Nystan (Nystatin) oral suspension

Nystan Oral Suspension is a prescription-only medicine used to treat and prevent a fungal infection in the mouth called oral thrush (the medical name is oral candidiasis). The active ingredient is nystatin, an antifungal medicine that kills the yeast responsible for the infection. The suspension (which simply means a liquid medicine that needs to be shaken before use) can also be used to prevent thrush in newborn babies whose mothers had a vaginal thrush infection at the time of birth, as it helps stop the infection from being passed to the baby. It is available as a ready-mixed liquid and comes in a 30ml bottle with a special dropper to help you measure the correct dose.

Nystatin works by killing the Candida albicans fungus – the yeast that causes oral thrush. You will often see oral thrush as creamy white patches on your tongue, inside your cheeks, on your gums or on the roof of your mouth. Nystatin attacks the cell walls of the fungus, breaking them down so the yeast cannot survive. It works where you need it most – inside your mouth – and is not absorbed into your bloodstream in any significant amount.

Using Nystan correctly makes all the difference. Here is the correct, step-by-step method: 1. Shake the bottle well. The medicine can settle at the bottom, so you must shake it thoroughly before each use. 2. Measure the dose. Use the plastic dropper that comes with the bottle to measure exactly 1ml of the suspension. Do not use a kitchen spoon – it will not be accurate. 3. Drop it into your mouth. Drop the 1ml of liquid directly into your mouth, aiming to cover the affected areas. 4. Keep it in your mouth for as long as possible. The longer the medicine stays in contact with the white patches, the better it will work. You should try to swish it around your mouth gently, holding it against the affected areas before swallowing. 5. Do not swallow it straight away. If you swallow it too quickly, it will not have enough time to work on the fungal infection in your mouth. 6. Repeat four times a day. Space your doses evenly throughout the day – for example, after breakfast, after lunch, after tea and before you go to bed. 7. Take it after meals. Ideally, you should use it just after you have eaten or drunk something. This is because the medicine is more likely to stay in contact with the affected surfaces of your mouth if they have just been wetted with food or drink.

The dosage depends on who is taking the medicine. For adults and older children: The recommended dose is 1ml of suspension dropped into the mouth four times a day (every six hours, or roughly after each main meal and at bedtime). For infants and younger children (over 4 weeks of age): The same dose applies – 1ml four times a day. For newborn babies (under 4 weeks of age): The recommended dose for prevention (for example, if the mother had a vaginal thrush infection at birth) is 1ml once a day dropped into the mouth. For older people: There are no specific dosage recommendations or precautions – the standard adult dose applies. The dose is the same for everyone over the age of 4 weeks, regardless of body weight, because nystatin is not absorbed into the bloodstream.

You should use Nystan four times a day for a full seven days. However, the key rule is that you must continue treatment for at least 48 hours after all symptoms have disappeared. This means that even if your mouth feels better and the white patches have gone, you should still finish the medicine for a couple of extra days to make sure the infection is completely cleared and does not return. Your doctor will normally have given you enough medicine to allow you to do this. If you have been using Nystan for 14 days of continuous treatment and there has been no improvement at all – or if your symptoms get worse – you should stop using the medicine and speak to your doctor. You may need a different type of antifungal treatment.

Nystan is generally very well tolerated, even with prolonged use, and serious side effects are rare. However, as with any medicine, side effects can sometimes occur. Common side effects (affecting fewer than 1 in 10 people): - Diarrhoea - Nausea (feeling sick) or vomiting - Stomach pain or general gastrointestinal upset - Mouth irritation – a mild burning sensation in your mouth These side effects are more likely to occur with very large doses. Oral doses of nystatin in excess of five million units per day have been known to cause nausea and gastrointestinal upset, but this is far above the normal 400,000-unit daily dose (1ml four times a day). Rare side effects (affecting fewer than 1 in 1,000 people): - Skin rash, including hives (urticaria) - Allergic reactions – if you experience swelling of the face, lips, tongue or throat, or difficulty breathing, stop taking the medicine immediately and seek emergency medical help. When to stop and speak to your doctor: - If you develop a severe allergic reaction (swelling of the face or throat, or difficulty breathing). - If you experience severe diarrhoea, vomiting or stomach pain. - If your oral thrush symptoms get worse instead of better. Most people find that any mild stomach upset settles down as their body gets used to the medicine.

There are only a few situations where you should not use this medicine. Do NOT use Nystan if: - You are allergic (hypersensitive) to nystatin or to any of the other ingredients in the suspension. - You have a rare hereditary sugar intolerance. This medicine contains sucrose (sugar). If you have been told by a doctor that you have a rare condition called fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency, you should not take this medicine, because your body may not be able to process the sugar it contains. - You have had a previous allergic reaction to methyl or propyl parahydroxybenzoate. The medicine contains these preservatives (also known as E218 and E216), which can cause allergic reactions in some people. The reactions may be delayed, meaning they can occur several hours or days after taking the medicine. - You are taking it for a fungal infection anywhere other than your mouth, oesophagus or intestines. Nystan should not be used to treat fungal infections of the blood or other parts of the body (systemic mycoses).

Yes, there are a few important points to be aware of, particularly if you have certain medical conditions. Sugar content (sucrose): Nystan contains sucrose. If you have diabetes or are on a sugar-controlled diet, you may want to discuss this with your doctor before using the medicine. The sugar content is relatively low, but it may still be a consideration for you. Alcohol content: Nystan contains a small amount of alcohol (ethanol). A full 30ml bottle contains 228mg of alcohol, which is equivalent to 0.76g per 100ml. The amount in a single 1ml dose is less than you would get from 0.2ml of beer or 0.1ml of wine. This tiny amount will not have any noticeable effect on an adult or child. Paraben preservatives: The medicine contains methyl and propyl parahydroxybenzoate (E218 and E216), which can cause allergic reactions, particularly in people who are sensitive to paraben preservatives. These reactions may be delayed. Not for systemic use: Nystan Oral Suspension is not absorbed into your bloodstream. It works locally in your mouth and digestive tract. It should never be used to treat fungal infections elsewhere in your body (such as in your blood, lungs or internal organs), because it would not reach those areas in sufficient quantities. Do not use nystatin tablets: Nystatin is also available as oral tablets, but these are not used for oral thrush – they are designed to treat fungal infections in the intestines. If your doctor prescribes Nystan Oral Suspension, it will be the liquid form, not the tablet.

Yes, you can. There are no known interactions between nystatin and other medicines. This is one of the great advantages of nystatin – it does not interfere with other drugs you may be taking. However, if you are taking other medicines that are applied directly to your mouth (such as a steroid inhaler for asthma or a mouthwash for other mouth conditions), you should try to space them apart from your nystatin dose. For example, you could use your steroid inhaler first, then wait a few minutes before using the nystatin, or vice versa. This is not because of a dangerous interaction, but simply to allow each medicine to work properly without being washed away by the other. If you have any concerns, speak to your doctor or pharmacist.

Pregnancy Nystatin is not absorbed into your bloodstream in significant amounts when you take it by mouth. Because of this, it is generally considered safe to use during pregnancy. However, animal reproductive studies have not been conducted with nystatin, so it is not known for certain whether it could cause any harm to a developing foetus. The official advice is that nystatin should be used during pregnancy only if the potential benefits outweigh any potential risks. In practice, most doctors consider the risk to be extremely low, and nystatin is often prescribed to pregnant women with oral thrush. Breastfeeding It is not known whether nystatin passes into breast milk, but because so little of the medicine is absorbed from the digestive tract, the amount that could potentially reach your breast milk is extremely low. Nystatin has been used for many years without reported side effects in breastfed babies, and it is not thought to pass into breast milk in any meaningful quantity. You can therefore use Nystan while you are breastfeeding. Practical advice: If you are pregnant, planning to become pregnant or are breastfeeding, it is always wise to speak to your doctor or pharmacist before starting any new medicine. They can confirm that Nystan is right for you.

No. Unlike some other antifungal medicines (such as metronidazole), nystatin does not interact with alcohol. You can drink alcohol as normal while using Nystan – the tiny amount of alcohol already contained in the medicine is negligible and will not affect you.

Store below 25°C. Keep the bottle at room temperature, away from direct sunlight and heat. Keep it out of the sight and reach of children. Do not freeze the medicine. Do not use it after the expiry date shown on the bottle label and carton. The expiry date refers to the last day of that month. Shake the bottle well before each use. If you have any leftover medicine after you have completed your treatment course, do not throw it away in household waste or pour it down the sink. Take it to your local pharmacy, where they will dispose of it safely for you.

You should be aware that the branded Nystan oral suspension has been discontinued by the manufacturer. However, generic nystatin oral suspension (100,000 units/ml) remains available and is routinely prescribed instead. Your doctor will almost certainly prescribe the generic version. The medicine itself is exactly the same – only the name on the bottle is different. If you have a prescription that says "Nystan", your pharmacist may dispense generic nystatin suspension instead. If you are ordering a repeat prescription, you should be aware that your doctor may now prescribe it simply as "Nystatin Oral Suspension".