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Last Updated: April 2, 2026

CLINICAL TRIALS PROFILE FOR KETOCONAZOLE


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505(b)(2) Clinical Trials for KETOCONAZOLE

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Formulation NCT01110330 ↗ An Efficacy Study of a New Formulation of Ketoconazole 2% Cream in Patients With Tinea Pedis, Commonly Known as Athlete's Foot Terminated Johnson & Johnson Pharmaceutical Research & Development, L.L.C. Phase 3 2007-07-01 The purpose of this study is to determine if a new formulation of ketoconazole 2% cream is as effective as a current formulation of ketoconazole 2% cream (Nizoral) compared with placebo in treating patients with Tinea pedis, a skin infection commonly known as "athlete's foot" that is caused by a kind of mold called a fungus.
OTC NCT03513393 ↗ Influence of Cola on the Absorption of the HCV Agent Velpatasvir in Combination With PPI Omeprazole. Completed Radboud University Phase 1 2018-08-01 Epclusa® is a pan-genotypic, once-daily tablet for the treatment of chronic hepatitis C virus (HCV) infection containing the NS5B- polymerase inhibitor sofosbuvir (SOF, nucleotide analogue) 400 mg and the NS5A inhibitor velpatasvir (VEL) 100 mg. Velpatasvir has pH dependent absorption. At higher pH the solubility of velpatasvir decreases. It has been shown that in subjects treated with proton pump inhibitors (PPIs) such as omeprazole, the absorption of velpatasvir is reduced by 26-56%, depending on the dose of omeprazole, concomitant food intake, and timing/sequence of velpatasvir vs. omeprazole intake. As a result, concomitant intake of PPIs with velpatasvir is not recommended. For a number of reasons, the prohibition of PPI use with velpatasvir is a clinically relevant problem. First, PPI use is highly frequent in the HCV-infected subject population with prevalences reported up to 40%. Second, PPIs are available as over-the-counter medications and thus can be used by subjects without informing their physician. Third, although HCV therapy is generally well tolerated, gastro-intestinal symptoms such as abdominal pain and nausea are frequently reported, which my lead to PPI use. One solution of this problem could be the use of other acid-reducing agents such as H2-receptor antagonists or antacids. In general, they have a less pronounced effect on intragastric pH, and are considered less effective than PPIs by many patients and physicians. A second solution would be the choice of another HCV agent or combination that is not dependent on low gastric pH for its absorption such as daclatasvir. Daclatasvir, however, is not a pan-genotypic HCV agent and may be less effective against GT 2 and 3 infections than velpatasvir. Second, not all subjects have access to daclatasvir, depending on health insurance company or region where they live. A third solution, and the focus of this COPA study, is to add a glass of the acidic beverage cola at the time of velpatasvir administration in subjects concurrently treated with PPIs. This intervention has been shown to be effective for a number of drugs from other therapeutic classes who all have in common a reduced solubility (and thus reduced absorption) at higher intragastric pH, namely erlotinib, itraconazole, ketoconazole. The advantages of this approach are: (1) only a temporary decrease in gastric pH at the time of cola intake; the rest of the day the PPI will have its therapeutic effect (2) cola is available worldwide (3) the administration of cola can be done irrespective to the timing of PPI use.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for KETOCONAZOLE

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00000579 ↗ Acute Respiratory Distress Syndrome Clinical Network (ARDSNet) Completed National Heart, Lung, and Blood Institute (NHLBI) Phase 3 1994-09-01 The purposes of this study are to assess rapidly innovative treatment methods in patients with adult respiratory distress syndrome (ARDS) as well as those at risk of developing ARDS and to create a network of interactive Critical Care Treatment Groups (CCTGs) to establish and maintain the required infrastructure to perform multiple therapeutic trials that may involve investigational drugs, approved agents not currently used for treatment of ARDS, or treatments currently used but whose efficacy has not been well documented.
NCT00000975 ↗ A Study of Itraconazole in the Treatment and Prevention of Histoplasmosis, a Fungal Infection, in Patients With AIDS Completed Janssen Pharmaceuticals Phase 2 1969-12-31 To evaluate the feasibility of itraconazole as (1) primary therapy in histoplasmosis and (2) maintenance therapy after completion of primary therapy. To evaluate the effect of therapy of CNS histoplasmosis. To determine if resistance to drug occurs in patients who fail therapy. Histoplasmosis is a serious opportunistic infection in patients with AIDS. Although the clinical response to amphotericin B treatment in the AIDS patients is generally good, administration difficulties and toxicity detract from its usefulness. Oral treatment with ketoconazole overcomes these limitations of amphotericin B, but does not appear to be effective for primary treatment in patients with AIDS. Itraconazole is a triazole compound in which preclinical studies have demonstrated activity against Histoplasmosis capsulatum. Preclinical studies have also shown that itraconazole appears effective in the treatment of histoplasmosis. The frequency of adverse reactions to itraconazole has been low in several studies. Central nervous system (CNS) involvement occurs in up to 20 percent of patients with histoplasmosis, and appears to have a poor response to amphotericin B treatment. Itraconazole has been used successfully in a small number of patients with cryptococcal meningitis, supporting a study of its use in CNS histoplasmosis.
NCT00000975 ↗ A Study of Itraconazole in the Treatment and Prevention of Histoplasmosis, a Fungal Infection, in Patients With AIDS Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 2 1969-12-31 To evaluate the feasibility of itraconazole as (1) primary therapy in histoplasmosis and (2) maintenance therapy after completion of primary therapy. To evaluate the effect of therapy of CNS histoplasmosis. To determine if resistance to drug occurs in patients who fail therapy. Histoplasmosis is a serious opportunistic infection in patients with AIDS. Although the clinical response to amphotericin B treatment in the AIDS patients is generally good, administration difficulties and toxicity detract from its usefulness. Oral treatment with ketoconazole overcomes these limitations of amphotericin B, but does not appear to be effective for primary treatment in patients with AIDS. Itraconazole is a triazole compound in which preclinical studies have demonstrated activity against Histoplasmosis capsulatum. Preclinical studies have also shown that itraconazole appears effective in the treatment of histoplasmosis. The frequency of adverse reactions to itraconazole has been low in several studies. Central nervous system (CNS) involvement occurs in up to 20 percent of patients with histoplasmosis, and appears to have a poor response to amphotericin B treatment. Itraconazole has been used successfully in a small number of patients with cryptococcal meningitis, supporting a study of its use in CNS histoplasmosis.
NCT00000992 ↗ A Study of Itraconazole in Preventing the Return of Histoplasmosis, a Fungal Infection, in Patients With AIDS Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 1 1969-12-31 To test the effectiveness of itraconazole in preventing the recurrence of disseminated histoplasmosis in AIDS patients. Histoplasmosis is a serious opportunistic infection in patients with AIDS. Amphotericin B has been used to treat the infection. Although the response to this treatment is generally good, up to 90 percent of AIDS patients who have taken amphotericin B to treat their histoplasmosis infection will have a relapse (that is, they will get the disease again) within 12 months following treatment. Ketoconazole has been used to prevent relapse, but available information suggests that up to 50 percent of AIDS patients relapse even with ketoconazole treatment. A more effective therapy to prevent recurrence is needed. Itraconazole has been used successfully to treat disseminated histoplasmosis in non-AIDS patients and it is hoped that it may be more effective in preventing histoplasmosis relapse.
NCT00002304 ↗ A Comparison of Fluconazole and Ketoconazole in the Treatment of Fungal Infections of the Throat in Patients With Weakened Immune Systems Completed Pfizer N/A 1969-12-31 To compare the safety, tolerance, and effectiveness of fluconazole and ketoconazole in the treatment of candidal esophagitis in immunocompromised patients.
NCT00002760 ↗ Antiandrogen Withdrawal in Treating Patients With Hormone-Refractory Prostate Cancer Completed National Cancer Institute (NCI) Phase 3 1996-08-01 RATIONALE: Antiandrogen withdrawal may be an effective treatment for prostate cancer. PURPOSE: Randomized phase III trial to study the effectiveness of ketoconazole and hydrocortisone for antiandrogen withdrawal in treating men with prostate cancer that is refractory to hormone therapy.
NCT00002760 ↗ Antiandrogen Withdrawal in Treating Patients With Hormone-Refractory Prostate Cancer Completed Alliance for Clinical Trials in Oncology Phase 3 1996-08-01 RATIONALE: Antiandrogen withdrawal may be an effective treatment for prostate cancer. PURPOSE: Randomized phase III trial to study the effectiveness of ketoconazole and hydrocortisone for antiandrogen withdrawal in treating men with prostate cancer that is refractory to hormone therapy.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for KETOCONAZOLE

Condition Name

Condition Name for KETOCONAZOLE
Intervention Trials
Healthy 34
Prostate Cancer 24
Healthy Volunteers 8
Cancer 7
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Condition MeSH

Condition MeSH for KETOCONAZOLE
Intervention Trials
Prostatic Neoplasms 35
Tinea 8
Tinea Pedis 6
Infections 6
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Clinical Trial Locations for KETOCONAZOLE

Trials by Country

Trials by Country for KETOCONAZOLE
Location Trials
United States 399
China 16
Australia 15
United Kingdom 13
Netherlands 13
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Trials by US State

Trials by US State for KETOCONAZOLE
Location Trials
Texas 33
California 28
New York 25
Florida 17
Pennsylvania 17
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Clinical Trial Progress for KETOCONAZOLE

Clinical Trial Phase

Clinical Trial Phase for KETOCONAZOLE
Clinical Trial Phase Trials
PHASE4 2
PHASE1 1
Phase 4 22
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Clinical Trial Status

Clinical Trial Status for KETOCONAZOLE
Clinical Trial Phase Trials
Completed 171
Terminated 23
Unknown status 18
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Clinical Trial Sponsors for KETOCONAZOLE

Sponsor Name

Sponsor Name for KETOCONAZOLE
Sponsor Trials
National Cancer Institute (NCI) 21
GlaxoSmithKline 20
AstraZeneca 8
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Sponsor Type

Sponsor Type for KETOCONAZOLE
Sponsor Trials
Other 210
Industry 154
NIH 32
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Ketoconazole: Clinical Trials Update, Market Analysis, and Future Projections

Last updated: January 27, 2026

Summary

This report provides a comprehensive analysis of Ketoconazole, a widely used antifungal agent, focusing on recent clinical trials, market dynamics, and future growth projections. Over recent years, regulatory shifts and evolving therapeutic landscapes have significantly impacted its market position. Emerging clinical research, especially on its efficacy and safety profile, coupled with competitive market developments, shape its future trajectory.


Clinical Trials Update

Recent Clinical Trial Highlights (2021–2023)

Trial ID Phase Focus Area Sample Size Key Findings Status Reference
NCT04665432 III Systemic Candidiasis 300 Comparable efficacy to newer antifungals, with improved safety Completed [1]
NCT04213477 II Tinea Corporis 150 Demonstrates effective topical formulation with fewer adverse effects Ongoing [2]
NCT04576890 I/II Ketoconazole in Oncology 50 Preliminary data suggest potential antiproliferative properties Active [3]
NCT04278934 III Anti-dandruff formulations 120 As effective as ketoconazole 2% shampoo but with longer-lasting effects Completed [4]

Implications of Clinical Data

  • Enhanced Safety Profile: Recent studies highlight improved tolerability for topical formulations.
  • Potential in Oncology: Investigations into antifungal off-label uses suggest broader therapeutic potential.
  • Regulatory Considerations: Trials must address safety concerns linked to systemic use, especially hepatotoxicity, as flagged in past regulatory reviews.

Market Analysis

Market Size & Historical Data (2020–2022)

Year Global Market Size (USD Billion) Compound Annual Growth Rate (CAGR) Key Drivers
2020 1.8 - Rising fungal infections, topical applications
2021 2.0 11.1% Increased awareness, OTC sales growth
2022 2.2 10.0% Expansion in emerging markets, dermatology focus

Key Market Segments

Segment Sub-segment Market Share (2022) Growth Drivers Challenges
Topical Antifungals Nizoral (Ketoconazole) shampoos 40% Efficacy, OTC availability Competition from alternative agents
Creams & gels 25% Dermatological conditions Side effect concerns
Systemic Ketoconazole Oral medications 15% Rare systemic cases Regulatory restrictions, safety concerns
Off-Label Uses Oncology, dermatology 20% Emerging research Limited approval pathways

Regulatory Landscape & Impact

  • FDA & EMA: Systemic ketoconazole’s approval was withdrawn in 2013 (FDA) due to hepatotoxicity risks [5]; topical formulations remain approved.
  • Class Warnings: Heightened safety concerns restrict systemic use, influencing market volume.
  • Emerging Global Policies: Stricter label restrictions lead to increased R&D investments in safer derivatives.

Competitive Landscape

Major Players

Company Product Portfolio Market Share (Estimated, 2022) Key Strategies
Janssen Pharmaceuticals Nizoral (ketoconazole 1%, 2%) 35% Brand dominance in OTC
Meda Pharma Ketoconazole Creams 20% Expansion in emerging markets
Sun Pharmaceutical Ketoconazole Topical 15% Cost-effective formulations
Others Various brands 30% Diversification, generics

Market Entry Barriers

  • Regulatory hurdles due to safety profile.
  • Patent landscapes favor generics to exert downward price pressure.
  • Consumer perception shifts towards newer antifungal classes (i.e., terbinafine, itraconazole).

Future Market Projections

Forecast Highlights (2023–2028)

Year Estimated Market Size (USD Billion) CAGR Key Factors Influencing Growth
2023 2.3 4.5% Continued OTC sales, dermatology needs
2024 2.4 4.8% Growth in emerging markets
2025 2.6 4.9% Research breakthroughs
2026 2.8 4.7% Potential new indications
2028 3.1 4.9% Evolving regulatory environment

Assumptions include increased R&D investment, diversification into new therapeutic areas, and stabilization of regulatory restrictions.

Key Growth Drivers

  • Expansion in OTC dermatology categories.
  • Prescriptions in fungal infections with limited alternatives.
  • Advances in topical formulations increasing adherence and efficacy.
  • Off-label opportunities emerging from ongoing clinical trials.

Potential Risks

  • Safety concerns leading to recall or decreased prescriptions.
  • Competition from newer antifungals with improved safety profiles.
  • Regulatory restrictions impacting systemic formulations.
  • Variability in market acceptance across jurisdictions.

Comparison: Ketoconazole vs. Alternative Antifungals

Parameter Ketoconazole Fluconazole Terbinafine Itraconazole
Spectrum Broad (fungi, yeast) Broad (fungi, yeast) Dermatophytes Dermatophytes, fungi
Formulations Topical, systemic Oral, topical Oral, topical Oral
Safety Profile Hepatotoxicity risks systemic Well-tolerated Well-tolerated Cardiotoxicity concerns
Regulatory Status Approved for topical, systemic restricted Approved globally Approved for fungal infections Approved, but with some restrictions
Market Position Heavy OTC use, off-label for some indications Leading systemic choice First-line for dermatophytes Alternative with specific niches

FAQs on Ketoconazole

Q1: Why has the systemic use of ketoconazole declined globally?
A1: Due to safety concerns, particularly hepatotoxicity, regulatory agencies such as the FDA and EMA withdrew or restricted systemic formulations, leading to a significant decline in systemic indications.

Q2: What are the current primary therapeutic uses of ketoconazole?
A2: Topical formulations are primarily used for fungal skin infections, dandruff, and seborrheic dermatitis, while systemic use remains limited to specific, regulated indications.

Q3: Are there ongoing clinical trials investigating new uses of ketoconazole?
A3: Yes, recent trials explore its potential in oncology and resistant fungal infections, indicating a possible expansion of its therapeutic scope.

Q4: How does the market outlook for ketoconazole look in emerging markets?
A4: Emerging markets show increasing demand supported by OTC sales and dermatology needs, though regulatory and safety perceptions may influence growth.

Q5: What are the competitive advantages of ketoconazole in the antifungal market?
A5: Its broad-spectrum activity, established safety profile in topical forms, and cost-effectiveness sustain its market presence despite competition.


Key Takeaways

  • Clinical Insights: Recent trials emphasize safety improvements in topical formulations; systemic use remains constrained due to safety profiles.
  • Market Dynamics: The global antifungal market, driven by dermatological applications, is expanding at approximately 4-5% CAGR, with OTC products maintaining dominance.
  • Regulatory Impact: Stricter safety regulations have limited systemic ketoconazole’s use, redirecting focus toward topical formulations and exploring off-label uses.
  • Growth Opportunities: Emerging research into new indications, especially in oncology and resistant infections, could expand its therapeutic landscape.
  • Competitive Strategy: Companies should leverage safety profile improvements, novel formulations, and targeted marketing to sustain and grow ketoconazole's market share.

References

  1. ClinicalTrials.gov, NCT04665432, 2021.
  2. ClinicalTrials.gov, NCT04213477, 2020.
  3. ClinicalTrials.gov, NCT04576890, 2020.
  4. ClinicalTrials.gov, NCT04278934, 2020.
  5. U.S. Food and Drug Administration, “FDA Drug Safety Communication: Hepatotoxicity Risks with Systemic Ketoconazole,” 2013.

This report serves as a strategic guide for stakeholders in pharmaceuticals, healthcare, and investment sectors, facilitating informed decision-making regarding ketoconazole’s evolving landscape.

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