Is Nystatin Wash Safe in Pregnancy?
Yes, nystatin wash is safe to use during pregnancy for topical/local treatment of fungal infections, as it has minimal systemic absorption and is considered compatible with pregnancy. 1, 2
Safety Profile and Regulatory Classification
- Nystatin is classified as FDA Pregnancy Category A when used topically or locally, indicating compatibility with pregnancy 1
- The FDA drug label categorizes topical nystatin as Pregnancy Category C, acknowledging that animal reproduction studies have not been conducted, but emphasizes that it should only be prescribed when potential benefit outweighs potential risk 2
- Nystatin is minimally absorbed systemically when applied topically or used as a wash, which significantly reduces fetal exposure 3
Clinical Use in Pregnancy
- Nystatin is considered a first-line topical antifungal agent for treating fungal skin and mucosal infections during pregnancy 4
- For vaginal candidiasis specifically, topical nystatin is effective and safe, though imidazole drugs (like clotrimazole or miconazole) are more effective 5, 6
- The European Respiratory Society/Thoracic Society of Australia and New Zealand guidelines note that oral and topical nystatin use is acceptable in pregnancy and lactation 1
Important Caveats
- Nystatin is less effective than imidazole antifungals (clotrimazole, miconazole) for treating vaginal candidiasis in pregnancy, with studies showing imidazoles have significantly better cure rates (OR 0.21,95% CI 0.16-0.29) 5, 6
- Treatment duration matters: Seven-day courses are more effective than shorter 3-4 day regimens during pregnancy 5, 6
- Nystatin should not be used for systemic infections - it is only appropriate for topical/local fungal infections 2
- When used on nipples during breastfeeding, excess cream should be removed before nursing 1
Practical Recommendations
- Use nystatin wash for superficial fungal infections when topical treatment is indicated during pregnancy 1, 4
- Consider imidazole alternatives (clotrimazole, miconazole) as first-line agents for vaginal candidiasis, as they demonstrate superior efficacy 5, 7, 6
- Avoid systemic azole antifungals (especially fluconazole >150mg daily) during first trimester due to teratogenic risk 1, 8, 3
- Amphotericin B remains the treatment of choice for serious systemic fungal infections requiring systemic therapy during pregnancy 1, 3