% bottle | $17 for 1, 6.6ml of 8% bottle of generic Ciclodan at Kroger | See latest prices |
Prescription drug prices often change. These are the most accurate medication prices at the time of publishing in ZIP code 23666 as of October 30, 2025. The listed price without insurance references the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs if available.
Save up to 80% on Ketoconazole with SingleCare
Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.
Top 5 ketoconazole alternatives
The following are some of the most common alternatives to ketoconazole.
1. Diflucan (fluconazole)
Ketoconazole and Diflucan are both antifungal medications. However, ketoconazole is mainly only used as a topical medication or shampoo. Diflucan, on the other hand, is commonly taken as an oral tablet or capsule to treat vaginal yeast infections, fungal meningitis, and other types of systemic fungal infections. While both medications work similarly to treat fungal infections, ketoconazole can interact with several more drugs than Diflucan.
2. Sporanox (itraconazole)
Sporanox is a brand-name antifungal medication that is also available as a generic called itraconazole. Unlike ketoconazole, Sporanox is most commonly used for systemic fungal infections, such as aspergillosis and histoplasmosis. However, healthcare providers may also prescribe Sporanox for fungal infections of the fingernail and toenail. Sporanox has a boxed warning; the most serious warning issued by the FDA regarding its risk of use in people with congestive heart failure (CHF) and its risk of drug interactions.
3. Lotrimin AF (clotrimazole)
Lotrimin AF is a popular topical antifungal medication. Unlike ketoconazole cream, Lotrimin cream is available OTC and is used for common skin fungal infections, such as athlete’s foot and jock itch. It contains the active ingredient clotrimazole and is typically applied to the affected area twice daily, whereas ketoconazole cream can be used once or twice daily depending on the condition being treated.
4. Lamisil (terbinafine)
Lamisil is another OTC antifungal medication. Similar to Lotrimin, Lamisil is typically used to treat skin fungal infections, such as athlete’s foot, ringworm, and jock itch. In contrast, topical ketoconazole is typically used to treat medical conditions such as dandruff or seborrheic dermatitis. Both medications have the potential to interact with other drugs, but ketoconazole tends to interact with more drugs than Lamisil.
5. Ciclodan (ciclopirox)
Ciclodan is a brand-name antifungal medication. Like ketoconazole, it is commonly used to treat scalp conditions such as seborrheic dermatitis, but it may also be used for skin fungal infections. The shampoo form of ciclopirox is only available by prescription, but Nizoral (ketoconazole) shampoo is available both OTC and with a prescription, depending on the strength.
Over-the-counter alternatives
OTC ketoconazole alternatives may be available depending on the condition being treated.
- Dandruff: The American Academy of Dermatology Association states that OTC dandruff shampoos can be used for mild cases of dandruff. In addition to ketoconazole shampoos, these include shampoos with any of the following ingredients: zinc pyrithione, salicylic acid, sulfur, selenium sulfide, and coal tar.
- Seborrheic dermatitis: According to the National Eczema Society, seborrheic dermatitis can be treated with OTC anti-yeast shampoos. These include Nizoral (ketoconazole), Dandrazol (ketoconazole), and Selsun. Severe cases of seborrheic dermatitis can be treated with a combination of ketoconazole shampoo and tar-based shampoos, such as Neutrogena T/Gel Therapeutic Shampoo or Capasal Therapeutic Shampoo.
- Fungal infections of the skin: If you’re using topical ketoconazole for skin infections like athlete’s foot or jock itch, OTC alternatives include clotrimazole, miconazole, tolnaftate, and terbinafine.
Natural alternatives to ketoconazole
Healthcare providers typically won’t prescribe natural alternatives for true fungal infections, such as athlete’s foot, jock itch, and systemic fungal infections. However, there are some natural treatments recommended for conditions like dandruff and seborrheic dermatitis. The Association of Accredited Naturopathic Medical Colleges recommends coconut oil, tea tree oil, omega-3 fatty acids, and apple cider vinegar as natural remedies for dandruff. Home remedies, such as mineral oil, peanut oil, and olive oil, may be beneficial for seborrheic dermatitis.
How to switch to a ketoconazole alternative
Whether you’re seeking an alternative to ketoconazole due to adverse effects, contraindications, or cost, it is a good idea to consult a healthcare provider for medical advice before stopping the drug. Stopping the drug earlier than prescribed may cause your infection to get worse or come back. A doctor can discuss which alternative is right for you based on their side effect profile, drug interactions, and warnings. If cost is a concern, consider signing up for a SingleCare prescription discount card, which can help you save up to 80% on your prescription.
Choosing the right path for antifungal treatment
Dealing with fungal infections is no easy task. Fortunately, there are a wide range of treatments available depending on what type of infection you have. Healthcare professionals can help determine an individualized treatment plan for your condition and review your other medications to avoid serious drug interactions. Ketoconazole alternatives they may discuss include Diflucan, Sporanox, Lotrimin AF, and Ciclodan.
- Athlete’s foot, Cleveland Clinic (2021)
- Dandruff: what it is & how to get rid of it, Association of Accredited Naturopathic Medical Colleges (2022)
- Fluconazole tablets full prescribing information, DailyMed (2024)
- How to treat dandruff, American Academy of Dermatology Association (2023)
- Itraconazole capsules full prescribing information, DailyMed (2023)
- Jock itch, Cleveland Clinic (2021)
- Ketoconazole cream full prescribing information, DailyMed (2025)
- Lamisil AT package insert, DailyMed (2025)
- Lotrimin AF jock itch cream package insert, DailyMed (2024)
- Nizoral ketoconazole shampoo package insert, DailyMed (2024)
- Seborrheic dermatitis, Mayo Clinic (2024)
- Seborrhoeic dermatitis in adults, National Eczema Society