Nystatin

Antibiotic Class:

Polyene antifungal agent

Antimicrobial Spectrum:

Candida albicans Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis,

Mechanism of Action:

Induces membrane permeability by forming complexes with ergosterol located in fungal membranes, leading to intracellular leakage and cell death. 

Pharmacodynamics:

Concentration dependant fungicidal effects in Candida spp.

Pharmacokinetics:

Absorption:  Nystatin is not absorbed to any significant extent following oral, cutaneous, or vaginal administration

Distribution:  No distribution studies have been published on nystatin

Metabolism:  No data available

Elimination:  No elimination studies have been published on nystatin due to its primary use in topical indications

Adverse Effects:

Gastrointestinal: Nausea, vomiting, diarrhea (following PO administration)

Dermatologic: Rare case reports of contact dermatitis, and skin eruptions have been reported

Dosage:

Topical: Powder 50 Million Units/10g, Cream 100,000 Units/g, Ointment, Oral pastilles 200,000 Units

Suspension: 100,000 Units/ml

Vaginal tablets: 100,000 Units

Adults:

Oral candidiasis: Swish and swallow 4-6mL (400,000 to 600,000 Units) PO four times daily

Topical: Apply cream or ointment two to three times daily to affected areas, OR apply topical powder to affected area two to three times daily

Vaginal infections: Insert 1 vaginal tablet into vagina at bedtime nightly x 14 days.

Infants:

Oral candidiasis: Using dropper, apply 1 mililiter to each buccal membrane (total of 2 milliliters OR 200,000 units) four times daily.

Children:

Oral candidiasis: Swish and swallow 4-6mL (400,000 to 600,000 Units) PO four times daily

Disease state based dosing:

Renal Failure:  No data available

Hepatic failures:  No data available

Contraindications/Warnings/Precautions:

Contraindications:  Hypersensitivity to nystatin

Precautions:  None

Drug Interactions:

None are known

Pregnancy:

Category C: Risk unknown. Human studies inadequate.

Monitoring Requirements:

Improvement in fungal infection by oral plaques, or topical improvement if applied for yeast infections of the skin

Generic names/Brand names/Manufacturer:

Bio-Statin – Bio-Tech Pharma;

Mycostatin® - Bristol-Myers Squibb

Nystop® - Paddock Labs

Pedi-Dri® - Pedinol

Nystatin Cream – Various manufacturers

Nystatin Ointment – Various manufacturers