Nystatin preparations

Lozenges and troehes are solid preparations designed to dissolve or disintegrate slowly in the mouth their base is usually flavored and sweetened. Examples of eom-pounded troehes include anesthetic (lidocaine), hormonal (testosterone), analgesie (ketamine), and antifungal (nystatin) preparations (Table 2). 

All nystatin preparations are well tolerated by patients. Very occasionally nausea, vomiting and diarrhoea are reported following oral administration and skin irritation following topical application. Commercial development of a parenteral liposomal formulation of nystatin is in progress for the treatment of systemic mycoses and it is anticipated that this will provide similar clinical benefits to those observed with AmBisome. 

Galego and Arroyo [14] described a simultaneous spectrophotometric determination of OTC, hydrocortisone, and nystatin in the pharmaceutical preparations by using ratio spectrum-zero crossing derivate method. The calculation was performed by using multivariate methods such as partial least squares (PLS)-l, PLS-2, and principal component regression (PCR). This method can be used to resolve accurately overlapped absorption spectra of those mixtures. 

The two azoles most commonly used topically are clotrimazole and miconazole several others are available (see Preparations Available). Both are available over-the-counter and are often used for vulvovaginal candidiasis. Oral clotrimazole troches are available for treatment of oral thrush and are a pleasant-tasting alternative to nystatin. In cream form, both agents are useful for dermatophytic infections, including tinea corporis, tinea pedis, and tinea cruris. Absorption is negligible, and adverse effects are rare. 

Nystatin is an ingredient of many proprietary preparations— see Martindale, The Extra Pharmacopoeia, 28th Edn. 

Aluminum tubes are often used as the immediate package for dermal preparations. One important point to remember is that after the application of creams, ointments, or gels to the skin, all of the photo protection provided by the packaging is lost and photodegradation can occur. Topically applied drug substances with proven photoinstability, e.g., corticosteroids (36), retinoic acid (37), dithranol (38), and anti-mycotics (natamycine and nystatine) (39) fall into this category. 

Kalinkova, G. Krasteva, S. IR-Spectroscopic investigation of interactions in the drug preparation nystatin-plaque. In Recent Developments in Molecular Spectroscopy, Jordanov, B., Kirov, N., Simova, P., Eds. World Scientific Singapore, 1989 705-709. 

A recent example involves the synthesis of N-glycosyl derivatives of polyene macrolide antibiotics, such as the preparation of N-(deoxyfructosyl)nystatin (128) by reaction of nystatin with (+)-glucose (Scheme 30)."°... 

Nystatin (Mycostatin, Nilstat, others) is useful only for candidiasis and is supplied in preparations intended for... 

An oral suspension that contains 100,000 units/ml of nystatin is given fom times a day. Premature and low-birth-weight neonates should receive 1 mL of this preparation, infants 2 mL, and children or adults 4 to 6 mL per dose. Older children and adults should be instructed to swish the drug around the mouth and then swallow. If not otherwise instructed, the patient may expectorate the bitter liquid and fail to treat the infected mucosa in the posterior pharynx or esophagus. Nystatin suspension is usually effective for oral candidiasis of the immunocompetent host. Other than the bitter taste and occasional complaints of nausea, adverse effects are uncommou. A 200,000-unit troche (mycostatin pastilles) is available for the treatment of oral candidiasis, and a 500,000-unit oral tablet is sold for the treatment of nonesophageal membrane G1 candidiasis. 

Nystatin (mycostatin, nilstat, others) is used only for candidiasis and is supplied in preparations intended for cutaneous, vaginal, or oral administration for this purpose. Infections of the nails and hyperkeratinized or crusted skin lesions do not respond. Topical preparations include ointments, creams, and powders, each containing 100,000 units per gram. Powders are preferred for moist lesions and are applied two or three times a day. Imadazoles or triazoles are more effective agents than nystatin for vaginal candidiasis. 

Neomycin is used to alter the intestinal flora in preparation of the bowel for surgery and in hepatic coma. In patients with allergic contact dermatitis to neomycin it may cause a flare of the skin lesions (Pirila and Rantanen 1960 Ekelund and Moller 1969). Nystatin is effective in eliminating moniliasis. Side effects are rare. A case of fixed drug eruption has been reported (Kandil 1969). 

The soluble complexes of heptaenes commercially available are formulated with detergent-like substances, e.g. sodium desoxycholate or sodium lauryl sulphate, and do not form true solutions but consist of colloidal dispersions in an aqueous medium. The in vitro solubility of drugs with low aqueous solubility may be enhanced by coprecipitation with poly(vinyl pyrrolidone) (PVP) [376, 377]. The preparation of nystatin—PVP complexes has been described [378-380]. The solubility of PVP coprecipitates was eight to ten times greater than the parent compound [381] but the coprecipitates showed decreased antibiotic stability. 

Uses stabilizer in steroid creams and rubber latex inhibitor in antifreeze solutions and cooling fluids in floor-polish remover in nystatin cream and aminophylline epoxy-curing agent accelerator in color development baths in photography in veterinary preparations in electroplating and electrophoretic gels, dyes, fungicides, insecticides, synthetic waxes, textile lubricants, and eye and nose drops solvent for casein, albumin, shellac... 

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