nystatin

Action

Interferes with fungal cell-wall synthesis, inhibiting formation of ergo sterols, increasing cell-wall permeability, and causing osmotic instability

Availability

Cream: 100,000 units/g

Ointment: 100,000 units/g

Powder: 100,000 units/g

Suspension: 100,000 units/ml

Tablets: 500,000 units

Troches: 200,000 units

Vaginal tablets: 100,000 units

Indications and dosages

➣ Candidiasis (topical use)

Adults and children: Apply cream, ointment, or powder two or three times daily until healing is complete.

➣ Oral candidiasis

Adults: 400,000 to 600,000 units (suspension) P.O. q.i.d. Have patient gargle and then swallow half of dose in each side of mouth.

Infants: 200,000 units (suspension) P.O. q.i.d. Use half of dose in each side of mouth.

Newborn and premature infants: 100,000 units (suspension) P.O. q.i.d. Use half of dose in each side of mouth.

➣ GI infections

Adults: 500,000 to 1 million units (one to two tablets) P.O. t.i.d. Continue for 48 hours after desired response occurs.

➣ Vaginal candidiasis

Adults: 100,000 units (one vaginal tablet) intravaginally daily for 2 weeks, or 100,000- to 500,000-unit applicatorful (cream) intravaginally once or twice daily for 2 weeks

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:

• renal or hepatic disease, achlorhydria

• pregnant or breastfeeding patients

• children younger than age 2.

Administration

• Give oral suspension by placing half of dose in each side of patient's mouth. Instruct patient to hold suspension in mouth, swish it around, or gargle for several minutes before swallowing it.

• To prepare oral solution from powder, add one-eighth teaspoon to 120 ml of water and stir well. Give immediately.

• Advise patient to let troche dissolve slowly and completely in mouth. Tell her not to chew or swallow it whole.

• Know that nystatin vaginal tablets can be given orally to treat oral candidiasis.

• To apply cream, ointment, or powder, gently and thoroughly massage preparation into skin.

• Use applicator provided for vaginal administration.

Adverse reactions

GI: nausea, vomiting, diarrhea, GI distress, oral irritation

GU: vulvovaginal irritation (with intravaginal form)

Skin: pruritus, rash

Interactions

Drug-drug. Topical corticosteroids: increased corticosteroid absorption

Drug-behaviors. Latex contraceptive use: damage to contraceptive (with intravaginal use)

Patient monitoring

• If patient takes oral tablets, inspect oral mucous membranes for irritation.

• With topical use, monitor affected area for increase in redness, swelling, or irritation.

Patient teaching

• Advise patient to continue taking for at least 48 hours after symptoms resolve.

• Instruct patient to let lozenge dissolve slowly in mouth. Tell her not to chew or swallow it.

• If patient misses a dose, tell her to take dose as soon as possible and then resume her regular dosing schedule.

• Inform patient that diabetes mellitus, reinfection by sexual partner, tight-fitting pantyhose, and use of antibiotics, hormonal contraceptives, or corticosteroids predispose her to vaginal infection. Urge her to wear cotton underwear.

• Tell female patient to practice careful hygiene in affected areas.

• Instruct patient using vaginal tablets to wash applicator thoroughly after each use.

• Tell patient to continue therapy during menstruation.

• As appropriate, review all significant adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.

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