nystatin (oral)

REMS

Oral suspension

Local treatment of oropharyngeal candidiasis.
Oral tabletTreatment of nonesophageal mucus membrane gastrointestinal candidiasis.

Action ⬆ ⬇

Binds to fungal cell membrane, allowing leakage of cellular contents.

Therapeutic effects:

Fungistatic or fungicidal action.

Spectrum:

Active against most pathogenic Candida species, including C. albicans.

Pharmacokinetics ⬆ ⬇

Absorption: Poorly absorbed; action is primarily local.

Distribution: Unknown.

Metabolism/Excretion: Excreted unchanged in the feces after oral administration.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(antifungal effects)

ROUTE	ONSET	PEAK	DURATION
PO	24–72 hr	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Some products may contain ethyl alcohol or benzyl alcohol; avoid use in patients who may be hypersensitive to or intolerant of these additives.

Use Cautiously in:

Denture wearers (dentures require soaking in nystatin suspension).

Adv. Reactions/Side Effects ⬆ ⬇

Derm: contact dermatitis, STEVENS-JOHNSON SYNDROME (SJS)

GI: diarrhea, nausea, stomach pain (large doses), vomiting

Interactions ⬆ ⬇

Drug-drug:

None reported.

Route/Dosage ⬆ ⬇

Oropharyngeal Candidiasis

PO (Adults and Children ): 400,000–600,000 units 4 times daily as oral suspension.
PO (Infants ): 200,000 units 4 times daily or 100,000 units to each side of the mouth 4 times daily.
PO (Neonates ): 100,000 units 4 times daily or 50,000 units to each side of the mouth 4 times a day.

Gastrointestinal Candidiasis

PO (Adults ): 500,000–1,000,000 units 3 times daily. Continue for ≥48 hr after clinical cure to prevent relapse.

Availability ⬆ ⬇

(Generic available)

Oral suspension: 100,000 units/mL
Oral tablets: 500,000 units

Assessment ⬆ ⬇

Inspect oral mucous membranes before and frequently during therapy for symptomatic improvement. ↑ irritation of mucous membranes may indicate need to discontinue medication.
Assess for rash or signs and symptoms of SJS periodically during therapy (fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis). If signs/symptoms of SJS occur, discontinue nystatin and provide supportive care.

Implementation ⬆ ⬇

Do not confuse nystatin with HMG-CoA reductase inhibitors (statins).
PO: Administer suspension by placing ½ of dose in each side of mouth. Patient should hold suspension in mouth or swish throughout mouth for several minutes before swallowing; then gargle and swallow. Use calibrated measuring device for liquid doses. Shake well before administration. Pedi: For neonates and infants, paint suspension into recesses of the mouth. Avoid feedings for 5–10 min following administration or administer after meals.

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of nystatin. Instruct patient to take as directed. If a dose is missed, take as soon as remembered but not if almost time for next dose. Do not double doses. Therapy should be continued for ≥2 days after symptoms subside. Advise patient to read Patient Information before starting therapy.
Pedi: Instruct parents or caregivers of infants and children on correct dose and administration. Remind them to use only the measuring device dispensed with the product.
Advise patient to report ↑ irritation of mucous membranes or lack of therapeutic response to health care provider.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇