What is Nystan?
Nystan (nystatin) is a polyene antifungal antibiotic derived from Streptomyces noursei, a soil bacterium. It is one of the oldest antifungal medicines in clinical use, having been in therapeutic use since the 1950s, and remains relevant today as an effective treatment for localised Candida infections.
Nystatin is listed on the WHO Model List of Essential Medicines. Its key characteristic is that it is essentially non-absorbable — when taken orally or applied topically, it acts exclusively at the site of application with negligible systemic absorption. This makes it particularly valuable in situations where systemic antifungal exposure should be minimised.
How does Nystan work?
Nystatin belongs to the polyene class of antifungals and works through a different mechanism to azole antifungals (such as fluconazole or clotrimazole):
- Direct membrane binding: Nystatin binds directly and irreversibly to ergosterol, the principal sterol component of the fungal cell membrane. This binding does not require activation by fungal enzymes.
- Membrane pore formation: The binding of multiple nystatin molecules to ergosterol creates channels (pores) in the fungal cell membrane.
- Loss of membrane integrity: These pores allow essential intracellular electrolytes and molecules (potassium ions, small proteins) to leak out of the fungal cell.
- Fungal cell death: The resulting disruption of osmotic balance and loss of vital cellular contents leads to fungal cell death (fungicidal effect).
Because human cells contain cholesterol rather than ergosterol as their primary membrane sterol, nystatin has very low affinity for human cell membranes, explaining its selectivity against fungi.
Why nystatin is not significantly absorbed systemically: Nystatin’s large molecular structure and polyene chemical properties prevent it from crossing mucosal barriers or intact skin in clinically meaningful amounts. This is both its limitation (it cannot treat systemic fungal infections) and its advantage (minimal systemic side effects and drug interactions).
Who is Nystan for?
Nystatin is indicated for localised Candida infections in adults and children:
- Oral candidiasis (oral thrush): Oral suspension — swish and swallow technique, four times daily
- Vaginal candidiasis: Vaginal pessaries — typically 14-night course; suitable option in pregnancy
- Skin candidiasis: Topical cream or powder for candidal intertrigo, nappy rash, candidal paronychia
- Gastrointestinal candidiasis: Oral tablets or suspension to treat candidal overgrowth in the gut (in immunocompromised patients or following prolonged antibiotic courses)
Nystatin is not appropriate for:
- Systemic (bloodstream) candida infections — requires systemic antifungal agents under specialist care
- Dermatophyte infections such as athlete’s foot or ringworm (nystatin is not effective against dermatophytes)
- Infections caused by organisms other than Candida
Posologia
| Formulation / Indication | Dose | Duration |
|---|---|---|
| Oral suspension (oral thrush) | 100,000 units (1 mL) four times daily | 7–14 days |
| Vaginal pessaries | 100,000 units (1 pessary) per night | 14 nights |
| Topical cream (skin candida) | Apply 2–4 times daily | Until resolved (often 2–4 weeks) |
| Oral tablets (GI candida) | 500,000 units (1 tablet) four times daily | As directed by doctor |
Oral suspension administration: The suspension should be shaken well before use. Place the dose in the mouth, swish it around all oral surfaces (teeth, gums, inside cheeks, tongue) for as long as possible, then swallow. Continue for 48 hours after symptoms resolve.
Vaginal pessaries: Insert high into the vagina at bedtime using the applicator provided.
Effetti collaterali
Nystatin is very well tolerated due to its minimal systemic absorption.
Oral suspension / tablets
- Nausea (uncommon)
- Vomiting (uncommon)
- Diarrhoea (uncommon at standard doses)
- Oral irritation or burning sensation (mild)
Vaginal pessaries
- Mild vaginal burning or irritation
- Increased vaginal discharge (mild)
Topical cream
- Local skin irritation, burning, or itching at the application site
- Rash (rare)
Systemic side effects
Systemic side effects are extremely rare at standard doses due to negligible absorption. At very high oral doses, gastrointestinal disturbance and hypersensitivity reactions have been reported rarely.
Nystan vs alternative antifungal treatments
| Treatment | Active Ingredient | Mechanism | Absorbed Systemically? | Key Use |
|---|---|---|---|---|
| Nystan | Nystatin | Ergosterol binding (polyene) | No | Localised Candida |
| Canesten Gyno | Clotrimazole | Ergosterol synthesis inhibition (azole) | Minimally | Vaginal/skin Candida |
| Diflucan | Fluconazole | Ergosterol synthesis inhibition (azole) | Yes (oral) | Vaginal/systemic Candida |
| Terbinafine | Terbinafine | Ergosterol synthesis inhibition (allylamine) | Yes (oral) | Dermatophytes (nail/skin) |
Nystan vs Canesten Gyno / Diflucan for vaginal thrush: Azole treatments (clotrimazole, fluconazole) are generally preferred for vaginal candidiasis due to shorter treatment courses and high efficacy. Nystatin’s 14-night course is less convenient but remains a valid option when azoles are not appropriate — for example, in documented azole allergy or when minimal systemic exposure is a priority.
Nystatin’s niche: Its non-absorbable nature makes it the preferred antifungal for treating localised Candida without any systemic drug exposure — a consideration particularly relevant in pregnancy and in patients on complex drug regimens where systemic azole drug interactions are a concern.
How to access Nystan online in Europe
Nystan is a prescription-only medicine (POM) in most EU member states. Non può essere legalmente dispensato senza una prescrizione valida da parte di un professionista medico autorizzato.
Prescrivia opera come intermediario tecnologico: non prescriviamo farmaci, non impieghiamo medici né vendiamo medicinali. La nostra piattaforma mette in contatto i pazienti con medici indipendenti registrati nell’UE che possono condurre valutazioni sanitarie online riservate.
Il processo:
- Completi una valutazione della salute: Describe your symptoms, relevant history, and any other medications or allergies.
- Revisione medica: Un medico indipendente registrato nell’UE esamina la Sua valutazione. If nystatin is clinically appropriate, they may issue a prescription.
- Dispensazione in farmacia: La prescrizione viene inviata a una farmacia partner autorizzata dell’UE per la dispensazione e la consegna diretta.
Importante: Prescrivia non garantisce che venga emessa una prescrizione. Tutte le decisioni prescrittive vengono prese in modo indipendente da professionisti medici qualificati.
Informazioni importanti sulla sicurezza
Informi il Suo medico prima di using Nystan se Lei:
- Are pregnant or breastfeeding (topical and vaginal nystatin is generally considered safe; a doctor should confirm the appropriate formulation)
- Have any known allergy to nystatin or other antifungal medicines
- Experience symptoms that could indicate an infection other than Candida — diagnosis should be confirmed before starting treatment
- Have had recurrent Candida infections (investigation of underlying causes may be warranted)
Interazioni farmacologiche: Due to negligible systemic absorption, clinically significant drug interactions with nystatin are not expected. This is a notable advantage over systemic azoles, which have multiple drug interactions.
Treatment failure: If symptoms do not improve after completing the recommended course, consult a doctor. The infection may not be caused by Candida, the causative organism may have reduced susceptibility to nystatin, or there may be an underlying condition predisposing to recurrence.
Fonti
Le informazioni mediche presenti in questa pagina si basano sulle seguenti fonti:
- European Medicines Agency (EMA). Nystatin — Summary of Product Characteristics. Disponibile su: ema.europa.eu
- World Health Organization (WHO). WHO Model List of Essential Medicines. 22nd edition, 2021. who.int
- Pappas PG, et al. Clinical Practice Guidelines for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America (IDSA). Clinical Infectious Diseases. 2016.
Questo contenuto viene rivisto periodicamente per riflettere le linee guida cliniche aggiornate. Viene fornito esclusivamente a scopo informativo e non costituisce consulenza medica. Consulti sempre un professionista sanitario qualificato per consigli pertinenti alle Sue circostanze di salute individuali.
Frequently asked questions
- What is Nystan (Nystatin) used for?
- Nystan (nystatin) is an antifungal medicine used to treat Candida infections affecting the mouth and throat (oral thrush), the vagina and vulva (vaginal candidiasis), the skin, and the gastrointestinal tract. It is available in several formulations: oral suspension, tablets, vaginal pessaries, and topical cream, making it versatile across different types of candidal infection.
- Why is Nystatin sometimes preferred over other antifungals?
- Nystatin is not significantly absorbed from the gut, skin, or mucous membranes, which means it acts locally at the site of infection with very low systemic exposure. This makes it a useful option when systemic antifungal exposure is undesirable — for example, in patients with certain drug interactions that would be a concern with oral fluconazole, or in specific situations during pregnancy where local vaginal treatment is preferred.
- How long does a Nystatin course take?
- For vaginal candidiasis, nystatin pessaries are typically used for 14 nights, which is longer than azole treatments such as clotrimazole or fluconazole. For oral thrush, nystatin oral suspension is used four times daily until symptoms resolve, typically for 7–14 days. Skin infections may require several weeks of topical treatment.
- Is Nystatin safe in pregnancy?
- Vaginal nystatin pessaries and topical nystatin cream are considered appropriate options during pregnancy, as systemic absorption is negligible. Oral nystatin suspension is also used during pregnancy for oral thrush. A doctor should always be consulted to confirm the diagnosis and appropriate formulation before starting treatment during pregnancy.
- Can I get Nystan online in Europe?
- Nystan is a prescription-only medicine in most EU member states. È possibile accedere a it through online intermediary platforms that connect you with independent EU-registered doctors for a confidential assessment and, if clinically appropriate, a prescription.
Trattamenti
Prescrivia è solo una piattaforma di intermediazione. Non forniamo servizi medici, non prescriviamo trattamenti e non dispensiamo farmaci. Tutte le decisioni mediche sono prese da medici indipendenti registrati nell'UE. Tutti i farmaci sono dispensati da farmacie autorizzate dell'UE. Questa piattaforma facilita i collegamenti tra pazienti e operatori sanitari.