Nilstat


nystatin

Bio-Statin, Candistatin, Dom-Nystatin, Mycostatin, Nadostine, Nilstat, Nyaderm, Nystan (UK), Nystop, Pedi-Dri, PMS-Nystatin, Ratio-Nystatin

Pharmacologic class: Antifungal

Therapeutic class: Anti-infective

Pregnancy risk category A

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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nystatin

(nye-stat-in) nystatin,

Mycostatin

(trade name),

Nadostine

(trade name),

Nilstat

(trade name),

PMS-Nystatin

(trade name)

Classification

Therapeutic: antifungals
Pregnancy Category: B
For other nystatin dosage forms, see antifungals (topical) and antifungals (vaginal)

Indications

Lozenges, oral suspension: Local treatment of oropharyngeal candidiasis.Treatment of intestinal candidiasis.

Action

Binds to fungal cell membrane, allowing leakage of cellular contents.

Therapeutic effects

Fungistatic or fungicidal action.Active against most pathogenic Candida species, including C. albicans.

Pharmacokinetics

Absorption: Poorly absorbed; action is primarily local.Distribution: Unknown.Metabolism and Excretion: Excreted unchanged in the feces after oral administration.Half-life: Unknown.

Time/action profile (antifungal effects)

ROUTEONSETPEAKDURATION
Toprapidunknown2 hr†
†Maintenance of saliva levels required to inhibit growth of Candida species after oral dissolution of 2 lozenges

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Some products may contain ethyl alcohol or benzyl alcohol—avoid use in patients who may be hypersensitive to or intolerant of these additives.Use Cautiously in: Denture wearers (dentures require soaking in nystatin suspension); Pediatric: Lozenges, pastilles, or troches may pose a choking risk for children <5 yr.

Adverse Reactions/Side Effects

Gastrointestinal

  • diarrhea
  • nausea
  • stomach pain (large doses)
  • vomiting

Dermatologic

  • contact dermatitis
  • Stevens-Johnson syndrome

Interactions

Drug-Drug interaction

None significant.

Route/Dosage

Oral (Adults and Children) 400,000–600,000 units 4 times daily as oral suspension or 200,000–400,000 units 4–5 times daily as pastilles (lozenges).Oral (Infants) 200,000 units 4 times daily or 100,000 units to each side of the mouth 4 times daily.Oral (Neonates, Premature, and Low Birth Weight) 100,000 units 4 times daily or 50,000 units to each side of the mouth 4 times a day.

Availability (generic available)

Oral suspension: 100,000 units/mL Oral pastilles (lozenges, troches): 200,000 units/troche Powder for oral suspension: 1/8 tsp = 500,000 units Oral tablets: 500,000 units

Nursing implications

Nursing assessment

  • Inspect oral mucous membranes before and frequently throughout therapy. Increased irritation of mucous membranes may indicate need to discontinue medication.

Potential Nursing Diagnoses

Risk for impaired skin integrity (Indications)
Risk for infection (Indications)

Implementation

  • Oral: Suspension should be administered by placing ½ of dose in each side of mouth. Patient should hold suspension in mouth or swish throughout mouth for several minutes before swallowing, then gargle and swallow. Use calibrated measuring device for liquid doses. Shake well before administration. Pediatric: For neonates and infants, paint suspension into recesses of the mouth.
    • To prepare oral solution from powder, add 1/8 tsp (approximately 500,000 units) to 120 mL of water and stir well. Prepare immediately before use; contains no preservatives.
    • Lozenges (pastilles) should be allowed to dissolve slowly and completely in mouth; do not chew or swallow whole. Nystatin vaginal tablets can be administered orally for treatment of oral candidiasis.

Patient/Family Teaching

  • Instruct patient to take medication as directed. If a dose is missed, take as soon as remembered but not if almost time for next dose. Do not double doses. Therapy should be continued for at least 2 days after symptoms subside.
  • Pediatric: Instruct parents or caregivers of infants and children on correct dose and administration. Remind them to use only the measuring devise dispensed with the product.
  • Advise patient to report increased irritation of mucous membranes or lack of therapeutic response to health care professional.

Evaluation/Desired Outcomes

  • Decrease in stomatitis.
    • To prevent relapse after oral therapy, therapy should be continued for 48 hr after symptoms have disappeared and cultures are negative.
    • Therapy for a period of 2 wk is usually sufficient, but more prolonged therapy may be necessary.

Nilstat

A brand name for the antifungal drug NYSTATIN.