OVERVIEWIntroductionNystatin is a topical and oral antifungal agent with activity against many species of yeast and candida albicans, which is used largely to treat skin and oropharyngeal candidiasis. Nystatin is not absorbed orally and has not been linked to drug induced liver injury. Show BackgroundNystatin (nye stat' in) is a polyene macrolide antibiotic that acts by binding to sterols in the plasma membranes of fungi causing the cells to leak, eventually leading to fungal cell death. Nystatin is indicated for the treatment of candidal infections of the skin, mucous membranes and gastrointestinal tract. It is not absorbed orally and thus not indicated for invasive fungal infections. Nystatin was approved by the FDA in 1971 and is currently widely used in the treatment of superficial candida infections of the skin, mucous membranes and gastrointestinal tract, including oropharyngeal candidiasis. Nystatin is available in multiple forms such as tablets, troches, powder for suspension, creams and ointments and varying concentrations which are usually measured in units. Nystatin is available in generic forms and under brand names such as Mycostatin, Nilstat, Nystat and Nystop. The recommended dose for oropharyngeal candidiasis is 500,000 to 1,000,000 units 3 to 5 times daily as oral suspension or tablets (dissolved in the mouth) for 1 to 2 weeks. Common side effects include metallic taste, dry mouth, anorexia and nausea. HepatotoxicityNystatin therapy has been associated with a low rate of serum enzyme abnormalities, although it has been difficult to attribute these elevations to nystatin. Despite its use for several decades, there have been no convincing cases of acute hepatic injury linked to nystatin therapy. While nystatin is usually is not normally absorbed, low concentrations may enter the circulation in patients with inflammation and damage to the gastrointestinal tract. Nevertheless, nystatin is considered very safe and is unlikely to cause hepatic injury. Likelihood score: E (unlikely cause of clinically apparent liver injury). Mechanism of InjuryThe absence of hepatotoxicity from nystatin is probably largely due to lack of absorption. Drug Class: Antifungal Agents PRODUCT INFORMATIONREPRESENTATIVE TRADE NAMES Nystatin – Generic, Mycostatin®, Nystat® DRUG CLASS Antifungal Agents COMPLETE LABELING Product labeling at DailyMed, National Library of Medicine, NIH CHEMICAL FORMULA AND STRUCTURE
ANNOTATED BIBLIOGRAPHYReferences updated: 30 April 2020
|