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nystatin

(nye stat' in)


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

Pregnancy Category C

Drug class
Antifungal

Therapeutic actions
Fungicidal and fungistatic: Binds to sterols in the cell membrane of the fungus with a
resultant change in membrane permeability, allowing leakage of intracellular components
and causing cell death.

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

Contraindications and cautions


• Contraindicated with allergy to nystatin or components used in preparation.
• Use cautiously with pregnancy, lactation.

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

Dosages
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 4–5 times/day for up to 14 days.
INFANTS
Oral suspension
200,000 units qid (100,000 in each side of mouth).
Premature and low–birth-weight infants: 100,000 units qid.
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 2–3 times/day until healing is
complete.
• Topical foot powder: For fungal infections of the feet, dust powder on feet and in
shoes and socks.

Pharmacokinetics
No general systemic absorption. Excreted unchanged in the feces after oral use.

Adverse effects
Oral
• GI: Diarrhea, nausea, vomiting, GI distress
Vaginal
• Local: Irritation, vulvovaginal burning
Topical
• Local: Local irritation

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. Pain 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.
• These side effects may occur: 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).

Adverse effects in Italic are most common; those in Bold are life-threatening.