Cetohexal inhibits hydroxylation of deoxycortisol, which results in diminished cortisol production, especially when given in divided doses. In some patients, symptomatic adrenal insufficiency may occur, presenting with hyponatremia, hyperkalemia, hypotension, lethargy, depression, and malaise.
A 77-year-old male with prostate cancer experienced adrenal crisis coincident with Cetohexal therapy. He presented with progressive right lower extremity weakness, debilitating low back pain, and a serum prostate-specific antigen level of 78.8 ng/mL. He was given Cetohexal 200 mg orally four times daily to reduce serum testosterone levels. Nine days after initiating Cetohexal therapy, he experienced generalized weakness, abdominal pain, nausea with vomiting, and severely diminished mentation. The urology service was advised of the patient's admission and suggested that adrenal insufficiency related to high-dose Cetohexal therapy should be considered in the differential diagnosis. However, a serum cortisol level was not obtained prior to steroid treatment. An ACTH stimulation test performed 2 days later showed no evidence of underlying adrenal insufficiency when the patient was no longer being given Cetohexal.
Rare (less than 0.1%): Hypothyroidism
Frequency not reported: Inhibition of cortisol production (sometimes resulting in symptomatic adrenal insufficiency), adrenal crisis
What is Cetohexal topical?
Cetohexal topical (for the skin) is an antifungal medicine used to treat infections such as athlete's foot, jock itch, ringworm, and seborrhea (dry, flaking skin or dandruff).
Cetohexal topical is also used to treat a fungal infection called pityriasis, which causes scaly discolored patches on the skin of the neck, chest, arms, or legs.
Cetohexal topical may also be used for purposes not listed in this medication guide.
What should I avoid while using Cetohexal topical?
Do not get this medicine in your eyes. If contact does occur, rinse with water.
Avoid covering treated skin areas with tight-fitting, synthetic clothing (such as nylon or polyester) that doesn't allow air to circulate to your skin. If you are treating your feet, wear clean cotton socks and sandals or shoes that allow for air circulation. Keep your feet as dry as possible.
You may need to avoid sunlight if you are treating pityriasis. Follow your doctor's instructions.
Avoid using skin products that can cause irritation, such as harsh soaps, shampoos, hair coloring or permanent chemicals, hair removers or waxes, or skin products with alcohol, spices, astringents, or lime.
Avoid using other medications on the areas you treat with Cetohexal topical unless your doctor tells you to.
Drug-drug. Antacids, anticholinergics, histamine2-receptor antagonists: decreased Cetohexal absorption
Cyclosporine: increased cyclosporine blood level
Isoniazid, rifampin: increased Cetohexal metabolism
Theophylline: decreased theophylline blood level
Topical corticosteroids: increased corticosteroid absorption
Triazolam (oral): increased triazolam effects
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase: increased levels
Hemoglobin, platelets, white blood cells: decreased levels
Drug-herbs. Yew: inhibited Cetohexal metabolism
Cetohexal may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- changes in hair texture
- blisters on scalp
- dry skin
- oily or dry hair or scalp
- irritation, itching, or stinging in the place where you applied the medication
Cetohexal therapy has commonly been associated with transient elevations in liver enzymes, which have resolved despite continued therapy.
Serious hepatotoxicity has been reported with both high doses for short durations and low doses for long therapy durations. Hepatic injury has usually (but not always) been reversible with discontinuation of Cetohexal therapy. Hepatitis has been reported in children.
Hepatotoxicity has been reported with oral Cetohexal rechallenge.
Severe hepatotoxicity (hepatocellular, cholestatic, or mixed) generally occurred after 1 or 2 months of therapy. Hepatic function usually returned to normal within 1 month, but cases of hepatic failure and death have occurred.
Frequency not reported: Hepatitis, jaundice, abnormal hepatic function, hepatotoxicity, transient elevations of liver enzymes, severe hepatotoxicity (hepatocellular, cholestatic, or mixed)
Postmarketing reports: Serious hepatotoxicity including cholestatic hepatitis, biopsy-confirmed hepatic necrosis, cirrhosis, hepatic failure (including cases resulting in death or requiring liver transplantation)
• Apply cream to damp skin of affected area and wide surrounding area.
• To use shampoo, wet hair, then apply shampoo and massage into scalp for 1 minute. Leave on for 5 minutes before rinsing. Rinse and repeat, this time leaving shampoo on scalp for 3 minutes before rinsing.
• Don't apply shampoo to broken or inflamed skin.
• In achlorhydria, dissolve 200-mg tablet in 4 ml of 0.2N hydrochloric acid solution.
• Withhold antacids for at least 2 hours after giving oral Cetohexal.
☞ Don't give concurrently with cisapride, available in U.S. for compassionate use only. (Astemizole and terfenadine are not available in U.S.)
Related Drug Information
- Cetohexal Information for Consumers
- Cetohexal Information for Healthcare Professionals (includes dosage details)
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Cetohexal and DHT receptors
A further study looked into the possibility that it could treat androgenic alopecia too. Unlike dandruff and seborrheic dermatitis, androgenic alopecia involves hair loss as a result of producing too many DHT receptors. It’s usually a genetic condition, which causes the hair loss we see with male pattern baldness.
Those who suffer from androgenic alopecia experience some physiological processes:
- The hair follicles shrink in size
- Their hair follicles spend less time in the anagen phase of hair growth, which is where it grows long and thick.
- Instead, they spend more time in the telogen phase of hair growth, which is where the follicles remain dormant.
- Because of this, the terminal to vellus hair ratio drops. Terminal hair is the hair that’s thick and strong, whereas vellus is thin and wispy.
For reasons we don’t understand, the terminal to vellus hair ratio will then increase in other areas of the body. One study from Japan found that those who have androgenic alopecia also have higher lipid profiles. When we have high lipid profiles, we’re even more likely to encounter harmful inflammatory processes that don’t allow cells to thrive or heal. As high serum lipid concentrations have a connection with increased inflammatory markers, it’s clear our hair follicles need all the help they can get.
What is Cetohexal?
Cetohexal belongs to a group of medications called the ‘azole antifungals.’ It’s available as an oral and topical medication, with the aim of treating certain fungal conditions. Its role is to stop the growth of fungus, but you must remain wary of applying the wrong product to your skin, as it can irritate.
Shampoos that contain Cetohexal stop fungus from spreading by killing their cell membranes. In other words, they break down the cell walls. When the fungi no longer have active cell walls, they find it difficult to spread. It achieves this by stopping them from producing a substance called ‘ergosterol,’ which they need to prevent holes from appearing in the cell membrane.
When holes appear in the cell membrane, substances that fungi would otherwise love to keep out start to filter in. Interestingly, scientists have found the ergosterol serves similar purposes to cholesterol.
For safety purposes, only use Cetohexal shampoo for hair loss as instructed by a professional doctor or pharmacist. Maintain a regular regimen while also making a point not to use it more often, or less frequently.
When used correctly, you are more than likely to start observing results within two to four weeks after the initiation of treatment. Consequently, if you haven’t noticed any change within a month, then you should contact your doctor and inquire about whether you should consider another treatment plan.
If you are part of the percentage of individuals whose skin type does not respond to Cetohexal shampoo for relief hair loss, do not lose hope. There are still other solutions. Some of the alternatives that you can try are shampoos that contain: salicylic acid, coal, tar, and pyrithione zinc.
What happens if I overdose?
An overdose of Cetohexal topical is not expected to be dangerous. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if anyone has accidentally swallowed the medication.
What is the most important information I should know about Cetohexal (Nizoral)?
This medicine should be used only when you cannot use other antifungal medications. Cetohexal can cause serious harm to your liver that may result in liver transplant or cause death.
Call your doctor at once if you have any signs of liver damage, such as nausea, vomiting, stomach pain, fever, tiredness, loss of appetite, dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes).
Tell your doctor about all your current medicines and any you start or stop using. Many drugs can interact, and some drugs should not be used together.
Cetohexal can also cause a serious heart problem. Call your doctor right away if you have fast or pounding heartbeats, shortness of breath, and sudden dizziness.
What should I discuss with my healthcare provider before taking Cetohexal (Nizoral)?
You should not use Cetohexal if you are allergic to it, or if you have liver disease.
Some medicines can cause unwanted or dangerous effects when used with Cetohexal. Your doctor may change your treatment plan if you also use:
Tell your doctor if you have ever had:
- liver problems;
- long QT syndrome (in you or a family member); or
- problems with your adrenal gland.
It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.
You should not breast-feed while using this medicine.
Do not give this medicine to a child without medical advice.
How should I take Cetohexal (Nizoral)?
Your doctor will perform blood tests to make sure you do not have conditions that would prevent you from safely using Cetohexal.
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.
You may need to use this medicine for up to 6 months.
Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Cetohexal will not treat a viral infection such as the flu or a common cold.
While using Cetohexal, you may need frequent blood tests to check your liver function.
Store at room temperature away from moisture, heat, and light.
Do not share this medicine with another person, even if they have the same symptoms you have.