General

Pronunciation:
nye-stat-in

Trade Name(s)

• Mycostatin

Ther. Class.

antifungals

For other nystatin dosage forms, see antifungals (topical) and antifungals (vaginal).

Indications

• Oral suspension: Local treatment of oropharyngeal candidiasis.
•  Oral tablet: Treatment of nonesophageal mucus membrane gastrointestinal candidiasis.

Action

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

Therapeutic Effect(s):

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 and Excretion: Excreted unchanged in the feces after oral administration.

Half-life: Unknown.

TIME/ACTION PROFILE (antifungal effects)

Contraindication/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).

Adverse Reactions/Side Effects

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

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

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

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.

Evaluation/Desired Outcomes

• Decrease in stomatitis.
• Treatment of intestinal candidiasis.