In July, 2013 the FDA issued a drug safety communication warning for oral ketoconazole (Nizoral) about the possibility of severe liver injuries, adrenal gland problems and harmful drug interactions with other medications. As a result, ketoconazole oral tablets should not be a first-line treatment for any fungal infection. Oral ketoconazole should be used for the treatment of certain fungal infections, known as endemic mycoses, only when alternative antifungal therapies are not available or tolerated. The topical formulations of ketoconazole have not been associated with liver damage, adrenal problems, or drug interactions. These formulations include creams, shampoos, foams, and gels applied to the skin, unlike the ketoconazole (Nizoral) tablets, which are taken by mouth.