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Topical shampoo: apply 1% (OTC) or 2% (prescription) to the scalp, lather, leave on ~3–5 minutes, rinse, twice weekly for seborrheic dermatitis/dandruff (less often for maintenance). Off-label hair-loss use follows the same 2–3×/week shampoo schedule, typically alongside minoxidil/finasteride. ORAL ketoconazole is a restricted systemic drug and is NOT a self-directed regimen — used only by specialists with liver and adrenal monitoring. A prescription drug; informational only, not a supplement.

Any time

Topical shampoo (ketoconazole 1% OTC or 2% prescription, Nizoral)

• ORAL ketoconazole: pre-existing or active liver disease (high risk of further hepatotoxicity)
• Known hypersensitivity to ketoconazole or imidazole antifungals
• Oral use is contraindicated with many CYP3A4-dependent drugs (QT-prolonging agents, certain statins, etc.)

• Statins (simvastatin, lovastatin) — oral ketoconazole
• QT-prolonging drugs (e.g. certain antiarrhythmics, antipsychotics) — oral
• Warfarin / anticoagulants — oral