I frequently use ketoconazole orally for nursing mothers when they have
no drug plan (even the wealthy find $300 for 14 tablets a bitter pill to
swallow).

It works fine, though it has the disadvantage, in this case, of not
getting into the milk in as high concentrations as fluconazole.  I
usually treat mother and baby, mother with 200 mg twice a day and the
baby with 5-10 mg/kg/day as a single dose.

There do seem to be cases of resistant Candida, and this will probably
increase.

I have not seen any serious side effects, but if they were as common as
that, that is, so common that I would likely have seen liver toxicity
given the number of patients I have treated (perhaps a few hundred), the
drug would not be on the market.  Do not forget that the majority of
these serious side effects have been seen in patients with AIDS, who
have been on large doses for many months or even years.  There may be
drug interactions, something about having AIDS that makes you more
sensitive to the drug... and so on.

Keeping my fingers crossed for no side effects.

Jack Newman, MD, FRCPC