Nystatin

Polyene·Infectious Diseases - Antifungals

Treatment and prophylaxis of oral, intestinal, and cutaneous Candida albicans infections

PBSANTIFUNGALNilstat, MycostatinOral drops/suspension (100,0…S4+1

Max Dose

4 Million U/day

Half-life

Not Absorbed

Route

TOPICAL/PO

Systemic Abs.

ZERO

Rapid Summary

Overview

Highly toxic polyene antifungal that is completely un-absorbable by the human gut. Acts as a brilliant, safe topical/luminal agent to kill Candida (Thrush) on contact.

Maximum Dose

Max 4 Million Units/day (e.g., 1 mL (100,000 U) QID for oral drops).

Clinical Focus

Must physically touch the fungus to kill it. Swallowing it like a normal pill does absolutely nothing for mouth ulcers.

Bottom Line

Nystatin is a topical/oral antifungal for mucocutaneous candidiasis with no systemic absorption, but must be held in the mouth as long as possible for oral thrush and has no systemic antifungal activity.

Formulation & Access

Brand Names

Nilstat, Mycostatin

Oral Routes

Oral drops/suspension (100,000 U/mL). Capsules (500,000 U).

Topical

Cream, Ointment (100,000 U/g).

Prescribing & PBS

Pharmacy Medicine (S2/S3) for topical/drops. S4 for capsules.

Indications & Use

Primary

PBSTGA

Treatment and prophylaxis of oral, intestinal, and cutaneous Candida albicans infections.

Clinical Place

First-line for simple oral thrush (e.g., secondary to steroid inhaler use). Replaced by Fluconazole if infection is severe or extends down the esophagus.

Quick reference

Class & Role

Polyene — Highly toxic polyene antifungal that is completely un-absorbable by the human gut.

Route / Formulation

Oral drops/suspension (100,000 U/mL). Capsules (500,000 U). (Nilstat, Mycostatin)

Usual Dose & Max

PO 1 mL (100,000 Units) QID. Swish the liquid around the mouth for as long as possible (minutes) before swallowing. Max 4 Million Units/day (e.g., 1 mL (100,000 U) QID for oral drops).

Key Indication Doses

Oral Candidiasis (Thrush): PO 1 mL (100,000 Units) QID. Swish the liquid around the mouth for as long as possible (minutes) before swallowing. Intestinal Candidiasis: PO 500,000 to 1,000,000 Units (Tablets) TDS to QID. Cutaneous Thrush: Topical Apply cream/ointment to affected skin (e.g., beneath breasts, groin) BD to QID.

Best Uses

Avoid / Cautions

NONE — Extremely safe due to lack of systemic absorption. Pregnancy Category A. Safe for breastfeeding infants (used commonly for neonatal oral thrush).

Key Risks

Gastrointestinal: Mild nausea, vomiting, diarrhea (only at massive oral doses). Systemic: Because it cannot enter the bloodstream, it has zero liver, cardiac, or renal toxicity.

Key Interactions

NONE — No systemic drug interactions.

Monitoring

Ensure patient removes dentures before using oral drops, and cleans dentures thoroughly to prevent re-infection. Instruct them to NOT eat or drink for 30 mins after swishing the drops.

Clinical Pearl

Nystatin only works by contact. If a patient immediately gulps the liquid down, it will completely fail to cure their mouth thrush. It must be held in the mouth and swished over the plaques.

Access

Nilstat, MycostatinOral drops/suspension (100,0…

Brand: Nilstat, Mycostatin
Formulation: Oral drops/suspension (100,000 U/mL)