BRAND NAMES
- International: Micostatin, Mycostatin, Nistatina, Nystatin
- Palestine: Candistan
- Tunisia: Mikostat, Nystatine
- U.S.: Nilstat
 MECHANISM OF ACTION
Nystatin is a polyene antibiotic with fungistatic and fungicidal activity, nystatin acts by binding to ergosterol and forms cytotoxic pores in cell membranes of susceptible candida species with a resultant change in membrane permeability allowing leakage of intracellular components.
Nystatin is absorbed very sparingly following oral administration when given in the recommended doses. The minimal absorption from oral dosage forms may however, be sufficient to provoke an allergic reaction in hypersensitive patients. No detectable blood levels are obtained following topical or vaginal applications
- Drops: Oropharyngeal/Esophageal Candidiasis (Thrush)
- Tablets and capsules: Intestinal candidiasis
- Vaginal tablets/suppositories/cream are used for Vaginal candidiasis
- Topical cream is used for superficial candidal infections of the skin
- Preventative treatment in people who are at risk for fungal infections, such as AIDS patients and patients receiving chemotherapy
- Preventative treatment in extremely low birthweight infants (<1000g) in neonatal intensive care units with high baselines of fungal infection
- Intestinal candidiasis: Usual dosage - 500,000 to 1 million units (1 to 2 tablets or capsules) three times daily. Treatment should generally be continued for at least 48 hours after clinical cure to prevent a relapse.
- Oral candidiasis:
- Infants, children and adults - 1 mL (100,000 units) of Nystatin drops, four times daily. The dose should be administered under the tongue or in the buccal cavity and held in the mouth and swirled around as long as possible before swallowing. Treatment should be continued for seven to 10 days and at least 48 hours after symptoms have disappeared and cultures are returned to normal.
- In immunocompromised patients, higher doses, for example 500,000 units 4 times daily may be needed. However, the use of alternate antifungal (Fluconazole) is preferred for the treatment of oral thrush in patients with immunosuppression.
Topical cream: Apply liberally to affected areas twice daily or as indicated until healing is complete.
Vaginal cream: The usual dosage is one full applicator of cream (5 g) inserted high in the vagina, once or twice daily. In most cases two weeks of therapy will be sufficient but more prolonged treatment may be necessary. It is important that therapy be continued during menstruation
Known hypersensitivity to Nystatin.
- If irritation or sensitization develops, treatment should be discontinued.
 PREGNANCY AND LACTATION
Pregnancy Category A (AU)
Pregnancy Category C (US): Although no adverse effects or complications have been reported in infants born to women treated with Nystatin, this preparation should be administered to pregnant women only if clearly needed.
Lactation: Not known if excreted in breast milk; use caution
 SIDE EFFECTS
Oral forms: Nystatin is virtually non-toxic and non-sensitizing, and is well tolerated by all age groups, including debilitated infants.
Nystatin may cause nausea and, at higher doses (exceeding 4-5 million units) diarrhea, gastrointestinal distress, and vomiting. Rash, including urticaria, has been reported rarely. Stevens-Johnson syndrome has been reported very rarely. Hypersensitivity and angioedema, including facial oedema, have been reported.
Topical Cream: Local irritation and sensitization (including: rash, dermatitis, pruritus, and burning) have been reported. If irritation on topical application should occur, discontinue medication.
Vaginal tablets may cause itching, soreness or redness of the vagina.
 RELATED LINKS
|Ergosterol target : Cell membrane target||Azoles (lanosterol 14 alpha-demethylase inhibitors) : Ergosterol inhibitors||Imidazoles||Topical: Bifonazole • Clotrimazole • Econazole • Fenticonazole • Ketoconazole • Isoconazole • Miconazole • Sertaconazole • Tioconazole|
|Triazoles|| Topical: Fluconazole • Terconazole|
Systemic: Fluconazole • Itraconazole • Posaconazole • Voriconazole
|Polyene antimycotics (ergosterol binding; they form pores in the membrane)|| Topical: Nystatin |
Systemic: Amphotericin B
|Allylamines (squalene epoxidase inhibitors) : Ergosterol inhibitors|| Topical: Amorolfine • Naftifine • Terbinafine |
|Echinocandins (β-glucan synthase inhibitors) : Cell wall target||Anidulafungin • Caspofungin • Micafungin|
|Pyrimidine analogues / Thymidylate synthase inhibitors : Nucleic acid inhibitors||Flucytosine|