Nystatin Orifarm (Nystatin)

Nystatin is used to treat fungal infections caused by Candida species affecting various mucosal and cutaneous sites.

• Oral thrush (candidiasis): reduces fungal load and relieves symptoms in the mouth and throat.
• Esophageal candidiasis: eradicates Candida overgrowth in the esophagus, improving swallowing and pain.
• Intestinal candidiasis: clears Candida from the gastrointestinal tract, helping prevent diarrhea and abdominal discomfort.

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

Nystatin may cause a range of adverse reactions, most of which are mild and reversible.

Common Side Effects

• Nausea: mild to moderate upset stomach.
• Vomiting: occasional episodes after oral administration.
• Diarrhea: loose stools during treatment.
• Abdominal pain: cramping or discomfort.
• Taste alteration: temporary change in taste perception.
• Mild oral irritation: transient burning or soreness.

Serious or Rare Side Effects

• Severe allergic reaction: rash, itching, swelling, or difficulty breathing.
• Hepatotoxicity: abnormal liver function tests in rare cases.
• Neutropenia: low white‑blood‑cell count, increasing infection risk.
• Stevens‑Johnson syndrome: rare severe skin reaction.
• Anaphylaxis: life‑threatening hypersensitivity.
• Persistent gastrointestinal ulceration: very uncommon prolonged use.

Before prescribing Nystatin, clinicians should consider several safety measures.

• Assess hypersensitivity: avoid use in patients with known allergy to polyene antifungals.
• Monitor renal function: adjust therapy if severe renal impairment is present.
• Evaluate hepatic status: caution in patients with liver disease, although systemic absorption is minimal.
• Use in immunocompromised patients: monitor closely for breakthrough infections.
• Concomitant antibiotics: be aware of potential overgrowth of resistant organisms.
• Store below 25°C: keep in the original container, protect from moisture and direct sunlight.

Nystatin has limited systemic absorption, but certain drug combinations may require attention.

Major Interactions (Avoid)

• Systemic azole antifungals (e.g., fluconazole): increased risk of hepatotoxicity when used together.
• Nephrotoxic agents (e.g., amphotericin B): additive renal toxicity in rare cases.

Moderate Interactions (Monitor Closely)

• Antacids containing aluminum or magnesium: may reduce oral suspension absorption.
• Broad‑spectrum antibiotics: can alter normal flora, potentially affecting fungal colonisation.
• Immunosuppressants (e.g., cyclosporine): heightened risk of opportunistic infections.
• Probiotic supplements: may interfere with intended antifungal activity.
• Oral corticosteroids: increased susceptibility to oral candidiasis, requiring careful monitoring.