nystatin

Drug Name

Generic Name :  nystatin

Brand Name:

  • Oral, oral suspensions, oral troche: Candistatin (CAN), Mycostatin, Nilstat, PMS Nystatin (CAN), ratio-Nystatin (CAN)
  • Vaginal preparations: Mycostatin
  • Topical application: Mycostatin, Nilstat

Classification: Antifungal

Pregnancy Category C

Dosage & Route

Available forms : Tablets—500,000 units; oral suspension—100,000 units/mL; troche—200,000 units; vaginal tablets—100,000 units; topical cream, ointment, powder—100,000 units/g

Vaginal preparations

  • 1 tablet (100,000 units) or 1 applicator of cream (100,000 units) daily–bid for 2 wk.

Topical

  • Vaginal preparations: Apply to affected area two to three times daily until healing is complete.
  • Topical foot powder: For fungal infections of the feet, dust powder on feet and in shoes and socks.
ADULTS AND PEDIATRIC PATIENTS EXCEPT INFANTS

Oral

  • 500,000–1,000,000 units tid. Continue for at least 48 hr after clinical cure.
    • Oral suspension: 400,000–600,000 units qid (one-half of dose in each side of mouth, retaining the drug as long as possible before swallowing).
    • Troche: Dissolve 1–2 tablets in mouth four to five times/day for up to 14 days.
INFANTS

Oral suspension

  • 200,000 units (2 mL) qid (100,000 in each side of mouth).
  • Premature and low–birth-weight infants: 100,000 units (1 mL) qid.
Therapeutic actions
  • Nystatin, a polyene antifungal, binds to ergosterol in the fungal cell membrane. This binding affects the cell wall permeability allowing leakage of cellular contents.
Indications
  • Oral: Treatment of oropharyngeal candidiasis
  • Oral suspension, troche: Treatment of oral candidiasis
  • Vaginal: Local treatment of vaginal candidiasis (moniliasis)
  • Topical applications: Treatment of cutaneous or mucocutaneous mycotic infections caused by Candida albicans and other Candida species
Adverse effects
  • Diarrhea, GI distress, nausea and vomiting. vaginal pessaries/cream: May damage latex contraceptives (e.g. diaphragms, condoms), additional contraceptive measures should be taken. Topical application: Irritation.
Contraindications
  • Hypersensitivity.
Nursing considerations
Assessment
  • History: Allergy to nystatin or components used in preparation, pregnancy, lactation
  • Physical: Skin color, lesions, area around lesions; bowel sounds; culture of area involved
Interventions
  • Culture fungus before therapy.
  • Have patient retain oral suspension in mouth as long as possible before swallowing. Paint suspension on each side of the mouth. Continue local treatment for at least 48 hr after clinical improvement is noted.
  • Prepare nystatin in the form of frozen flavored popsicles to improve oral retention of the drug for local application.
  • Administer nystatin troche orally for the treatment of oral candidiasis; have patient dissolve 1–2 tablets in mouth.
  • Insert vaginal suppositories high into the vagina. Have patient remain recumbent for 10–15 min after insertion. Provide sanitary napkin to protect clothing from stains.
  • Cleanse affected area before topical application unless otherwise indicated.
  • Monitor response to drug therapy. If no response is noted, arrange for further cultures to determine causative organism.
  • Ensure that patient receives the full course of therapy to eradicate the fungus and to prevent recurrence.
  • Discontinue topical or vaginal administration if rash or sensitivity occurs.
Teaching points
  • Take the full course of drug therapy even if symptoms improve. Continue during menstrual period if vaginal route is being used. Long-term use of the drug may be needed; beneficial effects may not be seen for several weeks. Vaginal suppositories should be inserted high into the vagina.
  • Use appropriate hygiene measures to prevent reinfection or spread of infection.
  • This drug is for the fungus being treated; do not self-medicate other problems.
  • Refrain from sexual intercourse or advise partner to use a condom to avoid reinfection; use a sanitary napkin to prevent staining of clothing with vaginal use.
  • You may experience these side effects: Nausea, vomiting, diarrhea (oral use); irritation, burning, stinging (local use).
  • Report worsening of condition; local irritation, burning (topical application); rash, irritation, pelvic pain (vaginal use); nausea, GI distress (oral administration).