NYSTATIN
(nye-stat'in)
Mycostatin, Nadostine

, Nilstat, Nyaderm

, Nystex, O-V Statin
Classifications: antiinfective; antifungal antibiotic
Prototype: Amphotericin B
Pregnancy Category: C

Availability

500,000 unit tablets; 100,000 units/mL oral suspension; 200,000 troches; 100,000 units vaginal tablets; 100,000 units/g cream, ointment, powder.

Actions

Nontoxic, nonsensitizing antifungal antibiotic produced by Streptomyces noursei. Binds to sterols in fungal cell membrane, thereby changing membrane potential and allowing leakage of intracellular components.

Therapeutic Effects

Fungistatic and fungicidal activity against a variety of yeasts and fungi; not appreciably active against bacteria, viruses, or protozoa.

Uses

Local infections of skin and mucous membranes caused by Candida sp. including Candida albicans (e.g., paronychia; cutaneous, oropharyngeal, vulvovaginal, and intestinal candidiasis).

Contraindications

Use of vaginal tablets during pregnancy (category C); vaginal infections caused by Gardnerella vaginalis or Trichomonas sp.

Cautious Use

Lactation.

Route & Dosage

Candida Infections
Adult: PO 500,000–1,000,000 U t.i.d.; 1–4 troches 4–5 times/d; Suspension: 400,000–600,000 U q.i.d. Intravaginal 1–2 tablets daily for 2 wk
Child: PO Suspension: 400,000–600,000 U q.i.d.
Infant: PO 100,000–200,000 U q.i.d.

Administration

Oral

Give reconstituted powder for oral suspension immediately after mixing.
Rinse mouth with 1–2 tsp using oral suspension. Keep in mouth (swish) as long as possible (at least 2 min), then spit it out. (If you cannot keep the liquid in your mouth or cannot spit, or if you have been told to "swish and swallow," you may swallow the drug.) For children, infants: Apply drug with swab to each side of mouth. Avoid food or drink for 30 min after treatment.

Topical

Store vaginal tablets in refrigerator below 15° C (59° F).

Adverse Effects (1%)

GI: Nausea, vomiting, epigastric distress, diarrhea (especially with high oral doses).

Pharmacokinetics

Absorption: Poorly absorbed from GI tract. Elimination: Excreted in feces.

Nursing Implications

Assessment & Drug Effects

Monitor oral cavity, especially the tongue, for signs of improvement.
Avoid occlusive dressings or applications of ointment preparation to moist, dark areas of body because they favor growth of yeast.

Patient & Family Education

This drug may cause contact dermatitis. Stop using the drug and report to physician if redness, swelling, or irritation develops.
Take for oral candidiasis (thrush) treatment after meals and at bedtime.
Dissolve troche in mouth (about 30 min). Do not chew or swallow. Avoid food and drink during period of dissolving and for 30 min after treatment.
Care of dentures: Remove dentures before each rinse with oral suspension and before use of troche. Remove dentures at night (infection occurs more frequently in person who wears dentures 24 h a day).
Dust shoes and stockings, as well as feet, with nystatin dusting powder.
Gently clean infected areas with tepid water before each application of topical preparation.
Continue medication for vulvovaginal candidiasis during menstruation.
Use vaginal tablets up to 6 wk before term to prevent thrush in the newborn.
Do not breast feed while taking this drug without consulting physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug