This article was originally written on January 26, 2019. Last Updated on June 22, 2024.
Nizoral (with ketoconazole 1%) is an extremely popular dermatologist recommended dandruff shampoo. It also has modest anti-androgenic and hair growth properties according to a number of studies.
As of June 2024, Nizoral has almost 94,000 reviews on Amazon, with an average rating of 4.6 out of 5 stars. It costs just $14.10 for the smaller 7 fl oz (200 ml) bottle. The larger 14 fl oz (400 ml) bottle is currently priced at $27.53 on Amazon. This is a very affordable price when compared to other bestselling dandruff shampoos.
Update: June 22, 2024 — The Washington Post has an article suggesting that over-the-counter and prescription antidandruff shampoos that contain ketoconazole may help fight hair loss.
There is some evidence that ketoconazole blocks the synthesis of dihydrotestosterone in the scalp and acts as an antagonist of the androgen receptor. See the list of supportive studies at the bottom of this post.
- A November 2023 study from India discussed the successful development and testing of a novel anti-dandruff shampoo incorporated with ketoconazole-coated zinc oxide nanoparticles. The researchers wanted to improve on existing ketoconazole (KTZ) based shampoos with weak skin epidermis absorption and permeability. The prepared nanoparticles showed enhanced activity against Malassezia furfur compared to regular KTZ (1%).
- A May 2022 study from Brazil found that ketoconazole shifts the scalp skin lipid profile, affects Malassezia lipid metabolism and favors biotin-producing bacteria. Biotin improves inflammatory conditions.
Nizoral Shampoo
Nizoral shampoo (1%) is one of the highest rated and reviewed anti-dandruff shampoos that you can buy without a prescription. I rank it as one of the 15 best hair loss shampoos in the world. You can buy it at most stores, including Walmart (5,000 reviews), Target (4,900 reviews), CVS (3,700 reviews) and Walgreens (3,700 reviews).
Nizoral A-D Anti-Dandruff Shampoo with ketoconazole 1%, is consistently rated as one of the best products to counter dandruff, scalp itching, flaking and fungus. We all shed millions of dead skin cells every single day. However, some people have excessive skin turnover on the scalp, leading to dandruff.
Nizoral (often misspelled as Nizarol) can improve psoriasis symptoms, scaly scalp skin, yeast infections and even foot fungus. Some reports suggest it can also benefit fungal acne, although facial usage is not recommended.
A small bottle of this highly rated antifungal anti-inflammatory product will last for many months. Note that Nizoral 2% shampoo comes in a red bottle and is a different product that requires a prescription in some countries.
The Nizoral 1 percent shampoo is an over-the-counter product, while the medicated 2 percent shampoo requires a prescription in the US. In the UK and Canada, you can purchase the latter off-the-shelf at pharmacies and on Amazon UK. It had 28,600 reviews as of June 2024, with an average rating of 4.6 out of 5 stars. Note that they delineate their units as 20 mg/g, which is the same as 2%. The bottle contains only 60ml of liquid.
Also worth noting, Nizoral shampoo can help reduce hair loss to a moderate extent due to its anti-androgenic properties. See the studies listed at the end of this post that support this point. Other popular hair loss shampoos include Revivogen and Shiseido Adenovital (number 1 in Japan) and Folligen (number 1 in South Korea).
Ketoconazole 1%: The Active Ingredient
The list of ingredients in Nizoral can be found in the FDA label pdf. The key active ingredient is ketoconazole 1%. Ketoconazole (abbreviated KCZ or KTZ) also has some anti-androgenic properties.
To date, only two drugs with very different mechanisms of action have been approved by the US FDA to treat hair loss: Finasteride (Propecia) and Minoxidil (Rogaine).
However, Ketoconazole also has some hair growth benefits. It is an imidazole anti-fungal agent that counters dandruff and scalp inflammation.
Ketaconazole will never be officially approved to treat hair loss, because its manufacturer is unlikely to ever file for approval. With sales of Nizoral already going strong globally, it is probably not worth going through all the rigorous expensive clinical trials to get little added benefit.
Ketoconazole is a synthetic drug that is used to treat fungal infections. In particular, the drug flushes out Malassezia (formerly known as Pityrosporum) yeast fungus. Malassezia has been implicated in problems such as dandruff and seborrheic dermatitis. The latter leads to clogged hair follicles.
Other names for similar fungal infections and overgrowth of the scalp include Pityriasis Versicolor, Pityrosporum Ovale and Malassezia Furfur. Skin conditions such as tinea and ringworm may also benefit from this product.
Ketoconazole was originally available in tablet form, but has since also been developed into topical forms such as creams, lotions and shampoos. Note that oral ingestion of ketoconazole can lead to serious side effects such as liver damage in some patients. However, topical cream and ketoconazole shampoo usage have generally not been linked to such side effects.
My Nizoral Experiences for Scalp Itching
A large proportion of hair loss sufferers seem to also get itchy and dry scalp conditions, including dandruff and seborrheic dermatitis. I am one of those, although the severity and frequency of my symptoms is moderate and sometimes goes away for months.
Some years ago, I started using Nizoral 1% anti dandruff shampoo for my itchy inflamed scalp instead of other regular shampoos. I was absolutely amazed at its effectiveness in completely eliminating my scalp itching and dandruff for at least a day or two after each application. My hair looked better and healthier, and it seemed like my daily hair shedding rate also declined.
However, starting in December 2023, I started using the Head & Shoulders medicated shampoo. Nizoral was making my hair a bit too dry and lifeless.
Nizoral Conditioner
Nizoral now also sells a popular deep moisturizing hair conditioner product. It is supposed to counter the drying effects of Nizoral shampoo.
The conditioner is free of sulfates, parabens, artificial fragrances and dyes. Among the key ingredients in the conditioner (which contains seven moisturizers) include:
- Shea Butter.
- Jojoba Seed Oil.
- Peppermint Oil.
- Tea Tree Leaf Oil.
How often Should you use Nizoral Shampoo?
I would recommend using Nizoral shampoo no more than twice a week in order to prevent excessive skin dryness. You also do not want your scalp microflora and fungi to become immune to the effects of ketoconazole. Overuse will make your scalp skin excessively dry and make your hair brittle. I would recommending rotating between several different products among the best dandruff shampoos available.
When you do shampoo with Nizoral, make sure to keep it on your scalp for at least 3-4 minutes after lathering and before rinsing. Some people recommend rinsing hair in cold water rather than hot water in the shower. The former prevents excessive moisture loss and skin drying out.
Shortages
In 2012 or so, it seemed like US drug stores and pharmacies such as Walmart, Walgreens and CVS stopped carrying Nizoral shampoo, at least when it comes to the most popular blue bottle variety (see photo further below). I thought this was because of the warnings related to side effects from taking oral ketoconazole. I later found out that the problems with availability were due to the shampoo’s manufacturer having production issues at its main plants, rather than any issues related to side effects.
Luckily, I had sufficient supplies to last me for a while, since you only need a small amount of Nizoral shampoo to make a big difference. Most people do not need to use it more than twice a week. However, this shortage continued in 2013 and I then had to pay a significant premium to buy it from a seller on ebay. A lot of people took advantage of this situation by selling their surplus Nizoral stock online in 2012 and 2013. In 2014, Nizoral came back on the market and the shortages finally ended. No supply issues have occurred since that time.
Nizoral Side Effects
As long as you are not taking Nizoral (i.e., Ketoconazole) orally, side effects are usually limited and transient. The main side effects that can arise from using Nizoral shampoo include:
- Itchy scalp.
- Dry scalp skin.
- An unnatural hair texture and feel.
- Rashes, hives and other allergic reactions.
- Red inflamed eyes in case the product accidentally gets in there.
Ketoconazole and Hair Loss Studies
You can find many studies that suggest Nizoral causes a reduction in hair loss and thinning. Ketoconazole has anti-androgenic properties that could slow the progression of androgenetic alopecia (aka male pattern baldness). Below are some such studies in order of oldest to most recent:
- Ketoconazole (KCZ) shampoo: effect of long-term use in androgenic alopecia (Belgium — 1998).
- Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations (Belgium — 2002).
- Ketoconazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men (US — 2004).
- Topical application of ketoconazole stimulates hair growth in mice (Japan — 2005).
- Reversal of androgenetic alopecia by topical ketoconazole: Relevance of antiandrogenic activity (Japan — 2007).
- A new ketoconazole topical gel formulation in seborrheic dermatitis: an updated review of the mechanism (Sweden — 2007).
- Promotive effect of topical ketoconazole, minoxidil, and minoxidil with tretinoin on hair growth in male mice (Iraq — 2014).
- Trichogenic effect of topical ketoconazole versus minoxidil 2% in female pattern hair loss (Egypt — 2019).
- Topical ketoconazole is a promising adjunctive or alternative therapy in the treatment of pattern hair loss (US — 2020).
In June 2018, Germany’s Stada acquired Nizoral from Johnson & Johnson. For more recent information, see Nizoral’s official Instagram page.
Excellent post! I’ve been using 1% niz shampoo since 2002 with Propecia. Made my hair thicker, and reduced inflammation. However, around 2009 or so I started get bad scaling and dermatitis on my scalp. I bumped up to 2% and use it 3x a week and it stopped the scaling. I was using 1% 4x a week. Most likely my scalp got immune to it. Niz is a great addition to treatments.
Thanks! I got my once a year compliment from “Mjones”:-)
I’ve been using nizoral 2% for years. In the UK it can be bought over the counter. I credit it to slowing down my hair loss progression.
Hey Del, im from the UK (London) and im considering going on Nizoral, any idea where to get 2% from?
Thanks.
Unfortunately, it actually gave me dandruff
3 years ago I suffered with an extreme case of Pityriasis Versicolor for 5 years since my return from my trip to Egypt. Doctors kept giving me anti-fungal cream that did no good.
I discovered this, used it for 2 weeks and it completely got rid of it. Cosmetically insignificant though for hair loss.
Hi Admin, I was wondering if you’d come across Tissuse before? Their smart hair transplant sounds interesting. Do you think they’re legit?
Btw, thanks for all your work! You’re the best source of information for the balding gentleman and ladies online!
Please search for “Tissuse” on this blog as I have mentioned them in the past. Thanks!
Great post, I recall a past post on Nizoral and I incorporated it into my weekly regimen. It made a noticeable difference in the texture & look of my hair. This is such a great resource.
A few posts ago John Doe mentioned a company — More Hair Naturally — selling a ferociously expensive, all natural, topical treatment. I noticed it shared a lot of the same ingredients as another topical I bought last year (the difference being I paid $17CAD for 60ml and they are charging $125US for 50ml).
The topical I bought is The Ordinary’s Multi-Peptide Serum for Hair Density.
It was a whimsical purchase that I thought would be for an occasional ‘whatever’ application. But now that I’ve looked closer at the actual studies of the ingredients, I might give this a legitimate daily 12 month trial run. I also microneedle and use Minoxidil, so I won’t be able to make a reliable judgement on its actual efficacy.
@Admin (and y’all) I’d be interested in getting your thoughts on some of these trademarked formulas in the ingredient list:
REDENSYL™(2014) is composed of DHQG and EGCG2 (two stabilized polyphenols) targeting the ORS bulge stem cells and the fibroblasts located in the dermal papilla. ~ The growth rate after ten days was +214% compared to minoxidil 1%(!?) at +118%.
CAPIXYL™(2016) is a biomimetic signal peptide (acetyl tetrapeptide-3) combined with a red clover extract rich in Biochanin A, working synergistically on DHT modulation via the inhibition of 5-α reductase and on the stimulation of ECM renewal and anchoring proteins. ~ 46% hair increase, 48% decrease in DHT —the conclusion only said it has proven better results in hair growth than Minoxidil.
BAICAPIL™(2016) is a combination of three botanical active ingredients that reduces hair loss, stimulates growth and increases hair density. ~ 68.6% increase in A/T ratio (activating Telogen and extending Anagen phase follicles) compared to placebo group.
AnaGain™(2014) reduces hair loss by inducing dermal papilla cells to reactivate hair growth. ~ Increased hair growth coefficient (proportion of active hair follicles) from 4 to 7.2 indicating a strong hair-regrowing effect.
Hmmmmmmm. We’ll see.
Vey interesting Toccata. No idea what to make of it, and they sell a number of products on Amazon, but not this one. So no reviews.
Dowsing hair with JAK – First Aclaris patient dowsed with JAK on May 23, 2018 (per global news wire). They know by now if it Does OR Does not work. Is the final treatment here? All eyes on their update report that is expected by June.
If the patient was dowsed with JAK on May 23, 2018 and it worked this would have been big news by now. Even if the company kept its mouth shut, the patient would not. That patient would be more popular on Instagram than that Russian girl with the bananas.
If you have to wait months for a report to come out, it’s usually a well written proof-read reviewed edited thesis on why what they tried did not work. This is the same in any tech industry.
I 100% agree with scott. The guy that grew back all is hair from the aclaris jak areata trial was all over the news, nightly news to be exact and it was during their phase 2 trial not when it ended. This stuff doesn’t work for mpb unfortunately. Honestly, jak is some serious immune altering drugs. Serious stuff. I asked my doctor about it and he said if it goes systematic it could cause issues. Any who let’s wait and see what aclaris says in July. Maybe we are wrong.
Thanks for writing this and providing links. I just want to add that my own experience with Nizoral has generally been positive.
Based in the UK, I’ve been using the 2% version twice a week for the last three years. I started using it because my scalp was sore and itchy, and after taking photos of the back of my head, which is something I’d never done before amazingly, I noticed that my scalp seemed to be showing through angrily at my vertex. My wife insisted that the hair itself was not thinning, and was actually just a whorl that I’d had since we met me 20 years before, but I was still unsure so decided to begin using Nizoral, a relatively side-effects free and non-commital treatment.
It reduced straight away the itching to a much more tolerable level, and soon reduced the redness of my scalp; at the vertex in particular the skin no longer shone through the hair as much. The first time I used it, I shed lots of hairs in one go, but honestly, ever since then, I struggle to see any hairs at all on my pillow.
I still don’t know if what I have is a whorl — the rest of my hair is thick and curly — or an area of thinning, but I will say that it has stayed the same for the years I’ve been using Nizoral. It does dry the scalp and hair considerably and especially in the winter months it can be a struggle to manage the condition, but it’s a good product overall, I suspect underestimated for preventing hair loss.
Very useful comment Jamie. Thanks.
Note that all the azole antifungals (ketoconazole, voriconazole, fluconazole, etc) taken in oral form have hair loss as one of the most common side effects. It is somewhat puzzling that ketoconazole in topical form seems to help. My own experience using Nizoral for 20 years is very positive about having a healthy scalp. My own experience with oral fluconazole is that produces quite a bit of hair loss that is really obvious 2-3 months after starting the treatment.
When I stop using it, my scalp becomes very painful.
But I think I noticed that finasteride calms down painful scalp too.
Well I have decided to get my second fue done… I have waited long enough to loose the remaining took a while, but after marriage it was easy.. women give you enough stress boost to loose the remaining…i will get it done by the end of year… Either with asmed or with dr Bhatti..
Good luck Farhan and let us know how it goes!
Can a drop of the eye be used to treat baldness and a combination of Cyporin (Cyclosporine) and LUMIGAN (bimatoprost)?
— Cyclosporine A /
This drug is performed in clinical trials under the name of WAY-316606
And also in other clinical trials under the name RT1640.
— Bimatoprost /
This drug has proven effective in lengthening eyelashes and hair growth is minimal.
The question to forum members and consultants in the treatment of baldness /
Can baldness be treated with eye drops because it contains an effective substance in the treatment of baldness?
Do you have any side effects?
People that are having success with nizoral: do you follow the rinse with a conditioner or do you wash out nizoral and call it a day? Also do you wash with regular shampoo the following day or do you wait a few days before washing again? My experience was that my scalp would get very oily and itchy if I did not wash my hair with another shampoo about 24 hours after nizoral wash. But if I wash with regular shampoo I can go two or three days without major itch or significant oil production unless I eat fried food.
@Tomjones
I use baby shampoo on the days I don’t use Nizoral (usually use Nizosal once at the weekend and again mid week). Nizoral is quite a strong cleaning agent so that’s why I balance it with a mild shampoo. My hair needs a daily wash, another reason to use a mild shampoo.
I’ve used Regenepure DR which is a Keto shampoo with aloe. Very soothing to the scalp.
Only downside ive noticed is the days you use it youre hair can be kinda flat
Has anyone else tried both? How do they compare?
I have always preferred regenepure dr over nizoral.
Admin Edit: https://www.hairlosscure2020.com/regenepure-dr-an-alternative-to-nizoral/
I used it every day when i first started using minoxidil. Since then i use it every second day and regenepure nt every day in between. I tried lipogaine big 3 keto shampoo and its very similar apart from not having aloe, it doesnt make your hair look flat, lipogaine big 3 is about 15 aud more expensive in my country so i usually stick to regenepure combo.
Lately i have been experimenting with other shampoos (head and shoulders and moogoo). They work for dandruff, but leave my scalp feeling greasy. I don’t really like the way my hair feels after using nizoral. Like straw. Especially the 2%. There is a very expensive leave in scalp treatment called activance from Australia. It definitely kept my scalp in optimum condition. The three things, regenepure dr, avtivance hypoallergenic spray and compounded minoxidil with low pg and 0.01%tretinoin was the best combination for my scalp and i plan to start this combo again. My scalp obviously doesnt like grease.
For me, it’s not flat after Regenepure DR, but awfully flat with Renepure DT. Very little volume. Maybe you could use it in combination with their conditioner? I always use it otherwise my hair gets crazy flat and tangled. Hard water doesn’t seem to help either.
If you live in a place where the water is not so hard, Nizoral will be a good one I believe. I used to apply it when I lived in Brazil, where water is soft and it would work wonders decreasing oleosity on my scalp. Moving to the Netherlands and I had to switch to Regenepure DR because the water is hard and Nizoral would make my scalp flaky.
Soft and hard water? What do you mean by that? I thought water was water. Maybe a different shower head would change the water pressure and feel of the water?
Hi Admin! First of all, congrats for your blog! Really trustful and filled with great information!
Every time I see a new shampoo on the market, I look for the ingredients and then I search here if you have commented on it :)
In one of your references in this post, I saw the compound Piroctone olamine. Ketoconazole makes my scalp too dry and I used Neofolics Shampoo, which has Piroctona olamine as a substitute. Really liked it! Maybe you could make a post about this compound? The problem with these products from small companies is what you mentioned in your post about Regenepure DR, who knows if the ingredients are actually what they state.
Cheers!
If you like the Piroctone olamine shampoo neofollics you should look up moogoo shampoo. Its an australian company shampoo that contains Piroctone olamine. It has no sls or parabens and also is a quarter of the price of neofollics. Its very popular here.
Rhodanine is another ingredient that could help with hair growth. Farmers use to ise it on sheep to thicken their wool, there are few shampoos out there that contain it but i always felt like my hair was extremely healthy when using it!
Just did some research and the other name for rhodanide is Thiocyanate. I really do think this atleast has a cosmetic effect. Also i believe it makes minoxidil haors appear sooner
Used to be a very frequent visitor of this site. Stepped away for a while a year or so ago and have recently came back. Unfortunate that no major strides have been made but I appreciate your passion and effort to keep covering this and keeping us updated Admin. Your dedication is unwavering and let’s people like me have some where to go to find good news and become informed. Thanks for all your hard work. I strongly believe 2020 will be a good year. We should start to see some good things coming out by then and hopefully that’ll be the start of a decades worth of treatments and cures and finally a light at the end of the tunnel. Stay strong everybody we’re almost there.
Amen brother
Well said Mman! – & yes thanks Admin also
Mman.. hope you’re right! Riken is my favorite right now.. Let’s hope they can do as they say. It’d be just amazing.
A few days ago i went to the pharmacy and bought both nizoral 1% and alpecin c1. My scalp has never been so itchy. I think its the alpecin.
Both contain sls and parabens so i dont think my scalp likes this.
I am going to continue with regenepure dr and nt.
This is unfortunate because the regenepure stuff is twice the price
Good article, but about the red bottle, mine’s not red. That stuff is made in Thailand. I get mine (2% Nizoral) made in Canada through eBay. It’s purple and white and made by Johnson & Johnson. (I’m not a big fan from drugs from India ‘n such.)
I’ve read so many great things about Nizoral, but as for me:
– It’s hard to say regarding hair loss because I’m on a lot of things and even at that I’ve had only some success.
– Nizoral definitely gets rid of my flakes though, 100%!!
– It also smells really good.
– I do not use conditioner with it because I like how it leaves my hair coarse. That makes it look thicker and gives it more volume when I style it. Trick is: get out of the shower and brush it back. (Use a thin brush first if the thicker brush tugs on your hair.) Then let it dry a little (until your hair is just damp), and then style it as you’d like, while still a bit damp.
– I use it 2-3x per week.
I get it from eBay in the US. It’s not always on there, but usually is (comes and goes, so sometimes I have to check back every couple weeks) and I find it for a good price too and quick ship.
Oh and a 4 oz (120 ml) bottle usually lasts me 2+ months.
The 2% is available over the counter in Australia. The bottle is small, (around AUD $14) but lasts for ages – you don’t need much. However, for combating any hair loss, it did nada (for me), but for getting rid of dandruff and itchy scalp…it did wonders.
I dye my hair so I don’t want to use shampoo except once per week. Then I only use a color-safe shampoo. Instead of Nizoral, I use Funginox 2% solution that has no cleanser in it. I dilute that (to save money) 50/50 with water and add some caffeine (why not). I apply that every morning before my shower for 30-60 min.
The irony is that all the azoles when taken orally produce significant and often irreversible hair loss. This is a very common side effect of most anti fungal medications.
A pharmacist reader e-mailed me the following:
“The cleansers in Nizoral shampoo are amphoteric and strip the hair of all natural oils. I recommend gentle cleansing of the scalp with the fingers. Cleanse the scalp not the hair so to speak. I believe twice a week is good until hair fall out is reduced, and then once a week for maintenance is my best guess. I believe Ketoconazole 2% is more effective and can be purchased in Canada over the counter.”