Nystatin

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Nystatin
Systematic (IUPAC) name
20-(4-amino-3,5-dihydroxy-6-methyl-oxan-2-yl) oxy- 4,22,24,28,29,32,34, 36-octahydroxy-2,3,5-trimethyl-26, 38-dioxo-1- oxacyclooctatriaconta-6,8,12,14,16, 18-hexaene-23-carboxylic acid
Identifiers
CAS number	400-61-9
ATC code	A07 AA02 D01 AA01 G01 AA01
PubChem	14960
DrugBank	APRD01146
Chemical data
Formula	C₄₇H₇₅NO₁₇
Mol. weight	926.09
Pharmacokinetic data
Bioavailability	0% on oral ingestion
Metabolism	?
Half life	?
Excretion	?
Therapeutic considerations
Pregnancy cat.	?
Legal status	?
Routes	topical & oral (but not absorbed)

Nystatin is a polyene antimycotic drug to which Candida spp. are sensitive. Nystatin is not absorbed from intact skin or mucous membranes and is considered a "clean" drug as it has no proven side effects.

1 Uses
2 Method of action
3 Origin
4 Brand names

[edit] Uses

Cutaneous, vaginal, mucosal and esophageal Candida infections can be treated with nystatin. Cryptococcus is also sensitive to nystatin. In the UK its license for treating neonatal oral thrush is restricted to those over the age of one month (miconazole is an appropriate alternative for younger babies).

Nystatin is often used as prophylaxis in patients who are at risk for fungal infections, such as AIDS patients with a low CD4⁺ count and patients receiving chemotherapy.

It is prescribed in units, with doses varying from 100,000 (for oral infections) to 1 million (for intestinal ones). As it is not absorbed from the gut, it is safe for oral use and does not have problems of drug interactions.

[edit] Method of action

Like amphotericin B and natamycin, nystatin binds to ergosterol, the main component of the fungal cell membrane. When present in sufficient concentrations, it forms a pore in the membrane that leads to K⁺ leakage and death of the fungus. As mammals do not have ergosterol-based cell membranes, the drug only affects fungi.

[edit] Origin

Like many other antimycotics and antibiotics, nystatin is of bacterial origin. It was isolated from Streptomyces noursei in 1950 by Elizabeth Lee Hazen and Rachel Fuller Brown, who were doing research for the Division of Laboratories and Research of the New York State Department of Health. The soil sample where they discovered nystatin, was from the garden of Hazen's friends called Nourses, therefore the strain was called noursei. Hazen and Brown named nystatin after the New York State Public Health Department (now known as the Wadsworth Center) in 1954.

[edit] Brand names

Nystan® (oral tablets, topical ointment, and pessaries, Bristol-Myers Squibb)
Infestat®
Nystamont®
Nystop® (topical powder, Paddock)
Nystex®
Mykinac®
Nysert® (vaginal suppositories, Procter & Gamble)
Nystaform® (topical ointment, combined with iodochlorhydroxyquine and hydrocortisone; Bayer)
Nilstat® (vaginal tablet, Lederle)
Korostatin® (vaginal tablets, Holland Rantos)
Mycostatin® (vaginal tablets, topical powder, Bristol-Myers Squibb)
Mycolog-II® (topical ointment, combined with triamcinolone; Apothecon)
Mytrex® (topical ointment, combined with triamcinolone)
Mykacet® (topical ointment, combined with triamcinolone)
Myco-Triacet II® (topical ointment, combined with triamcinolone)

Antifungals (D01 and J02) edit
Antibiotics:	Griseofulvin, Hitachimycin, Natamycin, Nystatin
Topical Azoles:	Clotrimazole, Econazole, Fluconazole, Ketoconazole, Miconazole, Oxiconazole, Sertaconazole, Sulconazole, Tioconazole
Other topicals:	Ciclopirox, Ethylparaben, Flucytosine, Salicylic acid, Selenium sulfide, Terbinafine, Tolnaftate
For systemic use:	Amphotericin B, Anidulafungin, Caspofungin, Griseofulvin, Itraconazole, Terbinafine, Voriconazole
Other:	Posaconazole, Thiabendazole, Tea tree oil