Nystatyna Teva (Nystatin)

Nystatin is used orally to treat Candida infections of the gastrointestinal and upper digestive tract.

• Oral thrush (oropharyngeal candidiasis): reduces fungal load and relieves symptoms such as soreness and white plaques.
• Gastrointestinal candidiasis: eradicates Candida overgrowth in the stomach and intestines, improving digestion and preventing systemic spread.
• Prophylaxis in immunocompromised patients: prevents colonisation of Candida in the gut during chemotherapy or transplant therapy.
• Prevention of Candida infection in neonates: limits fungal colonisation in premature infants receiving parenteral nutrition.

• Nystatin binds selectively to ergosterol, a sterol component of fungal cell membranes. This interaction creates pores that increase membrane permeability, causing leakage of intracellular electrolytes and macromolecules. The resulting loss of cellular integrity leads to fungal cell death, while human cells lacking ergosterol are largely unaffected. The drug remains largely confined to the gastrointestinal lumen, providing high local concentrations with minimal systemic absorption.

Oral nystatin is generally well tolerated, but some patients may experience adverse reactions.

Common Side Effects

• Nausea: mild stomach upset that usually resolves without treatment.
• Vomiting: occasional episodes, especially with higher volumes.
• Diarrhea: loose stools that are typically transient.
• Abdominal cramps: mild discomfort in the stomach area.
• Taste alteration: temporary metallic or bitter taste.

Serious or Rare Side Effects

• Allergic reaction: rash, itching, swelling, or difficulty breathing.
• Hepatotoxicity: abnormal liver enzymes in rare cases.
• Severe gastrointestinal irritation: persistent vomiting or bloody stools.
• Anaphylaxis: life‑threatening hypersensitivity requiring immediate medical care.

Before prescribing oral nystatin, clinicians should consider several safety and handling precautions.

• Assess renal function: adjust use in patients with severe renal impairment.
• Monitor for hypersensitivity: discontinue if rash, itching or swelling occurs.
• Use with caution in infants: dosage must be appropriate for neonatal weight.
• Avoid concomitant use with broad‑spectrum antibiotics without monitoring, as they may alter gut flora.
• Pregnancy and lactation: safety data are limited; weigh potential benefits against risks.
• Store at ambient temperature: keep below 25 °C, in the original container, protected from moisture and direct sunlight.

Nystatin may interact with other medicines, influencing its efficacy or safety.

Major Interactions (Avoid)

• Antifungal azoles (e.g., fluconazole): concurrent use can reduce nystatin’s local activity and increase risk of resistance.
• Systemic antibiotics with broad spectrum: may disrupt normal flora and promote overgrowth, diminishing therapeutic effect.

Moderate Interactions (Monitor Closely)

• Antacids containing aluminum or magnesium: may bind nystatin and lower its gastrointestinal availability.
• Probiotic supplements: could alter gut microbiota, requiring observation of clinical response.
• Immunosuppressants (e.g., cyclosporine): monitor for increased fungal burden despite prophylaxis.