Anti-fungal

All six species of Candida have significantly less buccal epithelial cell adhesion when using nystatin[1].
The antibiotic nystatin makes plasma membranes more permeable to chloridion and other small monovalent ions. Nystatin increases apical permeability of chloridion to the extent that transport across the basolateral membrane of tracheal epithelial cells limits transepithelial chloridion transport, mainly due to cotransporter activity. Nystatin (400 units/mL) abolishes UTP stimulation of transepithelial 36Cl flux and raises its basal level by about 1.5 times. Nystatin treatment also abolishes UTP stimulation of saturable, basolateral [3H]bumetanide binding, a measure of functioning Na-K-Cl cotransporters in these cells; isoproterenol stimulation of binding is only mildly inhibited by nystatin treatment[2].
By primarily promoting the clathrin-mediated pathway for endostatin internalization, nystatin dramatically increases the uptake of endostatin by endothelial cells. Nystatin-induced increased absorption of? Additionally, endostatin intensifies its inhibitory actions on the migration and formation of endothelial cell tubes[3].

Endostatin's antiangiogenic and antitumor efficacies in vivo are eventually increased when nystatin and endostatin are combined because they specifically increase endostatin uptake and biodistribution in tumor blood vessels and tumor tissues but not in the normal tissues of tumor-bearing mice[3].When compared to the no-treatment, saline, or empty-liposome groups, liposomal Nystatin, at doses as low as 2 mg/kg of body weight/day, protects neutropenic mice against Aspergillus-induced death in a statistically significant way at the 50-day time point[4].

Absorption, Distribution and Excretion
Systemic absorption of nystatin is minimal following oral administration, and no detectable plasma concentrations are attained following topical or vaginal administration.
The majority of orally administered nystatin is eliminated unchanged in the feces.
Nystatin is not absorbed into the systemic circulation and thus does not undergo distribution.
Nystatin penetrates eye poorly.
Nystatin is poorly absorbed from the GI tract, and detectable blood concentrations are not obtained after usual doses. Following oral administration, nystatin is excreted almost entirely in feces as unchanged drug.
In healthy individuals, mean salivary nystatin concentrations in excess of those required in vitro for growth inhibition of clinically important Candida persist for approximately 2 hours after the beginning of oral dissolution of two nystatin lozenges (400,000 units) administered simultaneously.
Not absorbed following topical application to intact skin or mucous membranes.
For more Absorption, Distribution and Excretion (Complete) data for NYSTATIN (6 total), please visit the HSDB record page.

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Metabolism / Metabolites
Because nystatin undergoes little-to-no systemic absorption it is not metabolized to any appreciable extent.

Hepatotoxicity
Nystatin therapy has been associated with a low rate of serum enzyme abnormalities, although it has been difficult to attribute these elevations to nystatin. Despite its use for several decades, there have been no convincing cases of acute hepatic injury linked to nystatin therapy. While nystatin is usually is not normally absorbed, low concentrations may enter the circulation in patients with inflammation and damage to the gastrointestinal tract. Nevertheless, nystatin is considered very safe and is unlikely to cause hepatic injury.
Likelihood score: E (unlikely cause of clinically apparent liver injury).

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Effects During Pregnancy and Lactation
◉ Summary of Use during Lactation
Although no information exists on the milk excretion of nystatin, it is virtually unabsorbed orally, therefore most reviewers and clinicians consider it acceptable for use in nursing mothers, including topical application to the nipples. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any excess cream should be removed from the nipples before nursing. Nystatin is less effective than other topical agents for the treatment of thrush.
◉ Effects in Breastfed Infants
Relevant published information was not found as of the revision date.
◉ Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.

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Protein Binding
Nystatin is not absorbed into the systemic circulation and is therefore not subject to plasma protein binding.

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Non-Human Toxicity Values
LD50 Mouse ip 200 mg/kg

[1]. Adhesion of oral Candida species to human buccal epithelial cells following brief exposure to nystatin. Oral Microbiol Immunol. 1999 Dec;14(6):358-63.

[2]. Na-K-Cl cotransport in nystatin-treated tracheal cells: regulation by isoproterenol, apical UTP, and [Cl]i. Am J Physiol. 1994 May;266(5 Pt 1):C1440-52.

[3]. Cholesterol sequestration by nystatin enhances the uptake and activity of endostatin in endothelium via regulating distinct endocytic pathways. Blood. 2011 Jun 9;117(23):6392-403.

[4]. Activity of liposomal nystatin against disseminated Aspergillus fumigatus infection in neutropenic mice. Antimicrob Agents Chemother. 1997 Oct;41(10):2238-43.

[5]. Oxaliplatin enhances TRAIL-induced apoptosis in gastric cancer cells by CBL-regulated death receptor redistribution in lipid rafts.FEBS Lett. 2009 Mar 4;583(5):943-8.

Therapeutic Uses
Antibiotics, Antifungal; Antibiotics, Macrolide; Ionophores
MEDICATION (VET):Antifungal; growth promotant
MEDICATION (VET): /Used in treatment of/ intestinal mycosis due to Candida albicans in poultry; occasionally orally in cats and dogs in suspected Candida intestinal overgrowth following antibiotic therapy, and also topically ... as cream or ointment on skin lesions ...
Nystatin vaginal tablets are used as lozenges to treat oropharyngeal candidiasis since their slow dissolution rate provides prolonged oral contact. /NOT included in US product labeling/
For more Therapeutic Uses (Complete) data for NYSTATIN (9 total), please visit the HSDB record page.

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Drug Warnings
Since it is not known whether nystatin is distributed into human milk, the drug should be used with caution in nursing women.
Adverse effects occur infrequently with oral nystatin therapy. Mild and transitory nausea, vomiting, GI distress, and diarrhea have occurred; high oral doses (e.g., greater than 5 million units daily) are most likely to produce these adverse GI effects. Hypersensitivity reactions have been reported very rarely.
Patients should be instructed to contact their physician if symptoms of irritation or sensitization occur during nystatin therapy. Patients should be warned against interrupting or discontinuing vaginal nystatin therapy during a prescribed regimen, even during menstruation or if symptomatic relief occurs after only a few days of therapy, unless otherwise instructed by their physician. Patients should be advised that adjunctive measures such as therapeutic douches are not necessary and may be inadvisable during vaginal nystatin therapy; however, cleansing douches may be used in nonpregnant women, if desired, for aesthetic effect.
Adverse reactions to topically applied nystatin are very infrequent, even during prolonged use. Irritation has occurred rarely. Hypersensitivity reactions to nystatin have been reported only rarely; however, preservatives (eg, ethylenediamine, parabens, thimerosal) in some of the formulations are associated with a high incidence of contact dermatitis. An acneiform eruption has occurred rarely following topical application of nystatin and triamcinolone acetonide.
For more Drug Warnings (Complete) data for NYSTATIN (9 total), please visit the HSDB record page.

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Pharmacodynamics
Nystatin is an antifungal that is both fungistatic and fungicidal in vitro against a wide variety of yeasts and yeast-like fungi. It exerts its antifungal effects via disruption of the fungal cell membrane. Resistance to nystatin is minimal in _Candida albicans_, but tends to develop in other species of _Candida_. Nystatin carries no significant activity against bacteria, protozoa, or viruses. It carries significant systemic toxicity and is currently unavailable in a formula appropriate for systemic use - its efficacy is currently restricted, therefore, to topical, oral, and gastrointestinal infections.

C47H75NO17

926.110

276.208

C, 60.96; H, 8.16; N, 1.51; O, 29.37

1400-61-9

11286230

Light yellow to khaki solid powder

0.9±0.1 g/cm3

400.2±14.0 °C at 760 mmHg

>155°C (dec.)

297.0±15.2 °C

0.0±2.0 mmHg at 25°C

1.504

6.14

12

18

3

65

1620

19

O1C2([H])C([H])([H])C([H])(C([H])=C([H])C([H])=C([H])C([H])=C([H])C([H])=C([H])C([H])([H])C([H])([H])C([H])=C([H])C([H])=C([H])[C@@]([H])(C([H])([H])[H])[C@@]([H])([C@]([H])(C([H])([H])[H])[C@@]([H])(C([H])([H])[H])OC(C([H])([H])C([H])(C([H])([H])C([H])(C([H])([H])C([H])(C([H])([H])C([H])([H])C([H])(C([H])(C([H])([H])[C@]1(C([H])([H])C([H])(C2([H])C(=O)O[H])O[H])O[H])O[H])O[H])O[H])O[H])O[H])=O)O[H])O[C@@]1([H])[C@@]([H])([C@@]([H])([C@]([H])([C@]([H])(C([H])([H])[H])O1)O[H])N([H])[H])O[H] |c:9,13,17,21,31,35|

VQOXZBDYSJBXMA-JKMCSYCMSA-N

InChI=1S/C47H75NO17/c1-27-17-15-13-11-9-7-5-6-8-10-12-14-16-18-34(64-46-44(58)41(48)43(57)30(4)63-46)24-38-40(45(59)60)37(54)26-47(61,65-38)25-36(53)35(52)20-19-31(49)21-32(50)22-33(51)23-39(55)62-29(3)28(2)42(27)56/h5-6,8,10-18,27-38,40-44,46,49-54,56-58,61H,7,9,19-26,48H2,1-4H3,(H,59,60)/b6-5-,10-8+,13-11+,14-12+,17-15+,18-16+/t27-,28-,29-,30+,31+,32+,33-,34+,35+,36-,37-,38-,40-,41-,42+,43+,44-,46+,47+/m0/s1

(1S,3S,4R,7R,9R,11S,15S,16R,17R,18S,19E,21E,25Z,27E,29E,31E,33S,35S,36S,37S)-33-(((2S,3S,4S,5S,6R)-4-amino-3,5-dihydroxy-6-methyltetrahydro-2H-pyran-2-yl)oxy)-1,3,4,7,9,11,17,37-octahydroxy-15,16,18-trimethyl-13-oxo-14,39-dioxabicyclo[33.3.1]nonatriaconta-19,21,25,27,29,31-hexaene-36-carboxylic acid

Nystatin; Mycostatin. AI3-26526; Barstatin 100; Biofanal; Candex; Candex Lotion; Candio-hermal; Diastatin; Fungicidin; Herniocid; HSDB 3138; Korostatin; Moronal; Myconystatin; Mycostatin; Nilstat; Nistatin; Nistatina; NSC 150817; Nyamyc; Nyotran; Nysert; Nystan; Nystatin; Nystatine; Nystavescent; Nystex; Nystop; O-V Statin; Stamycin; Zydin E

2934.99.9001

Powder      -20°C    3 years

                     4°C     2 years

In solvent   -80°C    6 months

                  -20°C    1 month

Note: (1). Please store this product in a sealed and protected environment (e.g. under nitrogen), avoid exposure to moisture and light.  (2). This product is not stable in solution, please use freshly prepared working solution for optimal results.

Room temperature (This product is stable at ambient temperature for a few days during ordinary shipping and time spent in Customs)

DMSO : ~50 mg/mL (~53.99 mM)

Solubility in Formulation 1: 2.5 mg/mL (2.70 mM) (saturation unknown) in 10% DMSO + 40% PEG300 + 5% Tween80 + 45% Saline (add these co-solvents sequentially from left to right, and one by one), suspension solution; with sonication.
For example, if 1 mL of working solution is to be prepared, you can add 100 μL of 25.0 mg/mL clear DMSO stock solution to 400 μL PEG300 and mix evenly; then add 50 μL Tween-80 to the above solution and mix evenly; then add 450 μL normal saline to adjust the volume to 1 mL.
Preparation of saline: Dissolve 0.9 g of sodium chloride in 100 mL ddH₂ O to obtain a clear solution.

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Solubility in Formulation 2: ≥ 2.5 mg/mL (2.70 mM) (saturation unknown) in 10% DMSO + 90% (20% SBE-β-CD in Saline) (add these co-solvents sequentially from left to right, and one by one), clear solution.
For example, if 1 mL of working solution is to be prepared, you can add 100 μL of 25.0 mg/mL clear DMSO stock solution to 900 μL of 20% SBE-β-CD physiological saline solution and mix evenly.
Preparation of 20% SBE-β-CD in Saline (4°C，1 week): Dissolve 2 g SBE-β-CD in 10 mL saline to obtain a clear solution.

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Solubility in Formulation 3: ≥ 2.5 mg/mL (2.70 mM) (saturation unknown) in 5% DMSO + 95% (20% SBE-β-CD in Saline) (add these co-solvents sequentially from left to right, and one by one), clear solution.
Preparation of 20% SBE-β-CD in Saline (4°C，1 week): Dissolve 2 g SBE-β-CD in 10 mL saline to obtain a clear solution.

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 (Please use freshly prepared in vivo formulations for optimal results.)