Nystatin

What is Nystatin Oral Suspension?

Nystatin oral suspension is an antifungal medication used to treat oral thrush, a condition caused by the overgrowth of the fungus Candida in the mouth. It may also be used to treat thrush of the throat and gut.

Nystatin belongs to a class of antifungal medicines called polyene antifungals, which work by binding to and breaking down the cell membranes of fungal organisms. It is dropped into the mouth using a pipette, where it targets the fungus locally rather than being absorbed into the bloodstream. The NHS lists it as a standard treatment for oral candidiasis.

Nystatin oral suspension is not intended to treat the symptoms of vaginal thrush. Alternative treatment options are available for treating this condition.

Nystatin oral suspension is a generic medication containing the same active ingredient (nystatin) as Nystan, a widely recognised oral thrush treatment. Nystan is no longer being manufactured.

How Does Nystatin Work?

Nystatin works by weakening fungal cell membranes, allowing cellular contents to leak out and killing the cells to clear the infection. It does this by binding to a compound called ergosterol, which cells need to maintain their cell membranes. This weakens the cell membrane and reduces its structural integrity.

What makes nystatin particularly effective is that it doesn't just slow the fungus down; it kills the fungal cells directly. Furthermore, nystatin specifically targets fungal cells, leaving healthy human cells largely unaffected. This selectivity helps explain why the treatment is generally well tolerated. As the NHS notes, side effects are uncommon, particularly because so little of the medicine is absorbed into the bloodstream when used orally.

How Long Does Nystatin Take to Work?

How long nystatin takes to work depends on the type of infection you have. In general, nystatin oral suspension takes about 2 days to start working. You will usually take it for around 7 days for visible signs of the infection to disappear. Importantly, you must continue taking it for 48 hours after the visible signs of the infection have resolved to prevent it from returning.

Some infections may take longer to treat. If you have been taking nystatin for more than 14 days, contact your prescriber.

How Effective is Nystatin for Oral Thrush?

Nystatin has been a trusted frontline treatment for oral thrush for decades. A 2019 review of available antifungal medications concluded that nystatin was a very effective option for treating oral candidiasis, with most infections eradicated within a few weeks. It also noted that nystatin had fewer side effects than systemic antifungal treatments. As such, many clinical guidelines worldwide recommend nystatin as a first-line treatment for mild disease, with systemic antifungals reserved for non-responding infections or significant immunocompromise.

Another 2021 systematic review examined evidence from a range of studies comparing several available antifungal medications for the treatment of oral thrush. It found that nystatin, as with every other antifungal medication, was better than placebo at curing oral fungal infection. However, it noted that other antifungals, such as miconazole, ketoconazole, and fluconazole, were more effective than nystatin. Importantly, these medications may be associated with an increased risk of side effects and drug interactions. As such, nystatin remains a highly effective and well-tolerated first-line option for treating oral thrush.

Research also suggests that how you use nystatin can affect results. Following dosage advice and completing the full course are consistently associated with higher cure rates. Usually, treatment should continue for at least 48 hours after symptoms disappear to be most effective.

How to Take Nystatin Oral Suspension

Always take Nystatin oral suspension exactly as prescribed. Make sure you use the provided measuring syringe, which is graduated in 0.5ml steps from 0.5ml to 5ml. Spread your doses evenly throughout the day.

If you're taking the medication for a mouth or throat infection, such as oral thrush, try not to swallow the suspension too quickly. The longer it is in contact with the infection site, the better.

On First Use

Before using Nystatin oral suspension for the first time, complete a few steps. These are:

• Remove the adapter from the syringe
• Remove the cap from the bottle
• Insert the adapter into the bottle
• Close the bottle

You will now be ready to take the medication whenever it is time for a dose.

Preparation of the Delivery Device

Before using Nystatin, prepare the delivery device. This is accomplished by:

• Shaking the suspension before each dose
• Removing the cap from the bottle
• Attaching the syringe to the adapter
• Turning the vial/syringe assembly (flip it upside down)
• Filling the syringe with a small amount of medicine. Ensure that you first pull the plunger, then push it upwards to avoid air bubbles.

In the last step of the medication preparation, you pull a small amount of the medication into the syringe before pushing it back into the bottle. This means that when you draw your dose, you avoid pulling air into the syringe that may have entered when you flipped the assembly. The Patient Information Leaflet contains drawings which may help you to understand this process better.

Dose Delivery

Now that the dose is prepared, administer it correctly. Follow these steps:

• Make sure that the plunger is at the bottom of the syringe
• Slowly pull the plunger to extract the required dose
• Once extracted, turn the vial/syringe assembly upside down (flip it again) and remove it by gently turning the syringe
• Introduce the tip of the syringe directly into the mouth
• Immediately administer the entire dose by slowly pressing the plunger
• Swirl the medication around the affected areas for as long as possible (the NHS suggests at least 30 seconds)
• Swallow the medicine. Do not spit Nystatin out.
• Wait 30 minutes after using Nystatin before eating or drinking.

Clean your mouth before using Nystatin oral suspension, so clean your teeth or dentures beforehand. If you have dentures, remove them before taking the treatment.

Repeat this process four times daily – for example, after each meal and before bedtime. Do not miss doses, as consistent use throughout your prescribed course gives the treatment the best chance of clearing the infection completely. If you are unsure about anything, contact your pharmacist or prescriber for guidance.

After Each Use

After administering the dose, do the following:

• Close the bottle with the cap, leaving the adapter in the bottle
• Rinse the syringe with water
• Store the dry syringe in the box

Never separate the dosing syringe from the other parts of the box or package leaflet.

Nystatin Dose Information

The recommended dose for adults is 1 ml of suspension dropped into the mouth four times a day. Take Nystatin after each meal and before bedtime.

A typical course lasts seven days, though your prescriber may adjust this depending on the severity of your infection. Treatment should generally continue for 48 hours after symptoms have cleared, as this helps clear the infection completely and prevent relapse. If symptoms worsen or persist beyond 14 days, seek medical advice.

If You Forget to Take Nystatin

If you forget to take Nystatin oral suspension, use it as soon as you remember, unless it is time for your next scheduled dose. In this case, take your usual dose as normal. Never try to double dose to make up for one you've forgotten. Inconsistent dosing may mean an infection takes longer to clear.

If You Take Too Much Nystatin Oral Suspension

If you take more Nystatin than prescribed, it should not cause any severe effects. This is because the amount of the medication absorbed by the body is very small. That being said, large oral doses of the treatment can occasionally cause:

• Sickness and diarrhoea
• Bloating
• Stomach cramps
• Indigestion

If you are concerned, or if a child has taken more nystatin than they should, seek urgent advice from your doctor.

Nystatin Side Effects

Much like all medicines, Nystatin has the potential to cause side effects, though not everyone will experience them. Adverse reactions are usually quite rare, though nausea has occasionally been reported during therapy. If irritation or sensitisation develops, discontinue treatment.

Other potential Nystatin side effects include:

There are several signs of an allergic reaction or Stevens-Johnson syndrome that you should watch for. These include:

• Hypersensitivity: Swelling of the lips or tongue and swelling of the face
• Stevens-Johnson syndrome: Blistering of the skin, mouth, eyes, and genitals

More information about Nystatin side effects can be found within the Patient Information Leaflet that comes with the medication. If you experience any adverse reactions, report them to your clinician or use the MHRA's Yellow Card scheme, as this can help provide more details about the treatment's safety profile.

Nystatin Interactions and Warnings

Nystatin oral suspension is available to adults aged 18 and over who have been assessed as suitable following an online consultation. It is not recommended for those with a known allergy to nystatin or its ingredients.

Precautions Before Taking Nystatin

To ensure that Nystatin oral suspension is suitable for you to take, there are several things you should speak to your clinician or doctor about before starting treatment. Ensure that you tell them:

• If you have a fungal infection in the lungs or on the skin
• If you have been told that you have an intolerance to some sugars
• About any other medicines you are taking, might take, or have recently taken. This includes over-the-counter treatments or herbal remedies

If you are unsure about whether any of the above applies to you, speak to your clinician or doctor for advice.

Pregnancy, Breastfeeding, and Fertility

If you are pregnant or breastfeeding, think you may be pregnant, or are planning to become pregnant, speak to your doctor before using nystatin. It is unknown if nystatin can affect a foetus or impact fertility. However, absorption of nystatin from the digestive tract is very small.

It is not known if nystatin is excreted in breast milk. Seek advice from your doctor if you are breastfeeding.

How to Get Nystatin Oral Suspension

Nystatin oral suspension is a prescription-only antifungal medication. As such, an appropriately trained prescriber must review your symptoms and medical history to issue a prescription. You can then purchase nystatin oral suspension at a licensed pharmacy, including reputable online pharmacies.

Can You Buy Nystatin over the Counter?

Nystatin is not available over-the-counter. Nystatin is a prescription-only medication. This is to ensure that a clinician has reviewed your symptoms and can monitor your treatment progress. Your prescriber may advise a change in medication if your symptoms do not respond to nystatin.

Is Nystatin Available on the NHS?

Yes. Nystatin is a commonly prescribed antifungal medication by NHS clinicians. It is often a first-line choice for mild oral thrush, alongside other oral suspensions or gels such as miconazole (Daktarin). In England, the standard prescription charge applies to all NHS prescriptions unless you have an exemption.

Can You Buy Nystatin Online?

Yes, you can buy Nystatin oral suspension online from trusted and reputable pharmacies such as Prescription Doctor. With us, there's no need for an appointment, just a brief medical questionnaire for our clinicians to review to ensure the treatment is suitable for your circumstances.

If approved, our General Pharmaceutical Council-registered pharmacy will dispatch your medication in plain packaging for total discretion, directly to your designated UK address. Orders approved before 3pm on a weekday could also arrive the very next day.

Frequently Asked Questions About Nystatin Oral Suspension