Doses - KETOCONAZOLE
(Note: Clinical antifungal effects may require 10-14 days of therapy)Dogs:
For coccidioidomycosis:
a) For the systemic form of the disease: 5 - 10 mg/kg PO bid; For the CNS form: 15 - 20mg/kg PO bid. Treatment should persist for a minimum of 3-6 months. Animals withboney lesions or relapses after discontinuing therapy, give lifelong therapy at 5 mg/kg
PO every other day. (Macy 1988)
For blastomycosis:
a) 10 mg/kg PO bid (15 - 20 mg/kg PO bid if CNS involvement) for at least 3 monthswith amphotericin B: initially at 0.25 - 0.5 mg/kg every other day IV. If tolerated, increase dose to 1 mg/kg until 4-5 mg/kg total dose is administered. See amphotericin Bmonograph for more information. (Macy 1988)
b) Ketoconazole 20 mg/kg/day PO once daily or divided bid; 40 mg/kg divided bid forocular or CNS involvement (for at least 2-3 months or until remission then startmaintenance) with amphotericin B 0.15 - 0.5 mg/kg IV 3 times a week. When a totaldose of amphotericin B reaches 4 - 6 mg/kg start maintenance dosage of amphotericin Bat 0.15 - 0.25 mg/kg IV once a month or use ketoconazole at 10 mg/kg PO either oncedaily, divided bid or ketoconazole at 2.5 - 5 mg/kg PO once daily. If CNS/ocularinvolvement, use ketoconazole at 20 - 40 mg/kg PO divided bid. (Greene, O'Neal, and Barsanti 1984)
For histoplasmosis:
a) 10 mg/kg PO once a day or twice a day for at least 3 months. Treat at least 30 days aftercomplete resolution of clinical disease. If patient relapses, retreat as above then put onmaintenance 5 mg/kg PO every other day indefinitely. For acute cases: use withamphotericin B (see blastomycosis recommendation by same author above). (Macy1988)
b) Ketoconazole 10 - 20 mg/day PO once daily or divided bid (for at least 2-3 months oruntil remission then start maintenance) with amphotericin B at 0.15 - 0.5 mg/kg IV 3times a week. When a total dose of amphotericin B reaches 2 - 4 mg/kg start maintenance dosage of amphotericin B at 0.15 - 0.25 mg/kg IV once a month or use ketoconazole at 10 mg/kg PO either once daily, divided bid or at 2.5 - 5 mg/kg PO oncedaily. (Greene, O'Neal, and Barsanti 1984)
For aspergillosis:
a) 20 mg/kg PO for at least 6 weeks; may require long-term/maintenance therapy. (Macy1988)
For cryptococcosis:
a) Amphotericin B 0.15 - 0.4 mg/kg IV 3 times a week with flucytosine 150 - 175 mg/kg
PO divided tid-qid. When a total dose of amphotericin B reaches 4 - 6 mg/kg startmaintenance dosage of amphotericin B at 0.15 - 0.25 mg/kg IV once a month withflucytosine at dosage above or with ketoconazole at 10 mg/kg PO once daily or dividedbid. (Greene, O'Neal, and Barsanti 1984)
For fungal myocarditis:
a) 10 mg/kg PO tid (Ogburn 1988)
For Candidal stomatitis (systemic therapy):
a) 10 mg/kg PO q8h until lesions resolve. (McKeever 1986)
For Malassezia dermatitis:
a) 5 - 10 mg/kg PO twice a day for 30 days. Often used with therapeutic shampoos containing selenium disulfide, miconazole, ketoconazole or chlorhexidine. Underlyingconditions must be identified and remedied or condition will recur. (Noxon 1997)
For treatment of hyperadrenocorticism:
a) 30 mg/kg PO once daily or divided bid. (Feldman 1989)
b) Initially, 10 mg/kg q12h for 7-10 days; monitor water consumption, appetite, and activity. Discontinue drug for 24-48 hours if adverse reactions occur. Reevaluate ACTHstimulation test at end of 7-10 days. If response is inadequate, increase dose to 15mg/kg q12h and repeat ACTH in 7-10 days. Once controlled, continue dosage long-term. (Bruyette and Feldman 1988)Cats:
For coccidioidomycosis:
a) For the systemic form of the disease: 5 - 10 mg/kg PO bid; For the CNS form: 15 - 20mg/kg PO bid. Treatment should persist for a minimum of 3-6 months. Animals withboney lesions or relapses after discontinuing therapy, give lifelong therapy at 5 mg/kg
PO every other day. (Macy 1988)
b) Very rare in the cat. Ketoconazole at 10 mg/kg PO once or twice a day (adjusted asnecessary). Long term therapy (>6 months) likely to be necessary. (Legendre 1989)
For blastomycosis:
a) 10 mg/kg PO bid (15 - 20 mg/kg PO bid if CNS involvement) for at least 3 monthswith amphotericin B: initially at 0.25 - 0.5 mg/kg every other day IV. If tolerated, increase dose to 1 mg/kg until 4-5 mg/kg total dose is administered. See amphotericin Bmonograph for more information. (Macy 1988)
b) 10 mg/kg q12h PO (for at least 60 days) with amphotericin B: 0.25 mg/kg in 30 ml
D5W IV over 15 minutes q48h. Continue amphotericin B therapy until a cumulativedose of 4 mg/kg is given or until BUN > 50 mg/dl. If renal toxicity does not develop, may increase dose to 0.5 mg/kg of amphotericin B. (Legendre 1989)
c) Ketoconazole 10 mg/day PO once daily or divided bid (for at least 2-3 months or untilremission, then start maintenance) with amphotericin B 0.15 - 0.5 mg/kg IV 3 times aweek. When a total dose of amphotericin B reaches 4 - 6 mg/kg start maintenancedosage of amphotericin B at 0.15 - 0.25 mg/kg IV once a month or use ketoconazole at10 mg/kg PO either once daily, divided bid or ketoconazole at 2.5 - 5 mg/kg PO oncedaily. If CNS/ocular involvement, use ketoconazole at 20 - 40 mg/kg PO divided bid.(Greene, O'Neal, and Barsanti 1984)
For histoplasmosis:
a) 10 mg/kg PO once a day or twice a day for at least 3 months. Treat at least 30 days aftercomplete resolution of clinical disease. If patient relapses, retreat as above then put onmaintenance 5 mg/kg PO every other day indefinitely. For acute cases: use withamphotericin B (see blastomycosis recommendation by same author). (Macy 1988)
b) 10 mg/kg PO q12h with amphotericin B at 0.25 mg/kg in 30 ml D5W IV over 15minutes q48h. Continue Amphotericin B therapy for 4-8 weeks or until BUN > 50mg/dl. If BUN increases greater than 50 mg/dl, continue ketoconazole alone.
Ketoconazole is used long-term (at least 6 months of duration). Despite aggressivetherapy prognosis is poor. (Legendre 1989)
c) Ketoconazole 10 mg/day PO once daily or divided bid (for at least 2-3 months or untilremission then start maintenance) with amphotericin B 0.15 - 0.5 mg/kg IV 3 times aweek. When a total dose of amphotericin B reaches 2 - 4 mg/kg start maintenancedosage of amphotericin B at 0.15 - 0.25 mg/kg IV once a month or use ketoconazole at10 mg/kg PO either once daily, divided bid or at 2.5 - 5 mg/kg PO once daily. (Greene,
O'Neal, and Barsanti 1984)
For cryptococcosis:
a) 10 mg/kg PO once a day or twice a day for 3 months or for at least 30 days after clinicaldisease has resolved. (Macy 1988)
b) 10 mg/kg bid. Very useful for this condition in cats, but at this dosage can produceanorexia and debility. (Legendre 1995)
c) Amphotericin B 0.15 - 0.4 mg/kg IV 3 times a week with flucytosine 125 - 250 mg/day
PO divided tid-qid. When a total dose of amphotericin B reaches 4 - 6 mg/kg startmaintenance dosage of amphotericin B at 0.15 - 0.25 mg/kg IV once a month withflucytosine at dosage above or with ketoconazole at 10 mg/kg PO once daily or dividedbid. (Greene, O'Neal, and Barsanti 1984)
For aspergillosis:
a) 20 mg/kg PO for at least 6 weeks; may require long-term/maintenance therapy. (Macy1988)
b) 10 mg/kg PO q12h. (Legendre 1989)
For treatment of hyperadrenocorticism:
a) 10 mg/kg PO bid. Only 2 patients treated. One died 7 days later of thrombocytopenia;other patient had an excellent response for 6 months. (Feldman 1989)Horses:
For susceptible fungal infections:
a) 10 mg/kg PO daily (McConnell and Hughey 1987)Birds:
For susceptible fungal infections:
a) For severe refractory candidiasis in Psittacines: 5 - 10 mg/kg as a gavage bid for 14days. For local effect in crop dissolve 1/4 tablet (50 mg) in 0.2 ml of 1 N hydrochloricacid and add 0.8 ml of water. Solution turns pale pink when dissolved. Add mixture tofood for gavage.
To add to water for most species: 200 mg/L for 7-14 days. As drug is not water solubleat neutral pH, dissolve in acid prior to adding to water (see above).
To add to feed for most species: 10 - 20 mg/kg for 7-14 days. Add to favorite food oradd to mash. (Clubb 1986)
b) For Candida infections of the oropharyngeal area: 10 - 15 mg/kg PO bid for 10-14days. (Flammer 1986)Reptiles:
For susceptible infections:
a) For most species:15 - 30 mg/kg PO once daily for 2-4 weeks. (Gauvin 1993)
For fungal shell diseases in turtles/tortoises:
a) 25 mg/kg PO once a day for 2-4 weeks (Rosskopf 1986)
Monitoring Parameters -1) Liver enzymes with chronic therapy (at least every 2 months; some clinicians say monthly) 2) CBC with platelets 3) Efficacy and other adverse effects
Client Information - If animal develops gastrointestinal symptoms divide dose and administer with meals. Long-term therapy with adequate dosing compliance is usually necessary for successful results; clients must be committed for both the financial and dosing burdens associated with therapy.
Dosage Forms/Preparations/FDA Approval Status/Withholding Times - Veterinary-Approved Products: None
Dogs: 
For coccidioidomycosis: a) For the systemic form of the disease: 5 - 10 mg/kg PO bid; For the CNS form: 15 - 20mg/kg PO bid. Treatment should persist for a minimum of 3-6 months. Animals withboney lesions or relapses after discontinuing therapy, give lifelong therapy at 5 mg/kg
PO every other day. (Macy 1988)
For blastomycosis:
a) 10 mg/kg PO bid (15 - 20 mg/kg PO bid if CNS involvement) for at least 3 monthswith amphotericin B: initially at 0.25 - 0.5 mg/kg every other day IV. If tolerated, increase dose to 1 mg/kg until 4-5 mg/kg total dose is administered. See amphotericin Bmonograph for more information. (Macy 1988)
b) Ketoconazole 20 mg/kg/day PO once daily or divided bid; 40 mg/kg divided bid forocular or CNS involvement (for at least 2-3 months or until remission then startmaintenance) with amphotericin B 0.15 - 0.5 mg/kg IV 3 times a week. When a totaldose of amphotericin B reaches 4 - 6 mg/kg start maintenance dosage of amphotericin Bat 0.15 - 0.25 mg/kg IV once a month or use ketoconazole at 10 mg/kg PO either oncedaily, divided bid or ketoconazole at 2.5 - 5 mg/kg PO once daily. If CNS/ocularinvolvement, use ketoconazole at 20 - 40 mg/kg PO divided bid. (Greene, O'Neal, and Barsanti 1984)
For histoplasmosis:
a) 10 mg/kg PO once a day or twice a day for at least 3 months. Treat at least 30 days aftercomplete resolution of clinical disease. If patient relapses, retreat as above then put onmaintenance 5 mg/kg PO every other day indefinitely. For acute cases: use withamphotericin B (see blastomycosis recommendation by same author above). (Macy1988)
b) Ketoconazole 10 - 20 mg/day PO once daily or divided bid (for at least 2-3 months oruntil remission then start maintenance) with amphotericin B at 0.15 - 0.5 mg/kg IV 3times a week. When a total dose of amphotericin B reaches 2 - 4 mg/kg start maintenance dosage of amphotericin B at 0.15 - 0.25 mg/kg IV once a month or use ketoconazole at 10 mg/kg PO either once daily, divided bid or at 2.5 - 5 mg/kg PO oncedaily. (Greene, O'Neal, and Barsanti 1984)
For aspergillosis:
a) 20 mg/kg PO for at least 6 weeks; may require long-term/maintenance therapy. (Macy1988)
For cryptococcosis:
a) Amphotericin B 0.15 - 0.4 mg/kg IV 3 times a week with flucytosine 150 - 175 mg/kg
PO divided tid-qid. When a total dose of amphotericin B reaches 4 - 6 mg/kg startmaintenance dosage of amphotericin B at 0.15 - 0.25 mg/kg IV once a month withflucytosine at dosage above or with ketoconazole at 10 mg/kg PO once daily or dividedbid. (Greene, O'Neal, and Barsanti 1984)
For fungal myocarditis:
a) 10 mg/kg PO tid (Ogburn 1988)
For Candidal stomatitis (systemic therapy):
a) 10 mg/kg PO q8h until lesions resolve. (McKeever 1986)
For Malassezia dermatitis:
a) 5 - 10 mg/kg PO twice a day for 30 days. Often used with therapeutic shampoos containing selenium disulfide, miconazole, ketoconazole or chlorhexidine. Underlyingconditions must be identified and remedied or condition will recur. (Noxon 1997)
For treatment of hyperadrenocorticism:
a) 30 mg/kg PO once daily or divided bid. (Feldman 1989)
b) Initially, 10 mg/kg q12h for 7-10 days; monitor water consumption, appetite, and activity. Discontinue drug for 24-48 hours if adverse reactions occur. Reevaluate ACTHstimulation test at end of 7-10 days. If response is inadequate, increase dose to 15mg/kg q12h and repeat ACTH in 7-10 days. Once controlled, continue dosage long-term. (Bruyette and Feldman 1988)
Cats: 
For coccidioidomycosis: a) For the systemic form of the disease: 5 - 10 mg/kg PO bid; For the CNS form: 15 - 20mg/kg PO bid. Treatment should persist for a minimum of 3-6 months. Animals withboney lesions or relapses after discontinuing therapy, give lifelong therapy at 5 mg/kg
PO every other day. (Macy 1988)
b) Very rare in the cat. Ketoconazole at 10 mg/kg PO once or twice a day (adjusted asnecessary). Long term therapy (>6 months) likely to be necessary. (Legendre 1989)
For blastomycosis:
a) 10 mg/kg PO bid (15 - 20 mg/kg PO bid if CNS involvement) for at least 3 monthswith amphotericin B: initially at 0.25 - 0.5 mg/kg every other day IV. If tolerated, increase dose to 1 mg/kg until 4-5 mg/kg total dose is administered. See amphotericin Bmonograph for more information. (Macy 1988)
b) 10 mg/kg q12h PO (for at least 60 days) with amphotericin B: 0.25 mg/kg in 30 ml
D5W IV over 15 minutes q48h. Continue amphotericin B therapy until a cumulativedose of 4 mg/kg is given or until BUN > 50 mg/dl. If renal toxicity does not develop, may increase dose to 0.5 mg/kg of amphotericin B. (Legendre 1989)
c) Ketoconazole 10 mg/day PO once daily or divided bid (for at least 2-3 months or untilremission, then start maintenance) with amphotericin B 0.15 - 0.5 mg/kg IV 3 times aweek. When a total dose of amphotericin B reaches 4 - 6 mg/kg start maintenancedosage of amphotericin B at 0.15 - 0.25 mg/kg IV once a month or use ketoconazole at10 mg/kg PO either once daily, divided bid or ketoconazole at 2.5 - 5 mg/kg PO oncedaily. If CNS/ocular involvement, use ketoconazole at 20 - 40 mg/kg PO divided bid.(Greene, O'Neal, and Barsanti 1984)
For histoplasmosis:
a) 10 mg/kg PO once a day or twice a day for at least 3 months. Treat at least 30 days aftercomplete resolution of clinical disease. If patient relapses, retreat as above then put onmaintenance 5 mg/kg PO every other day indefinitely. For acute cases: use withamphotericin B (see blastomycosis recommendation by same author). (Macy 1988)
b) 10 mg/kg PO q12h with amphotericin B at 0.25 mg/kg in 30 ml D5W IV over 15minutes q48h. Continue Amphotericin B therapy for 4-8 weeks or until BUN > 50mg/dl. If BUN increases greater than 50 mg/dl, continue ketoconazole alone.
Ketoconazole is used long-term (at least 6 months of duration). Despite aggressivetherapy prognosis is poor. (Legendre 1989)
c) Ketoconazole 10 mg/day PO once daily or divided bid (for at least 2-3 months or untilremission then start maintenance) with amphotericin B 0.15 - 0.5 mg/kg IV 3 times aweek. When a total dose of amphotericin B reaches 2 - 4 mg/kg start maintenancedosage of amphotericin B at 0.15 - 0.25 mg/kg IV once a month or use ketoconazole at10 mg/kg PO either once daily, divided bid or at 2.5 - 5 mg/kg PO once daily. (Greene,
O'Neal, and Barsanti 1984)
For cryptococcosis:
a) 10 mg/kg PO once a day or twice a day for 3 months or for at least 30 days after clinicaldisease has resolved. (Macy 1988)
b) 10 mg/kg bid. Very useful for this condition in cats, but at this dosage can produceanorexia and debility. (Legendre 1995)
c) Amphotericin B 0.15 - 0.4 mg/kg IV 3 times a week with flucytosine 125 - 250 mg/day
PO divided tid-qid. When a total dose of amphotericin B reaches 4 - 6 mg/kg startmaintenance dosage of amphotericin B at 0.15 - 0.25 mg/kg IV once a month withflucytosine at dosage above or with ketoconazole at 10 mg/kg PO once daily or dividedbid. (Greene, O'Neal, and Barsanti 1984)
For aspergillosis:
a) 20 mg/kg PO for at least 6 weeks; may require long-term/maintenance therapy. (Macy1988)
b) 10 mg/kg PO q12h. (Legendre 1989)
For treatment of hyperadrenocorticism:
a) 10 mg/kg PO bid. Only 2 patients treated. One died 7 days later of thrombocytopenia;other patient had an excellent response for 6 months. (Feldman 1989)
Horses: 
For susceptible fungal infections: a) 10 mg/kg PO daily (McConnell and Hughey 1987)
Birds: 
For susceptible fungal infections: a) For severe refractory candidiasis in Psittacines: 5 - 10 mg/kg as a gavage bid for 14days. For local effect in crop dissolve 1/4 tablet (50 mg) in 0.2 ml of 1 N hydrochloricacid and add 0.8 ml of water. Solution turns pale pink when dissolved. Add mixture tofood for gavage.
To add to water for most species: 200 mg/L for 7-14 days. As drug is not water solubleat neutral pH, dissolve in acid prior to adding to water (see above).
To add to feed for most species: 10 - 20 mg/kg for 7-14 days. Add to favorite food oradd to mash. (Clubb 1986)
b) For Candida infections of the oropharyngeal area: 10 - 15 mg/kg PO bid for 10-14days. (Flammer 1986)
Reptiles: 
For susceptible infections: a) For most species:15 - 30 mg/kg PO once daily for 2-4 weeks. (Gauvin 1993)
For fungal shell diseases in turtles/tortoises:
a) 25 mg/kg PO once a day for 2-4 weeks (Rosskopf 1986)
Monitoring Parameters -
Client Information - If animal develops gastrointestinal symptoms divide dose and administer with meals. Long-term therapy with adequate dosing compliance is usually necessary for successful results; clients must be committed for both the financial and dosing burdens associated with therapy.
Dosage Forms/Preparations/FDA Approval Status/Withholding Times - Veterinary-Approved Products: None