Drug Guide
Nystatin and Triamcinolone Acetonide
Classification
Therapeutic: Topical antifungal and corticosteroid combination
Pharmacological: Antifungal (Nystatin), Corticosteroid (Triamcinolone Acetonide)
FDA Approved Indications
- Treatment of Cutaneous Candidiasis with inflammation
- Adjunctive treatment of inflammatory dermatoses prone to fungal superinfection
Mechanism of Action
Nystatin binds to ergosterol in fungal cell membranes, creating pores that cause cell contents to leak, leading to fungal cell death. Triamcinolone acetonide suppresses inflammation, reducing swelling, redness, and itching by inhibiting multiple inflammatory cytokines.
Dosage and Administration
Adult: Apply a thin layer to affected area 2-4 times daily as advised by healthcare provider.
Pediatric: As directed by a healthcare provider, usually similar to adult dosing but with careful monitoring.
Geriatric: Use with caution; consider reduced frequency and dose due to increased skin fragility.
Renal Impairment: No dose adjustment needed for topical use.
Hepatic Impairment: No specific adjustment for topical use.
Pharmacokinetics
Absorption: Minimal systemic absorption from topical application.
Distribution: Primarily localized at the application site.
Metabolism: Nystatin is not significantly metabolized; Triamcinolone undergoes hepatic metabolism.
Excretion: Elimination via feces and urine depending on systemic absorption.
Half Life: Nystatin: primarily local action, not applicable; Triamcinolone: approximately 2 hours systemically.
Contraindications
- Hypersensitivity to any component.
- Viral, bacterial, or fungal infections not susceptible to the antifungal.
- Untreated cutaneous infections.
Precautions
- Use cautiously in broken or raw skin; avoid extensive or occlusive dressings; monitor for signs of secondary infection.
Adverse Reactions - Common
- Skin irritation or burning sensation (Common)
- Itching (Common)
Adverse Reactions - Serious
- Allergic contact dermatitis (Rare)
- Secondary bacterial or fungal infections at application site (Rare)
Drug-Drug Interactions
- None specifically identified for topical use; systemic interactions are unlikely.
Drug-Food Interactions
- None
Drug-Herb Interactions
- None
Nursing Implications
Assessment: Assess skin condition and signs of infection or hypersensitivity before application.
Diagnoses:
- Impaired skin integrity related to topical application.
Implementation: Apply as prescribed, clean affected area before application, avoid contact with eyes.
Evaluation: Monitor skin response; assess for adverse reactions or signs of systemic absorption.
Patient/Family Teaching
- Use as directed; do not cover the area with occlusive dressings unless instructed.
- Wash hands before and after applying medication.
- Report any signs of allergic reaction or worsening skin condition.
Special Considerations
Black Box Warnings:
- None
Genetic Factors: None specific.
Lab Test Interference: None expected from topical use.
Overdose Management
Signs/Symptoms: Excessive absorption may lead to systemic corticosteroid effects such as adrenal suppression, hyperglycemia, or Cushingoid appearance.
Treatment: Discontinue use; manage symptoms supportively; consider systemic corticosteroid if needed.
Storage and Handling
Storage: Store at room temperature away from moisture and heat.
Stability: Stable for up to the expiration date when stored properly.