Can I take ketoconazole while pregnant or breastfeeding?
A plain-words look at what the NHS, the US drug label and LactMed say about ketoconazole.
In short
Pregnancy: You can use ketoconazole cream or shampoo while pregnant.
Breastfeeding: You can use ketoconazole cream or shampoo while breastfeeding. It's very unlikely that any of it will reach your breast milk.
Your doctor, midwife or pharmacist can help you decide.
What this means for you
Pregnancy
- Your body takes in only tiny amounts of ketoconazole, so your baby will not be affected.
Breastfeeding
- You can use ketoconazole cream or shampoo while breastfeeding.
- It's very unlikely that any of it will reach your breast milk.
- If you're using ketoconazole cream to treat thrush (candida) of the breast, your baby will need their own medicine at the same time.
- Keep your baby away from any areas of skin where you've applied ketoconazole.
- Wash your hands after using it and before you pick up your baby.
- If you apply it to your breasts or nipples, remove it by washing before a feed.
- It's important that your baby does not swallow any of the cream.
- As soon as you can, get in touch with your midwife, health visitor or doctor if your baby is feeding less well than normal, or if anything else about your baby worries you.
Talk to your doctor or pharmacist
This page is educational, not advice for your own situation. Talk to your doctor, midwife or pharmacist before you start, stop or change any medicine in pregnancy or while breastfeeding.
The details: what each source says
Ketoconazole in pregnancy
The NHS says
You can use ketoconazole cream or shampoo while pregnant.
Your body takes in only tiny amounts of ketoconazole, so your baby will not be affected.
In our words, from the NHS page Ketoconazole (nhs.uk). Contains public sector information licensed under the Open Government Licence v3.0 (OGL v3.0). The NHS does not endorse this site.
The US drug label says
If pregnant or breast-feeding, ask a doctor before use.
Drug Facts label: Nizoral (topical), Kramer Laboratories. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.
Pregnancy Teratogenic effects Pregnancy Category C Ketoconazole has been shown to be teratogenic (syndactylia and oligodactylia) in the rat when given orally in the diet at 80 mg/kg/day, (10 times the maximum recommended human oral dose). However, these effects may be related to maternal toxicity, which was seen at this and higher dose levels. There are no adequate and well-controlled studies in pregnant women. Ketoconazole should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Prescribing label, section “Pregnancy”: Ketoconazole (topical), REMEDYREPACK INC. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.
This quote is from the topical formulation label.
Ketoconazole while breastfeeding
The NHS says
You can use ketoconazole cream or shampoo while breastfeeding. It's very unlikely that any of it will reach your breast milk.
If you're using ketoconazole cream to treat thrush (candida) of the breast, your baby will need their own medicine at the same time.
Keep your baby away from any areas of skin where you've applied ketoconazole. Wash your hands after using it and before you pick up your baby. If you apply it to your breasts or nipples, remove it by washing before a feed. It's important that your baby does not swallow any of the cream.
As soon as you can, get in touch with your midwife, health visitor or doctor if your baby is feeding less well than normal, or if anything else about your baby worries you.
In our words, from the NHS page Ketoconazole (nhs.uk). Contains public sector information licensed under the Open Government Licence v3.0 (OGL v3.0). The NHS does not endorse this site.
LactMed says
Because there is little published experience with ketoconazole or levoketoconazole during breastfeeding and its potential liver enzyme inhibition and liver toxicity, other agents are preferred. The manufacturers recommend that mothers taking ketoconazole or levoketoconazole avoid breastfeeding during treatment and for 1 day after the last dose.
Use of ketoconazole shampoo or topical use on the skin by the mother poses little to no risk to the breastfed infant.[1,2] However, topical use on the breast or nipples should be avoided in nursing mothers because of possible oral ingestion by the infant and the availability of safer alternatives. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.[3]
“Summary of Use during Lactation”, LactMed record “Ketoconazole” (LM361), quoted verbatim. Everything LactMed reports about Ketoconazole while breastfeeding.
The US prescribing label says
Nursing Mothers It is not known whether Ketoconazole Cream, 2% administered topically could result in sufficient systemic absorption to produce detectable quantities in breast milk. Nevertheless, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
Prescribing label, section “Nursing Mothers”: Ketoconazole (topical), REMEDYREPACK INC. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.
This quote is from the topical formulation label.
Other names
UK brand names (per the NHS): Daktarin Gold, Daktarin Intensiv, Dandrazol, Nizoral.
Sources
- NHS, Ketoconazole (nhs.uk), page last reviewed 16 August 2024. Paraphrased. Contains public sector information licensed under the Open Government Licence v3.0.
- US drug label: Nizoral (topical), Kramer Laboratories, human otc drug, label effective 21 August 2025, set ID f5c8c5b4-49bd-4dc7-8c29-8f1317c6ef88. DailyMed (National Library of Medicine). Public domain; quoted verbatim.
- US drug label: Ketoconazole (topical), REMEDYREPACK INC., human prescription drug, label effective 1 September 2026, set ID ea56cddf-94c9-46b6-8791-995b741cfbd7. DailyMed (National Library of Medicine). Public domain; quoted verbatim.
- Drugs and Lactation Database (LactMed), National Institute of Child Health and Human Development (NICHD), via NCBI Bookshelf, record “Ketoconazole” (LM361), bulk release of 22 September 2026. LactMed on NCBI Bookshelf. Public domain; quoted verbatim. LactMed is a registered trademark of the U.S. Department of Health and Human Services.
Sources checked 26 September 2026. How we source and check every page.
Educational summary of named sources, not medical advice.