Drug Guide
Nystatin
Classification
Therapeutic: Antifungal
Pharmacological: Polyene antifungal
FDA Approved Indications
- Superficial candidiasis
- Oral and oesophageal candidiasis
- Cutaneous and mucocutaneous candidiasis
Mechanism of Action
Nystatin binds to ergosterol in fungal cell membranes, creating pores that increase membrane permeability, leading to cell death.
Dosage and Administration
Adult: Dosing varies based on formulation and site of infection; typically, for oral candidiasis, 100,000 to 400,000 units daily in divided doses.
Pediatric: Similar dosing as adults, tailored to weight and age; consult specific formulation instructions.
Geriatric: Dosing adjustments generally not required, but monitor for renal function and adverse effects.
Renal Impairment: Use with caution; adjust dose if necessary and monitor for toxicity.
Hepatic Impairment: No specific adjustment recommended.
Pharmacokinetics
Absorption: Poorly absorbed from gastrointestinal (GI) tract when administered orally.
Distribution: Distributed mainly in the GI tract; minimal systemic absorption when used topically.
Metabolism: Not significantly metabolized; remains largely unabsorbed when taken orally.
Excretion: Excreted in feces.
Half Life: Not applicable due to minimal systemic absorption.
Contraindications
- Hypersensitivity to nystatin or other polyene antifungals
Precautions
- Use with caution in patients with mucosal or cutaneous damage; monitor for hypersensitivity reactions.
Adverse Reactions - Common
- Gastrointestinal upset (nausea, vomiting, diarrhea) (Common)
- Skin irritation at application site (Common)
Adverse Reactions - Serious
- Hypersensitivity reactions including rash, itching, swelling, dizziness (Rare)
Drug-Drug Interactions
- None well-documented; usually topical and minimal systemic absorption limits interactions.
Drug-Food Interactions
- None significant.
Drug-Herb Interactions
- Limited data; caution with herbal products that may alter absorption or efficacy.
Nursing Implications
Assessment: Assess for signs of fungal infection; monitor for adverse reactions.
Diagnoses:
- Impaired skin integrity
- Ineffective tissue perfusion related to infection.
Implementation: Administer as prescribed; topical or oral, with attention to site and formulation.
Evaluation: Monitor resolution of infection and side effects.
Patient/Family Teaching
- Complete prescribed course.
- Report any allergic reactions or side effects.
- Maintain good hygiene to assist in infection control.
Special Considerations
Black Box Warnings:
- No black box warnings for nystatin.
Genetic Factors: None established.
Lab Test Interference: None significant.
Overdose Management
Signs/Symptoms: Gastrointestinal disturbances, nausea, vomiting.
Treatment: Supportive care; no specific antidote due to low systemic absorption.
Storage and Handling
Storage: Store at room temperature, protected from moisture.
Stability: Stable under recommended conditions.