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People’s Pharmacy: Why does Nizoral shampoo work for dandruff?

Oct. 18, 2022 Updated Tue., Oct. 18, 2022 at 6:13 p.m.

By Joe Graedon, M.S., and Teresa Graedon, Ph.D. KING FEATURES SYNDICATE

Q. I am a big fan of Nizoral shampoo. It used to only be available by prescription. Now I can buy it over the counter. What’s the difference?

I don’t just use Nizoral for dandruff. I also use it as a body wash – on my face, behind my ears and between my toes. I leave it on for about two to three minutes and then rinse it off. I find it gets rid of my dandruff and itchy, flaky skin. Nizoral also seems to help with my athlete’s foot problem.

A. A 2% formulation of Nizoral (ketoconazole) was approved by the Food and Drug Administration in 1990 to control “flaking, scaling and itching associated with dandruff.” This antifungal shampoo required a doctor’s prescription.

In 1997, the FDA permitted over-the-counter sale of a lower-strength (1%) formulation called Nizoral A-D (Anti-Dandruff) Shampoo. Even at this reduced concentration, the anti-fungal ingredient, ketoconazole, is quite effective. It can discourage yeast growth on the scalp and skin.

Some dermatologists prescribe the 2% shampoo to treat jock itch (tinea cruris) and ringworm (tinea corporis). It can also help control another fungal infection called tinea versicolor that causes discolored skin patches.

To learn more about other effective dandruff control strategies and ways to deal with hair loss, you may wish to download our free Guide to Hair and Nail Care. This online resource is available under the Health eGuides tab at

Q. What is it in Ozempic that makes you so exhausted?

A. Doctors prescribe semaglutide (Ozempic) to control blood glucose for people with Type 2 diabetes. The most common side effects are stomachache, nausea, vomiting, diarrhea or constipation.

Some people also report feeling tired, though it is considered an uncommon complication. We do not have an explanation for this adverse reaction, though you should monitor your blood sugar levels to make sure they don’t fall too low. If that were to happen, symptoms might include dizziness, shakiness, fatigue, headache and difficulty concentrating.

Q. I was prescribed lisinopril for high blood pressure over 10 years ago. It worked great with no side effects until recently. At first, I just noticed a little swelling in my face. Then my lips started swelling, too. When my tongue swelled up, I was transferred to the ER by ambulance.

They treated me with an epinephrine injection and kept me overnight for observation. I was surprised that I could develop such a bad reaction after 10 years. You would think that such a serious side effect would have showed up much earlier. The ER doctor said it can happen after one day or after 20 years. Do people know this?

A. Angioedema (swelling of the mouth, tongue or throat) can be a life-threatening reaction to “-pril”type blood pressure drugs. This category includes benazepril, captopril, enalapril, lisinopril and quinapril. Swelling of the tongue or throat requires emergency medical treatment.

There is another kind of angioedema that can occur in the digestive tract. The same blood pressure medications can cause abdominal obstruction. This kind of swelling can lead to bloating and severe stomach pain and cramping. Such an adverse drug reaction can be hard to diagnose and is also life threatening.

We fear that patients are not always warned about angioedema. People should be warned that it can occur unexpectedly, after many years of treatment.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”

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