nystatin: clinical use

Prescribing considerations

• Confirm a susceptible, local candidal infection; oral nystatin is unsuitable for systemic mycoses.
• Maximise contact between the suspension and affected oral surfaces; dilution may reduce efficacy.
• Reassess worsening or persistent symptoms and consider diagnosis, adherence and alternative therapy.
• Consider the sucrose, ethanol and paraben excipients when selecting a product.

Contraindications and cautions

• Hypersensitivity to nystatin or any excipient.
• The selected sucrose-containing suspension should not be used in hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency.

Monitoring

• Assess clinical response and gastrointestinal tolerability.
• Stop and review if irritation, sensitisation, angioedema or a serious skin reaction develops.

Clinical pharmacology

Nystatin is an antifungal antibiotic active against Candida. It disrupts fungal membranes, is negligibly absorbed from the gastrointestinal tract and is mainly passed unchanged in faeces.

Formulation and product differences

• The selected product is a ready-mixed oral suspension supplied with a graduated syringe and adapter.
• It must be shaken before use and should not be diluted.
• It contains sucrose, a small amount of ethanol, methyl and propyl parahydroxybenzoates, flavourings and other excipients; it is essentially sodium-free.
• Topical nystatin products may contain additional active ingredients and are not interchangeable with this oral suspension.

Oral suspension

Route: Oral

Strengths: 100000 units/mL