Nystatin Acis (Nystatin)

Nystatin is an antifungal agent that acts on Candida species affecting mucosal surfaces and skin.

• Oropharyngeal candidiasis: reduces fungal load and relieves symptoms of oral thrush.
• Esophageal candidiasis: helps clear infection and improve swallowing.
• Cutaneous candidiasis: treats skin infections such as diaper rash and intertrigo.
• Gastrointestinal candidiasis: controls fungal overgrowth in the GI tract.
• Prophylaxis in immunocompromised patients: prevents Candida colonisation during chemotherapy or transplant.

• Nystatin binds to ergosterol, a sterol component of fungal cell membranes, forming pores that increase membrane permeability. This leads to leakage of intracellular electrolytes and macromolecules, resulting in fungal cell death without significant systemic absorption.

Nystatin is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Nausea: mild gastrointestinal discomfort.
• Vomiting: occasional episodes after oral administration.
• Diarrhea: loose stools during treatment.
• Abdominal pain: cramping or discomfort.
• Taste alteration: temporary change in taste perception.
• Local irritation: burning or itching at the site of topical application.

Serious or Rare Side Effects

• Severe allergic reaction: rash, itching, swelling, or anaphylaxis.
• Hepatic dysfunction: rare liver enzyme elevations.
• Stevens‑Johnson syndrome: severe skin reaction.
• Toxic epidermal necrolysis: extensive skin detachment.
• Hemolysis: rare in patients with G6PD deficiency.
• Systemic fungal infection: extremely rare due to poor absorption.

Before using Nystatin, consider the following safety measures.

• Confirm diagnosis: ensure infection is caused by Candida species.
• Hypersensitivity: avoid if known allergy to nystatin or formulation excipients.
• Systemic infection: not indicated for invasive candidiasis; use systemic antifungals instead.
• Infants and neonates: monitor closely for tolerance and dosing accuracy.
• Concomitant antibiotics: watch for overgrowth of resistant organisms.
• Store at room temperature: keep in original container, protect from moisture and direct sunlight.

Nystatin may interact with other medications, though systemic absorption is minimal.

Major Interactions (Avoid)

• Systemic azole antifungals (e.g., fluconazole): may increase risk of toxicity when combined.
• Broad‑spectrum antibiotics: can alter gut flora and affect nystatin efficacy.

Moderate Interactions (Monitor Closely)

• Antacids containing aluminum or magnesium: may reduce oral absorption.
• Oral corticosteroids: may increase risk of oral candidiasis recurrence.
• Immunosuppressants: monitor for opportunistic infections.
• Probiotics: assess for potential synergistic effects on gut flora.
• Vitamin supplements (high dose): observe for gastrointestinal upset.