Nystatin

Pronunciation: nye-STAT-in
Class: Antifungal

Trade Names

Nilstat
- Oral suspension 100,000 units
- Bulk powder 150 million units
- Bulk powder 1 billion units
- Bulk powder 2 billion units

Nystatin
- Cream 100,000 units
- Ointment 100,000 units

Pedi-Dri
- Powder 100,000 units/g

Candistatin (Canada)
Nyaderm (Canada)
ratio-Nystatin (Canada)

Pharmacology

Binds to fungal cell membrane, changing membrane permeability and allowing leakage of intracellular components.

Indications and Usage

Treatment of intestinal, oral, vulvovaginal, cutaneous, or mucocutaneous candidiasis.

Contraindications

Standard considerations.

Dosage and Administration

Intestinal Candidiasis
Adults and Children

PO 500,000 to 1,000,000 units 3 times daily. Continue treatment for at least 48 h after clinical cure.

Oral or Mucocutaneous Candidiasis
Adults and Children

PO (suspension) 200,000 to 600,000 units 4 times daily; swish and swallow, or (oral pastilles) 1 to 2 pastilles (200,000 to 400,000 units) dissolved in mouth 4 to 5 times/day.

Infants

PO 200,000 units 4 times daily.

Vaginal Candidiasis
Adults

Intravaginal 100,000 units every day for 2 wk.

Cutaneous Candidiasis
Adults and Children

Topical Apply to affected areas twice daily to 3 times daily.

General Advice

  • For troche/pastilles administration, have patient dissolve troche in mouth. Instruct patient not to chew or swallow troche whole. Have patient retain troche in mouth as long as possible before swallowing.
  • For administration of oral suspension, place half of dose in each side of mouth. Have patient swish thoroughly around in mouth and retain in mouth as long as possible before swallowing. Shake suspension well. Use calibrated dropper provided.
  • Do not mix oral suspension in foods.
  • To use powder for extemporaneous compounding, reconstitute ⅛ tsp (500,000 units) in half glass of water and stir well. Use immediately; do not store. Can be administered in form of flavored frozen popsicle.

Storage/Stability

Refrigerate vaginal tablets. Store oral suspension in refrigerator. Protect from heat, light, moisture, and air.

Drug Interactions

None well documented.

Laboratory Test Interactions

None well documented.

Adverse Reactions

GI

Diarrhea; GI distress; nausea; vomiting (with large oral doses).

Dermatologic

Irritation (with topical use).

Precautions

Pregnancy

Category C (oral); Category A (vaginal).

Lactation

Undetermined.

Effectiveness

Has no activity against bacteria or trichomonads. Not indicated for systemic mycoses.

Topical preparations

Not for ophthalmic use.

Overdosage

Symptoms

Nausea, diarrhea, vomiting.

Patient Information

  • Instruct patient that long-term therapy may be needed to clear infection and that patient should complete entire course of medication. Take drug for 2 days after symptoms have disappeared or as directed.
  • Advise patient using vaginal preparations to wear light-day pad; drug may stain clothing and linens.
  • Advise patient to notify health care provider if irritation occurs.
  • Assure patient that relief from itching may occur after 24 to 72 h.
  • Instruct patient to practice good hand washing before and after each application of topical or vaginal medication. Remind patient to wash applicator after each use.
  • Advise patient with oral candidiasis not to use mouthwash, which may alter normal flora and promote infections.
  • Teach patient to continue using vaginal tablets even when menstruating because treatment should be continued for 2 wk. Instruct patient to avoid using tampons.
  • Explain to patient that during pregnancy, use of vaginal applicator may be contraindicated, and manual insertion of vaginal tablets may be preferred.
  • Advise patient to prevent reinfection (ie, avoid intercourse during therapy or use condoms).
  • Instruct patient to discontinue drug and notify health care provider if vaginal tablets cause irritation, redness, or swelling.

Copyright © 2009 Wolters Kluwer Health.

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