Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
EXSEL vs AUKELSO
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Exsel (selenium sulfide) is an antifungal agent that reduces the production of cutaneous oils and exerts cytostatic effects on epidermal cells. It inhibits the growth of Pityrosporum ovale and other fungi by interfering with oxidative enzyme systems, leading to decreased sebum production and normalization of epidermal turnover.
Selective inhibitor of the mammalian target of rapamycin (m TOR) kinase, specifically the m TORC1 complex, leading to inhibition of cell proliferation, angiogenesis, and glucose uptake.
Treatment of tinea versicolor (pityriasis versicolor),Management of dandruff and seborrheic dermatitis of the scalp
Advanced renal cell carcinoma,Progressive neuroendocrine tumors of pancreatic origin,Subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis,Advanced neuroendocrine tumors of gastrointestinal or lung origin
1-2 mg orally once daily; maximum dose 2 mg/day.
400 mg orally twice daily with food.
Terminal half-life: 12-18 hours (mean 15 h); requires dose adjustment in renal impairment (Cr Cl <30 m L/min).
Terminal elimination half-life approximately 24 hours (range 20–28 h), supports once-daily dosing; prolonged in severe hepatic impairment.
Minimal systemic absorption after topical application; any absorbed selenium is primarily excreted in urine, with minor metabolism via reduction to selenides and methylation to dimethylselenide.
Primarily metabolized by CYP3A4
Renal: ~70% unchanged; biliary/fecal: ~30% as metabolites.
Primarily hepatic metabolism with biliary excretion; ~20% renal elimination of unchanged drug. Fecal excretion of metabolites accounts for ~65% of total clearance.
95% bound to albumin and alpha-1-acid glycoprotein.
High protein binding, approximately 99.8%, primarily to albumin and alpha-1-acid glycoprotein.
0.8-1.2 L/kg; indicates extensive extravascular distribution.
Volume of distribution ~0.15 L/kg (range 0.12–0.18 L/kg), indicating limited extravascular distribution, predominantly confined to plasma and extracellular fluid.
Oral: 60-80%; first-pass metabolism reduces bioavailability by 20-40%.
Oral bioavailability ~85%; unaffected by food.
No adjustment required for mild to moderate impairment. Severe impairment (GFR <30 m L/min): contraindicated.
GFR ≥60 m L/min: no adjustment; GFR 30-59 m L/min: 200 mg twice daily; GFR <30 m L/min: 200 mg once daily; hemodialysis: 200 mg three times weekly after dialysis.
Child-Pugh A: no adjustment. Child-Pugh B or C: contraindicated.
Child-Pugh A: no adjustment; Child-Pugh B: 200 mg twice daily; Child-Pugh C: 200 mg once daily.
Not recommended for use in pediatric patients due to lack of safety and efficacy data.
Body weight 10-20 kg: 200 mg twice daily; 20-40 kg: 300 mg twice daily; ≥40 kg: 400 mg twice daily.
Start at 1 mg orally once daily; titrate cautiously due to increased risk of falls and hypotension.
No specific dose adjustment based on age alone; monitor renal function and adjust per renal guidelines.
None.
No FDA black box warning.
Avoid contact with eyes, eyelids, and mucous membranes. If contact occurs, rinse thoroughly with water. Discontinue if local irritation or sensitization develops. Use with caution in patients with inflamed or broken skin due to increased absorption risk. Not for use on large areas of the body for prolonged periods.
Non-infectious pneumonitis,Infections (including opportunistic infections),Hypersensitivity reactions,Renal impairment,Metabolic effects (hyperglycemia, hyperlipidemia),Interstitial lung disease,Hemorrhagic events,Wound healing complications,Immunosuppression,Increased risk of thrombosis
Hypersensitivity to selenium sulfide or any component of the formulation. Do not use on broken or inflamed skin.
Hypersensitivity to everolimus or any component of the formulation
No known food interactions.
Avoid grapefruit and grapefruit juice; may increase drug levels. Take with or without food, but high-fat meals may increase absorption. Avoid alcohol due to hepatotoxicity risk.
Pregnancy Category D. First trimester: Associated with Ebstein's anomaly and other congenital heart defects; avoid if possible. Second and third trimesters: Risk of fetal hyperthyroidism or hypothyroidism, cranial synostosis, intellectual disability, and neonatal goiter if maternal hyperthyroidism is treated with this drug. Use only if clearly needed and maternal benefit outweighs fetal risk.
First trimester: Avoid use due to potential for fetal harm based on animal studies showing developmental toxicity (including cardiovascular and skeletal malformations). Second and third trimesters: Use only if maternal benefit outweighs fetal risk; may cause fetal growth restriction or oligohydramnios in off-label experience. No adequate human data.
Excreted in human milk. M/P ratio not available. Potential for serious adverse reactions in nursing infants, including thyroid dysfunction and arrhythmias. Decision to discontinue nursing or drug based on importance of drug to mother.
No human data on milk excretion or infant effects. M/P ratio unknown. Due to potential for serious adverse reactions (e.g., immunosuppression), advise against breastfeeding during treatment and for 2 weeks after last dose.
Pregnancy may increase clearance of this drug; dose adjustments often not required, but individualize based on maternal thyroid function and clinical response. Lower doses may be needed to avoid fetal hypothyroidism.
No established dose adjustment in pregnancy. Consider reduced dosing if increased clearance occurs (second trimester). Monitor drug levels if available; otherwise, adjust based on clinical response and toxicity.
EXSEL (selenium disulfide) 2.5% shampoo: Use twice weekly for 2 weeks, then once weekly for maintenance. Limit application to 5-10 minutes before rinsing. Avoid contact with eyes or broken skin. Can cause temporary hair discoloration (especially on bleached or permed hair). May stain jewelry and clothing. For dandruff and seborrheic dermatitis of the scalp.
Monitor for QT prolongation, electrolyte abnormalities, and hepatotoxicity. Adjust dose in renal impairment (Cr Cl <30 m L/min). Avoid use with strong CYP3A4 inhibitors or inducers. Note potential for phototoxicity; advise sun avoidance.
Shake bottle well before use.,Wet hair thoroughly before applying shampoo.,Apply enough shampoo to lather and massage into scalp for 2-3 minutes.,Leave on scalp for 5 minutes (up to 10 minutes) before rinsing thoroughly.,Rinse hair and scalp completely to avoid residue.,Use twice weekly for first 2 weeks, then once weekly as directed.,Avoid contact with eyes; if contact occurs, rinse thoroughly with water.,Do not use on broken or irritated skin.,Discontinue use and consult doctor if rash or irritation develops.,May stain clothing and jewelry; rinse thoroughly after use.
Take exactly as prescribed; do not change dose or stop without consulting doctor.,Avoid grapefruit and grapefruit juice during treatment.,Use effective contraception during therapy and for 1 month after last dose.,Report symptoms like irregular heartbeat, fainting, severe nausea/vomiting, or yellowing of skin/eyes immediately.,Use sunscreen and protective clothing; avoid sun exposure, even through glass.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about EXSEL vs AUKELSO, answered by our medical review team.
EXSEL is a Topical Antifungal that works by Exsel (selenium sulfide) is an antifungal agent that reduces the production of cutaneous oils and exerts cytostatic effects on epidermal cells. It inhibits the growth of Pityrosporum ovale and other fungi by interfering with oxidative enzyme systems, leading to decreased sebum production and normalization of epidermal turnover.. AUKELSO is a Topical Antifungal that works by Selective inhibitor of the mammalian target of rapamycin (m TOR) kinase, specifically the m TORC1 complex, leading to inhibition of cell proliferation, angiogenesis, and glucose uptake.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between EXSEL and AUKELSO depend on the specific clinical indication. These are both Topical Antifungal agents and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of EXSEL is: 1-2 mg orally once daily; maximum dose 2 mg/day.. The standard adult dose of AUKELSO is: 400 mg orally twice daily with food.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between EXSEL and AUKELSO in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. EXSEL is classified as Category C. Pregnancy Category D. First trimester: Associated with Ebstein's anomaly and other congenital heart defects; avoid if possible. Second and third trimesters: Risk of fetal hyperthyr. AUKELSO is classified as Category C. First trimester: Avoid use due to potential for fetal harm based on animal studies showing developmental toxicity (including cardiovascular and skeletal malformations). Second and . Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.