Drug reference

Nystatin

Polyene antifungal (topical/oral non-absorbed) · Antifungal

Also known as Mycostatin, Nystop, Nilstat

START

Oral thrush: 400,000–600,000 U QID, swish & swallow

TYPICAL MAX

~3,000,000 units/day (intestinal)

STOP IF

Hypersensitivity or severe mucocutaneous reaction

WATCH

Clinical response; continue 48 h after symptom resolution

CDSCO approvedSchedule HJan AushadhiATC A07AA02

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1d · symptom relief
PEAK: 2d · clinical effect
t½: 36s · not absorbed
DURATION: 6h · QID contact

EXCRETION

Faecal (oral); essentially unchanged

route + CYP

INTERACTIONS

—

none in our sources

PREGNANCY

Topical/oral non-absorbed — considered safe in pregnancy.

FDA category + note

Available in India

1 branded formulation. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Binds ergosterol in fungal cell membranes, forming pores that cause leakage of intracellular contents; fungicidal against Candida; not absorbed from intact GI tract or skin.

Indications

Oral/oropharyngeal candidiasisIntestinal candidiasisCutaneous/mucocutaneous Candida infectionVulvovaginal candidiasis (topical)

Dosing

Adult: Oral candidiasis: 400,000–600,000 units (4–6 mL suspension) QID, swish and swallow. Intestinal: 500,000–1,000,000 units TID. Topical: apply 2–3 times daily.
Pediatric: Infants: 100,000 units QID; older children 400,000–600,000 units QID.
Renal adjustment: No adjustment (not absorbed).
Hepatic adjustment: No adjustment (not absorbed).
Geriatric: No specific adjustment.
Max dose: Up to ~3,000,000 units/day (intestinal)

Pharmacokinetics

Onset

Symptomatic improvement 24–72 h

Peak effect

Local (luminal/surface) — not systemic

Duration

Local contact duration (QID dosing)

Half-life

Not applicable (non-absorbed)

Bioavailability

Negligible (acts topically/luminally)

Protein binding

Not applicable

Metabolism

Not metabolised systemically

Excretion

Faecal (oral); essentially unchanged

Contraindications

Hypersensitivity to nystatin
Not for systemic mycoses (not absorbed)

Side effects

Common

NauseaVomitingDiarrhoea (high oral doses)Local irritation (topical)Bad taste

Serious

Stevens-Johnson syndrome (very rare)
Hypersensitivity reaction

Pregnancy & lactation

Pregnancy

Topical/oral non-absorbed — considered safe in pregnancy.

Lactation

Not absorbed — compatible with breastfeeding.

Drug interactions

Chlorhexidine Mouthwash

Mild

Database

Possible in-vitro inactivation

Separate oral applications