How do I order nystatin powder?

How to Order Nystatin Powder

Nystatin is not typically available as a standalone powder formulation for routine clinical use; instead, it is commercially available as oral suspension (100,000 units/mL), vaginal tablets (100,000 units), and topical creams/ointments. 1

Available Commercial Formulations

Oral Suspension (Most Common)

• Nystatin oral suspension 100,000 units/mL is the standard formulation available by prescription 1
• Available in multiple sizes:
  • 60 mL bottles (2 fl oz) with calibrated dropper 1
  • 237 mL bottles (8 fl oz) 1
  • 480 mL bottles (16 fl oz) 1
  • 5 mL unit dose cups 1
• Flavors include cherry and bubblegum 1
• Requires prescription (Rx only) 1

Ordering Instructions for Standard Formulations

• Write prescription for "Nystatin Oral Suspension 100,000 units/mL" with appropriate volume based on treatment duration 2, 3
• For 7-14 day treatment at 4-6 mL four times daily, prescribe at least 240 mL (8 fl oz bottle) 2, 3, 1
• Specify "shake well before using" on prescription 1

When Nystatin Powder May Be Needed

Compounded Preparations

• Nystatin powder for compounding became available in some countries (e.g., Czech Republic) around 2010 for magistral (extemporaneous) preparation 4
• Used to create custom formulations including viscous oromucosal suspensions, oral/oromucosal hydrogels, and oromucosal gelatine globules 4
• Requires specialized compounding pharmacy 4

Topical Powder for Burns

• High-concentration nystatin powder (6,000 units/g) has been used successfully for angioinvasive fungal infections in severe burn patients 5
• This is a specialized formulation not routinely available and would require hospital pharmacy compounding 5
• Effective for both superficial and deep tissue fungal infections refractory to other agents 5

Practical Ordering Algorithm

For Oral Candidiasis (Most Common Indication)

1. Prescribe nystatin oral suspension 100,000 units/mL 2, 3, 1
2. Dosing: 4-6 mL (400,000-600,000 units) four times daily for 7-14 days in adults 2, 3
3. Pediatric dosing: 1-7 days treatment duration 2, 3
4. Volume needed: 240-480 mL for full adult course 1

For Vaginal Candidiasis

• Prescribe nystatin vaginal tablets 100,000 units 6, 2
• Dosing: 1 tablet intravaginally daily for 14 days 6, 2
• Note: Azole antifungals are more effective than nystatin for this indication 6

For Specialized Powder Needs

• Contact a compounding pharmacy that can source pharmaceutical-grade nystatin powder 4
• Specify intended use (oral, topical, concentration needed) 4, 5
• For burn wound infections requiring high-concentration powder, coordinate with hospital pharmacy 5

Important Caveats

• Nystatin is less effective than systemic azoles (fluconazole) for moderate to severe oral candidiasis 2
• Commercial oral suspension is adequate for most clinical scenarios; powder formulation is rarely necessary 1
• If standard formulations fail, consider switching to fluconazole 100-200 mg daily rather than seeking alternative nystatin formulations 2, 3
• Storage: Keep at 20-25°C (68-77°F); avoid freezing 1