Ketoconazole is one of the only hair loss treatments that you don’t need a prescription for and is backed by science.
It is an antifungal medication and is used to treat a variety of fungal infections. However, it’s also sometimes used off-label to treat hair loss and improve hair volume—and it appears to work.
It isn’t a miracle cure—while it appears to be effective, other hair loss treatments (like finasteride and minoxidil) are still better established. Still, ketoconazole appears to work, especially when taken in combination with other treatment options.
Here’s everything you need to know about ketoconazole (sometimes sold as Nizoral) and hair loss: what it is, how it works, the research on its effectiveness, and side effects.
What is ketoconazole?
Ketoconazole is an antifungal medication which means it’s used to fight fungal infections. It can be applied topically to the skin or taken orally as a systemic antifungal medication. Ketoconazole is commonly used to treat, pityriasis versicolor, seborrheic dermatitis, and cutaneous candidiasis, among others.
Ketoconazole is frequently used for fungal infections on the scalp. This includes tinea capitis (also known as scalp ringworm) and dandruff. When it is used for this purpose, it’s usually sold in a shampoo formula to be applied directly to the hair and scalp.
Ketoconazole is often sold under the brand name “Nizoral”.
Ketoconazole (Nizoral) and hair loss
Does ketoconazole shampoo stop hair loss? Yes, you can use ketoconazole products for hair loss treatment.
How does ketoconazole work for hair loss? It’s not exactly clear, but there are two mechanisms that are thought to be important.
Reducing inflammation of the scalp
The first is by reducing particular fungi that are usually present on the scalp. An imbalance of microflora may be one cause of inflammation in hair follicles. It’s suspected that such inflammation in the hair follicles may contribute to hair loss. Ketoconazole is suspected to rebalance the microflora, reducing inflammation, and ultimately preventing hair loss.
Blocking DHT
As well as being antifungal, Ketoconazole is often acknowledged to be an antiandrogen, meaning that it can block some hormones—like DHT—from having their effects on hair cells. Since DHT plays an important role in causing androgenic alopecia (AGA), the most common form of hair loss in men, blocking it can help prevent hair loss in most men.
In particular, ketoconazole shampoos seem to inhibit the enzyme that turns testosterone into DHT (called 5α-Reductase). By reducing the production of DHT, the scalp’s hormonal environment is friendlier to hair follicles and enhances hair growth.
Effectiveness of ketoconazole
So how effective is Ketoconazole for hair loss? Does it actually work?
There is much less research available on the effectiveness of ketoconazole for hair loss than there is for other hair loss treatments—finasteride (generic Propecia), minoxidil (generic Rogaine), and dutasteride.
Still, the research that does exist suggests it may help treat hair loss.
One study found that 2% ketoconazole, when combined with finasteride, led to significantly improved hair growth after a year. Another study found that 2% ketoconazole was effective by itself in improving hair density and size. Finally, a systematic review of 7 studies found that ketoconazole appeared to be a promising adjunctive or alternative treatment for AGA.
Each of the above studies notes that more research—especially clinical trials—is needed to be confident in its effectiveness. But so far, the research suggests that ketoconazole can be helpful at treating hair loss—especially when it’s used together with more established treatments like finasteride.
Does ketoconazole work for female pattern hair loss?
Yes, it appears to. One small study from 2019 found that ketoconazole created a significant improvement in hair outcomes for women. Its effect was similar to minoxidil, although its effects came slightly later.
Note that the women who used ketoconazole also experienced fewer side effects than the women who used minoxidil.
Does ketoconazole work better than other hair loss treatments?
Ketoconazole vs. minoxidil: There is significantly less research on the effectiveness of ketoconazole than there is for minoxidil. We know minoxidil works. Ketoconazole seems effective, but it’s not nearly as certain. One very small study did find that ketoconazole was slightly more effective than minoxidil for hair loss, but the authors noted that to be sure we must “await further controlled study in a larger group of subjects.”
Ketoconazole vs. finasteride: Finasteride’s effectiveness is much better supported by the research literature than ketoconazole’s. While there haven’t been any studies directly comparing the two, finasteride is widely acknowledged as one of the most effective hair loss treatments available. However, in one study, finasteride combined with ketoconazole was found to lead to better hair growth than finasteride alone.
Ketoconazole vs. dutasteride: Again, we’re not aware of any research comparing these two directly. However, the evidence supporting dutasteride (Avodart) is very strong, whereas it’s not nearly as strong for ketoconazole.
Remember: The gold standard for treating AGA is a combination of finasteride and minoxidil.
How long does ketoconazole take to work
Like other hair loss treatments, results come slowly. It takes about 6 months before you’ll start to notice the effects of ketoconazole. By a year, you should see its full effects.
Ketoconazole side effects
Is ketoconazole safe?
Yes, ketoconazole is generally considered safe and well-tolerated by most people. Ketoconazole shampoos for hair loss treatment and dandruff are especially safe and adverse side effects for these are quite uncommon.
Uncommon side effects of ketoconazole shampoo:
- Itching
- Stinging
- Skin irritation
- Dryness or oiliness of the hair and scalp
- Headache
Rare side effects of ketoconazole shampoo:
- Hair loss
- Abnormal hair texture
- Dry skin
Note, though, that there are more significant side effects when ketoconazole is taken in pill form. We won’t cover those here because ketoconazole pills are not used to enhance hair growth. You can find a list of side effects when ketoconazole is taken as a pill here.
How do I use ketoconazole shampoo?
Always follow the instructions of your doctor, pharmacist, or manufacturer instructions. Do not use more of it, use it more often, or use it for a longer time, than instructed. Doing so could cause irritation or unwanted side effects.
Note that there are generally two strengths of this shampoo: over-the-counter-strength (usually 1% ketoconazole or less) and prescription-strength (usually 2% ketoconazole). These have slightly different instructions.
Over-the-counter ketoconazole shampoo can be used as follows:
- Ensure your skin isn’t irritated or broken before using.
- Apply the shampoo to wet hair. Gently lather and rub into your hair and scalp.
- Rinse your hair and scalp with warm water.
- Repeat the application one more time.
- Rinse your hair and scalp with warm water again, and then dry your hair.
Prescription ketoconazole shampoo can be used as follows:
- Ensure your skin isn’t irritated or broken before using.
- Apply the shampoo to wet hair. Gently lather and rub into your hair and scalp in the affected area and around it.
- Leave a good lather in place for 5 minutes.
- Rinse your hair and scalp with warm water again, and then dry your hair.
How often should I use ketoconazole shampoo for hair loss?
Can I use ketoconazole shampoo every day?
It depends on the strength you’re using. Again, always read the directions on the label to understand the necessary frequency of application.
Generally, 2% ketoconazole shampoo can be used twice a week for dandruff and three times a week for hair loss. It should not be used every day unless by instruction from your doctor.
Over-the-counter versions vary—some of them can be used daily. Again, always make sure to check the instructions.
Do I need a prescription to buy ketoconazole in Canada?
You don’t need a prescription to buy over-the-counter versions with 1% ketoconazole or less. However, you do need a prescription to buy stronger formulas, like 2% ketoconazole.
Where can I buy ketoconazole in Canada?
You can buy ketoconazole shampoos from pharmacies or even from us here at Hair Supply—we sell an anti-dandruff hair loss shampoo with 1% ketoconazole as the active ingredient. For other hair loss treatment options, check out all our products.
We don’t sell prescription-strength ketoconazole shampoos or other forms of ketoconazole. You can find these in your local pharmacy.
Find the best hair loss treatment
95% of all hair loss is treatable. And treatments are easily available throughout Canada from online shops like Hair Supply.
Not sure exactly what you need? Feel free to reach out and we’ll be happy to help.