II. Indications
-
Cutaneous Candidiasis (topical Nystatin)
- Candida Diaper Dermatitis
- Candidal Intertrigo
-
Oral Candidiasis (Thrush)
- First-line agent
-
Yeast Vaginitis
- Other medications are preferred
III. Contraindications
- Dermatophytes or tinea fungal infections (ineffective)
IV. Mechanism
- Macrolide Antifungal and Polyene Antifungal (as is Amphotericin B)
- Like Amphotericin B, Nystatin binds sterols in fungal plasma membranes, resulting in fungal cell leak and death
- Synthesized by the Bacteria streptomyces noursei, Staphylococcus aureus, and other Streptomyces species
- Three biologically active components (A1, A2, A3) form the Nystatin complex
V. Medications
- Topical Nystatin (100,000 units/gram)
- Available as a cream, ointment or powder
- Oral
- Suspension: 100,000 units/ml
- Film-coated tablets: 500,000 units
VI. Dosing: Topical for Cutaneous Candidiasis (topical Nystatin)
- Apply 2 to 3 times daily
VII. Dosing: Oral Candidiasis (Thrush)
- Adults
- Pastilles: 200,000 unit lozenge four times daily for 14 days
- Swish and swallow: 500,000 units (5 ml) four times daily for 14 days
- Tablets: Two 500,000 unit tablets three times daily for 14 days
- Child
- Swish and swallow 500,000 units (5 ml) orally four times daily for 14 days
- Infant
- Suspension (100,000 u/ml): Swab 1 ml on each cheek four times daily for 14 days
- Decrease dose in Preterm or low-birth weight infants to 0.5 ml/cheek
- Avoid feeding infant for 5 to 10 minutes after dose
VIII. Dosing: Yeast Vaginitis
- Nystatin vaginal tablet (100,000 unit) PV daily for 14 days
- Nystatin ointment (100,000 units/g)
- Ointments are less irritating than creams
IX. Safety
- Pregnancy category C
- Considered safe in Lactation
X. Pharmacokinetics
- When taken orally, Nystatin is not absorbed
- Excreted unchanged in feces
XI. Resources
- Nystatin Suspension (DailyMed)
- Nystatin Tablet (DailyMed)
- Nystatin Cream (DailyMed)
Images: Related links to external sites (from Bing)
Related Studies
| nystatin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| NYSTATIN 100,000 UNIT/GM CREAM | Generic | $0.19 per gram |
| NYSTATIN 100,000 UNIT/GM OINT | Generic | $0.27 per gram |
| NYSTATIN 100,000 UNIT/GM POWD | Generic | $0.31 per gram |
| NYSTATIN 100,000 UNIT/ML SUSP | Generic | $0.09 per ml |
| NYSTATIN 500,000 UNIT ORAL TAB | Generic | $0.35 each |
| NYSTATIN-TRIAMCINOLONE CREAM | Generic | $0.26 per gram |
| NYSTATIN-TRIAMCINOLONE OINTM | Generic | $0.37 per gram |
| NYSTATIN-TRIAMCINOLONE OINTMENT | Generic | $0.37 per gram |