There are two different dosage levels used for the administration of Ketoconazole (Keto), a commonly used 2nd line hormone deprivation drug used after the failure of the traditional drugs (Lupron, Zoladex etc.). Low dosage keto involves taking 200 mg three times a day (600 mg per day), while high dose keto uses 400 three times a day (1,200 mg per day). Both low and high dose keto should be taken along with hydrocortisone to avoid adrenal insufficiency.

Keto clears the body very quickly, so it is vital that you stay on a very strict schedule of a dose every eight (8) hours. Most men find it helpful set an alarm clock so they don’t accidentally miss the schedule.

Dosing of the hydrocortisone is different from the keto, adding to the complications of scheduling your drugs. The normal schedule for Hydrocortisone involves take two tablets with breakfast and one table with dinner. Including ydrocortisone regardless of the keto dose schedule is important to avoid adrenal insufficiency.

Most men begin keto using the low dose schedule. After you been on the low dose regimen for a couple of weeks and have no life threatening side effects, including liver functions and your PSA has deceased, you will probably move to the high dose schedule.

Proper absorption of the keto is important. To insure the proper absorption of the keto you must make sure that your stomach is in an acid state (see yesterday’s post “Ketoconazole – How To Take It So That It Works” at
An acid state can be achieved by drinking an acid drink, like orange juice or coke, but never should you drink grapefruit juice with keto. Do not eat any food with the keto as it will buffer the acidity in your stomach. However, when you take the Hydrocortisone always take it with a meal, even a small meal is adequate.

Never drink any alcoholic beverages (including just one beer) when taking keto no matter what dosing schedule you are using.
Try and have at least a regular, daily bowel movement to prevent the Keto from building up to a toxic level.

Many men do get added time with a controlled PSA using keto along with hydrocortisone. Make sure to include it in your treatment regiment when the first line therapies fail.

Joel T. Nowak, M.A., M.S.W.