Candidiasis, oropharyngeal, mild disease (alternative agent): Oral: Suspension (swish and swallow): 400,000 to 600,000 units 4 times daily; swish in the mouth and retain for as long as possible (several minutes) before swallowing. Duration is for 7 to 14 days (HHS [adult OI] 2021; IDSA [Pappas 2016]).
Note: Powder for compounding: 1/8 teaspoon (500,000 units) to equal approximately 1/2 cup of water; give 4 times/day.
Peritoneal dialysis-associated infection (concurrently treated with antibacterials), prevention of secondary fungal infection: Oral: 500,000 units 3 or 4 times daily for the duration of antibacterial therapy; may extend nystatin duration for an additional 3 days after the last dose of an aminoglycoside or an additional 7 days after the last dose of vancomycin (Lo 1996; Wong 2007; Zaruba 1991).
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Nystatin (oral): Pediatric drug information")
Candidiasis, oropharyngeal (mild), treatment: Note: Treat for 7 to 14 days (Bradley 2021; HHS [OI pediatric 2021]; IDSA [Pappas 2016]).
Infants: Oral suspension: Oral: 200,000 units 4 times daily; administer half of dose to each side of mouth (Krol 2007; Red Book [AAP 2021]; manufacturer's labeling).
Children and Adolescents: Oral suspension: Oral: 400,000 to 600,000 units 4 times daily; administer half of dose to each side of mouth; swish and retain in the mouth for as long as possible before swallowing (Bradley 2021; HHS [OI adult 2021]; HHS [OI pediatric 2021]; manufacturer's labeling).
Peritonitis (peritoneal dialysis), prophylaxis for high-risk situations (eg, during antibiotic therapy or percutaneous endoscopic gastrostomy [PEG] placement): Infants, Children, and Adolescents: Oral suspension: Oral: 10,000 units/kg/dose once daily (ISPD [Warady 2012]).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral [preservative free]:
Bio-Statin: 500,000 units [DSC], 1,000,000 units [DSC] [dye free]
Powder, Oral:
Bio-Statin: (1 ea [DSC])
Suspension, Mouth/Throat:
Generic: 100,000 units/mL (5 mL, 60 mL, 473 mL, 480 mL)
Tablet, Oral:
Generic: 500,000 units
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Suspension, Mouth/Throat:
Generic: 100,000 units/mL (5 mL, 24 mL, 48 mL, 100 mL, 500 mL, 1000 mL)
Oral: Suspension: Shake well before using. For treatment of oropharyngeal candidiasis, should be swished about the mouth and retained in the mouth for as long as possible (several minutes) before swallowing.
Oral: Suspension: Shake suspension well before use.
Oropharyngeal candidiasis treatment: Swish suspension about the mouth and retain in the mouth for as long as possible (several minutes) before swallowing. For neonates and infants, paint nystatin suspension into recesses of the mouth. To allow adequate contact time with site of infection, it is recommended to avoid feedings for 5 to 10 minutes following administration or to administer after meals (Red Book [AAP 2021]; manufacturer's labeling).
Treatment of candidiasis in the oral cavity.
Peritoneal dialysis-associated infection (concurrently treated with antibacterials), prevention of secondary fungal infection
Nystatin may be confused with HMG-CoA reductase inhibitors (also known as "statins"; eg, atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin), Nitrostat.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%: Gastrointestinal: Diarrhea, nausea, stomach pain, vomiting
<1%, postmarketing, and/or case reports: Hypersensitivity reaction
Hypersensitivity to nystatin or any component of the formulation
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Saccharomyces boulardii: Antifungal Agents (Systemic, Oral) may diminish the therapeutic effect of Saccharomyces boulardii. Risk X: Avoid combination
Animal reproduction studies have not been conducted. Adverse events in the fetus or newborn have not been reported following maternal use of vaginal nystatin during pregnancy. Absorption following oral use is poor.
Excretion into breast milk is not known; however, absorption following oral use is poor.
Binds to sterols in fungal cell membrane, changing the cell wall permeability allowing for leakage of cellular contents
Onset of action: Symptomatic relief from candidiasis: 24 to 72 hours.
Absorption: Poorly absorbed.
Excretion: Feces (as unchanged drug).
Suspension (Nystatin Mouth/Throat)
100000 units/mL (per mL): $0.16 - $1.01
Tablets (Nystatin Oral)
500000 unit (per each): $1.31 - $1.42
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