Version July 2025
Diaper dermatitis, candidal: Topical: Ointment, cream: Apply to affected area 2 to 4 times daily; most studies have used 4 times daily dosing (Ref).
Mucocutaneous candidal infection:
Manufacturer's labeling:
Cream; ointment: Topical: Apply to affected area twice daily
Powder: Topical: Apply to affected area 2 to 3 times daily
Alternate dosing: Limited data available: Cream, ointment, powder: Topical: Apply to affected area 2 to 4 times daily (Ref).
Diaper dermatitis, candidal: Limited data available: Infants: Ointment, cream: Topical: Apply 2 to 4 times daily to affected area; most studies have used 4 times daily dosing (Ref).
Mucocutaneous candidal infection: Infants, Children, and Adolescents:
Manufacturer's labeling:
Cream/ointment: Topical: Apply to affected area twice daily
Powder: Topical: Apply to affected area 2 to 3 times daily
Alternate dosing: Limited data available: Cream, ointment, powder: Topical: Apply to affected area 2 to 4 times daily (Ref).
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
(For additional information see "Nystatin (topical): Drug information")
Candidiasis, vulvovaginal, caused by Candida glabrata (alternative agent) (off-label use): Note: Reserve use for patients with no other clear cause of symptoms as non-albicans Candida are frequent vaginal colonizers (Ref).
Intravaginal (off-label route): One extemporaneously compounded suppository (100,000 units) once daily (at bedtime) for 14 to 30 days (Ref).
Fungal infection (cutaneous and mucocutaneous): Topical: Note: Cream is usually preferred to ointment for intertriginous areas; very moist lesions are best treated with topical powder.
Cream, ointment: Apply to the affected areas twice daily or as indicated until healing is complete.
Powder: Apply to the affected areas 2 to 3 times daily until healing is complete.
There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption
There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
<1%:
Dermatologic: Eczema
Hypersensitivity: Hypersensitivity reaction
Local: Application-site burning, application-site pain, application-site pruritus, application-site rash
Hypersensitivity to nystatin or any component of the formulation
Concerns related to adverse effects:
• Hypersensitivity: May occur; immediately discontinue if signs of a hypersensitivity reaction occur.
• Irritation: Discontinue if irritation occurs.
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP, 1997; Shehab, 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Cream, External:
Generic: 100,000 units/g (15 g, 30 g)
Ointment, External:
Generic: 100,000 units/g (15 g, 30 g)
Powder, External:
Klayesta: 100,000 units/g (15 g, 30 g, 60 g)
Nyamyc: 100,000 units/g (15 g, 30 g, 60 g)
Nystop: 100,000 units/g (15 g, 30 g, 60 g)
Generic: 100,000 units/g (15 g, 30 g, 60 g)
Yes
Cream (Nystatin External)
100000 units/g (per gram): $1.17
Ointment (Nystatin External)
100000 units/g (per gram): $1.12 - $1.17
Powder (Klayesta External)
100000 units/g (per gram): $1.67
Powder (Nyamyc External)
100000 units/g (per gram): $2.44
Powder (Nystatin External)
100000 units/g (per gram): $1.09 - $1.60
Powder (Nystop External)
100000 units/g (per gram): $1.79
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Intravaginal suppository (100,000 units per suppository):
Nystatin intravaginal suppositories (100,000 units per suppository) may be made using nystatin powder and polyethylene glycol. To make 100 intravaginal suppositories, melt 95 g of polyethylene glycol 1000 and 5 g of polyethylene glycol 3350 to 60°C (140°F) (the quantity of polyethylene glycols used may need to be adjusted depending on mold used). Incorporate nystatin powder 10,000,000 units and mix well. Pour into vaginal suppository mold; allow to cool and trim if necessary. Package in tight, light-resistant containers with a beyond-use date of up to 6 months; label "for vaginal use only," "keep out of reach of children," and "use only as directed."
Allen LV Jr. Nystatin 100,000-units vaginal inserts. IJPC. 2016;20(4):322.
For topical use only.
Cream or ointment: Gently massage formulation into the skin.
Powder: Dust in shoes, in stockings, and on feet for treatment of candidal infection of the feet; also used on very moist lesions
Topical: For topical external use only; not for systemic, oral, intravaginal, or ophthalmic use. Apply liberally to clean/dry skin. For fungal infection of the feet, the powder should be dusted in all footwear (in addition to application to the feet).
Vaginal (off-label route): Administer at bedtime; insert extemporaneously prepared suppository into vagina (Ref).
Cream, ointment: Store at room temperature.
Topical powder: Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Avoid excessive heat (40°C [104°F]).
Treatment of cutaneous and mucocutaneous fungal infections caused by susceptible Candida species (FDA approved in all ages)
Nystatin may be confused with HMG-CoA reductase inhibitors (also known as "statins"; eg, atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin), Nitrostat.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Progesterone: Antifungal Agents (Vaginal) may decrease therapeutic effects of Progesterone. Risk X: Avoid
Animal reproduction studies have not been conducted. Absorption following oral use is poor and nystatin is not absorbed following application to mucous membranes or intact skin.
KOH smears or cultures should be used to confirm diagnosis of cutaneous or mucocutaneous candidiasis.
Binds to sterols in fungal cell membrane, changing the cell wall permeability allowing for leakage of cellular contents
Onset of action: Symptomatic relief from candidiasis: 24 to 72 hours
Absorption: None through mucous membranes or intact skin
