This topical solution contains ketoconazole 2% and ibuprofen 2% in a DMSO solution. It is available by prescription in a 15 mL bottles.

DMSO is an effective penetration enhancer for topical drug delivery with established clinical evidence. It facilitates transdermal delivery of both hydrophilic and lipophilic medications, enables localized delivery by enhancing skin permeation. DMSO also serves as an effective vehicle for topical NSAID administration. Its long history in pharmaceutics supports its clinical use as a penetration enhancer when properly formulated and administered [1].

Ketoconazole is an antifungal agent. It alters the permeability of the cell wall ultimately leading to cell death [2].

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) often used for pain management. Its inclusion may help reduce pain and inflammation for the tissues surrounding the nails. Resistance to antifungals due to efflux pump overexpression was frequently observed among clinical isolates, but this resistance could be reversed with certain modulators, particularly ibuprofen. Ibuprofen shows promise as an adjunct to azole therapy and merits further clinical trials [3].

Dimethyl sulfoxide (DMSO) is a solvent included in an effort to increase penetration of ketoconazole and ibuprofen into the nail bed.

This combination of antifungal medication plus a nonsteroidal anti-inflammatory is designed for direct application in nail disorders. This may be considered by a provider who is treating a patient with onychomycosis. Onychomycosis is a fungal nail infection characterized by brittleness, discoloration, and thickening of the nails.

Topical ketoconazole is an azole antifungal that works by compromising fungal cell membrane integrity which leads to fungal cell death. It is active against dermatophytes, yeasts (including Candida species), and some molds responsible for nail infections. Evidence includes a study where topical ketoconazole cream was used successfully after nail avulsion, highlighting its potential role in combination approaches [4]. Topical therapy may be particularly useful in superficial or early infections, and in patients where systemic therapy is contraindicated or not well tolerated. Importantly, ketoconazole maintains a broad spectrum of antifungal activity and remains a potential option in carefully selected cases, especially as part of multimodal treatment strategies [4, 5].

Ibuprofen is included to help reduce pain and inflammation for the tissues surrounding the nails. Additionally, resistance to antifungals due to efflux pump overexpression was frequently observed among clinical isolates, but this resistance could be reversed with certain modulators, particularly ibuprofen. Ibuprofen shows promise as an adjunct to azole therapy and merits further clinical trials [3].

DMSO is an effective penetration enhancer for topical drug delivery with established clinical evidence. It facilitates transdermal delivery of both hydrophilic and lipophilic medications, enables localized delivery by enhancing skin permeation. DMSO also serves as an effective vehicle for topical NSAID administration. Its long history in pharmaceutics supports its clinical use as a penetration enhancer when properly formulated and administered [2].

1. PRESCRIBER & PATIENT INFORMATION

Prescribing clinician’s name, licensing information, address and contact information. Patients’ full name, date of birth, shipping address and contact information.

2. COMPLETE PRESCRIPTION INFORMATION

Include: drug, dosage, and dosage form, quantity, SIG, and refills if requested.

3. PRESCRIPTION TRANSMITTAL
Fax: (940) 382-2694
Phone: 940-382-6758 | Speak to a pharmacist
Escribe ID: 0903012660 or CARIE BOYD Pharmaceuticals

•  Select Medication from the drop-down menu (bulk ingredient or powder is OK)
•  Use the words Please Compound in the SIG or Comments section followed by the compounded medication you want to NOTE: If you cannot find the same strength or form, that’s OK, write exactly what you want into the SIG or Comments section. In most cases we’ll be able to custom compound the prescribed medication.

Store at controlled room temperature. Protect from light.

[1] Marren K. Dimethyl sulfoxide: an effective penetration enhancer for topical administration of NSAIDs. Phys Sportsmed. 2011 Sep;39(3):75-82. doi: 10.3810/psm.2011.09.1923. PMID: 22030943.
[2]Lexicomp. (n.d.). Ketoconazole: Drug information. In Lexicomp Online. Wolters Kluwer. Retrieved August 26, 2025, from https://www.online.lexi.com/
[3] Cidália Pina-Vaz, Acácio Gonçalves Rodrigues, Sofia Costa-de-Oliveira, Elisabete Ricardo, Per-Anders Mårdh, Potent synergic effect between ibuprofen and azoles on Candida resulting from blockade of efflux pumps as determined by FUN-1 staining and flow cytometry, Journal of Antimicrobial Chemotherapy, Volume 56, Issue 4, October 2005, Pages 678–685, https://doi.org/10.1093/jac/dki264
[4] Hettinger DF, Valinsky MS. Treatment of onychomycosis with nail avulsion and topical ketoconazole. J Am Podiatr Med Assoc. 1991 Jan;81(1):28-32. doi: 10.7547/87507315-81-1-28. PMID: 1825225.
[5] Roberts DT. Oral therapeutic agents in fungal nail disease. J Am Acad Dermatol. 1994 Sep;31(3 Pt 2):S78-81. doi: 10.1016/s0190-9622(08)81274-1. PMID: 8077514.