Usage
Nystatin is prescribed for the treatment and prevention of fungal infections caused by Candida albicans. These infections commonly occur in the mouth (oral thrush), esophagus, intestines, and vagina. It can also be used to prevent fungal overgrowth in patients taking broad-spectrum antibiotics. Its pharmacological classification is antifungal antibiotic, specifically a polyene antifungal.
Nystatin works by binding to ergosterol, a crucial component of fungal cell membranes. This binding disrupts the membrane integrity, leading to leakage of essential cellular contents and ultimately fungal cell death.
Alternate Names
Nystatin is also known by various brand names, including Mycostatin, Nilstat, Nyamyc, Nystex, and Nystop. There are no widely recognized international or regional variations of the generic name “Nystatin”.
How It Works
Pharmacodynamics: Nystatin exerts its antifungal effect by binding to ergosterol in the fungal cell membrane. This binding compromises membrane permeability, causing leakage of potassium and other intracellular components, eventually leading to fungal cell death.
Pharmacokinetics: Nystatin is poorly absorbed from the gastrointestinal tract following oral administration. This localized action makes it suitable for treating infections of the mucous membranes and the intestinal tract. Most of the administered dose is excreted unchanged in the feces. Due to its negligible systemic absorption, metabolism and elimination pathways through the renal or hepatic systems are not significant for orally administered Nystatin.
Mode of Action: Nystatin’s mode of action is primarily based on its binding to ergosterol, a sterol found in fungal cell membranes but not in human cells. This specific binding makes Nystatin selectively toxic to fungi.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Nystatin’s action involves sterol binding rather than receptor interactions, enzyme inhibition, or neurotransmitter modulation.
Elimination Pathways: After oral administration, Nystatin is minimally absorbed and primarily eliminated unchanged in the feces.
Dosage
Standard Dosage
Adults:
For oral thrush: 400,000–600,000 units (4–6 mL of suspension) four times daily, swished in the mouth for several minutes and then swallowed. For intestinal candidiasis: 500,000–1,000,000 units (5-10 mL of suspension or one to two 500,000 unit tablets) three or four times a day. The suspension or lozenge should be retained in the mouth as long as possible before swallowing. Treatment is typically continued for 48 hours after symptoms resolve and cultures are negative.
Children:
Infants (1-2 years): 1-2ml, 4 times a day
Children (≥ 2 years): 1ml 4 times a day.
Children (≥ 5 years): 4 to 6 milliliters (mL) (about 1 teaspoonful) four times a day
For older infants: 2 mL four times a day.
For premature and low-birth-weight infants: 1 mL four times a day
Pediatric dosing may also be weight-based, and it’s crucial to consult pediatric dosing guidelines.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically required. However, close monitoring for adverse effects is recommended.
- Patients with Renal Impairment: No specific dose modifications are necessary due to minimal systemic absorption.
- Patients with Hepatic Dysfunction: No specific dose modifications are necessary due to minimal systemic absorption.
- Patients with Comorbid Conditions: Dose adjustments may be necessary depending on the comorbid condition and potential drug interactions. For example, patients with diabetes should be aware of the sucrose content in some Nystatin formulations.
Clinical Use Cases
Nystatin’s usage is generally limited to the treatment of candidiasis, thus it is not indicated for clinical settings like Intubation, Surgical Procedures, Mechanical Ventilation, Intensive Care Unit (ICU) Use, or Emergency Situations.
Dosage Adjustments
Dosage adjustments may be required based on individual patient response and tolerance to therapy. No specific modifications are necessary for renal or hepatic dysfunction due to limited systemic absorption.
Side Effects
Common Side Effects
Nausea, vomiting, diarrhea, stomach pain, and mouth irritation. Rarely, rash and hives may occur.
Rare but Serious Side Effects
Severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome (SJS), angioedema.
Long-Term Effects
No significant long-term adverse effects are typically associated with Nystatin use.
Adverse Drug Reactions (ADR)
Clinically significant ADRs include SJS and anaphylaxis, both requiring immediate medical intervention.
Contraindications
Hypersensitivity to Nystatin is a contraindication. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take the oral suspension containing sucrose.
Drug Interactions
No clinically significant drug interactions are known with orally administered Nystatin due to its minimal systemic absorption. However, always check for potential interactions, especially in patients with renal insufficiency where slight absorption can occur.
Pregnancy and Breastfeeding
Nystatin is considered safe to use during pregnancy and breastfeeding as it is not systemically absorbed in significant amounts. Although, insignificant amounts are present in breastmilk it has been used for many years without side effects in breastfed babies.
Drug Profile Summary
- Mechanism of Action: Binds to ergosterol in fungal cell membranes, disrupting integrity and causing cell death.
- Side Effects: Nausea, vomiting, diarrhea, stomach pain, mouth irritation; rarely, rash, hives, SJS, and anaphylaxis.
- Contraindications: Hypersensitivity to Nystatin.
- Drug Interactions: No clinically significant interactions are known with oral Nystatin.
- Pregnancy & Breastfeeding: Generally considered safe for use during pregnancy and breastfeeding.
- Dosage: Adults: 400,000–600,000 units QID for oral thrush; 500,000–1,000,000 units TID or QID for intestinal candidiasis. Pediatric dosages vary by age and formulation; consult pediatric guidelines.
- Monitoring Parameters: Resolution of clinical symptoms (e.g., white patches in mouth, diarrhea) and negative fungal cultures.
Popular Combinations
Nystatin is often used alone, but it can be combined with other antifungals for specific infections or in severe cases. Combination therapy should be guided by clinical experience and patient-specific factors.
Precautions
- General Precautions: Assess for hypersensitivity before administration. Monitor for adverse effects.
- Specific Populations: Use with caution in patients with diabetes due to the sucrose content in some formulations. No special precautions are needed for pregnant/breastfeeding women, children, or elderly patients based on currently available information.
- Lifestyle Considerations: No specific lifestyle considerations are associated with Nystatin use, such as dietary restrictions or limitations on driving.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Nystatin?
A: The dosage varies depending on the patient’s age, the type and location of the infection, and the formulation of Nystatin used. Standard adult doses range from 400,000–600,000 units QID for oral thrush to 500,000–1,000,000 units TID or QID for intestinal candidiasis. Pediatric dosages are available and should be consulted.
Q2: How should Nystatin oral suspension be administered?
A: The suspension should be swished thoroughly in the mouth for several minutes before swallowing. For infants and young children, one-half of the dose should be placed in each side of the mouth, and they should avoid feeding for 5-10 minutes after administration.
Q3: Can Nystatin be used during pregnancy?
A: Yes, Nystatin is generally considered safe to use during pregnancy due to its lack of significant systemic absorption.
Q4: What are the common side effects of Nystatin?
A: The most common side effects are gastrointestinal, including nausea, vomiting, diarrhea, and stomach upset. Oral formulations may cause mild mouth irritation.
Q5: How long should Nystatin treatment be continued?
A: Treatment should typically continue for at least 48 hours after the resolution of symptoms and negative fungal cultures to prevent relapse.
Q6: Are there any drug interactions with Nystatin?
A: No clinically significant drug interactions are known with oral Nystatin due to minimal systemic absorption. Always check for potential interactions, especially if the patient has other medical conditions.
Q7: Is Nystatin effective against all types of fungal infections?
A: No, Nystatin is primarily effective against Candida albicans. It is not effective against all types of fungi.
Q8: What should I do if a patient develops a rash while taking Nystatin?
A: A rash could indicate an allergic reaction. Discontinue Nystatin immediately and evaluate the patient for alternative antifungal treatment.
Q9: Can Nystatin be used to treat systemic fungal infections?
A: No, Nystatin is not absorbed systemically and is only suitable for treating localized candidiasis of the mucous membranes and gastrointestinal tract.
Q10: How should Nystatin be stored?
A: Store at room temperature, away from moisture, heat, and direct light. Always refer to the manufacturer’s instructions for specific storage recommendations.
