NYSTATIN - nystatin suspension 
Taro Pharmaceuticals U.S.A., Inc.

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Nystatin
Oral Suspension,
USP

Rx only

DESCRIPTION

Nystatin is an antimycotic polyene antibiotic obtained from Streptomyces noursei. Structural formula:

Nystatin Oral Suspension, for oral administration, is cherry/mint flavored, containing 100,000 USP Nystatin Units per mL. Inactive ingredients: alcohol (≤ 1% v/v), 49.8% (w/v) sucrose, purified water, glycerin, sodium citrate, magnesium aluminum silicate, flavors, saccharin sodium, xanthan gum, benzaldehyde, edetate calcium disodium, methylparaben and propylparaben.

CLINICAL PHARMACOLOGY

Pharmacokinetics

Gastrointestinal absorption of nystatin is insignificant. Most orally administered nystatin is passed unchanged in the stool. In patients with renal insufficiency receiving oral therapy with conventional dosage forms, significant plasma concentrations of nystatin may occasionally occur.

Microbiology

Nystatin is both fungistatic and fungicidal in vitro against a wide variety of yeasts and yeast-like fungi. Candida albicans demonstrates no significant resistance to nystatin in vitro on repeated subculture in increasing levels of nystatin; other Candida species become quite resistant. Generally, resistance does not develop in vivo. Nystatin acts by binding to sterols in the cell membrane of susceptible Candida species with a resultant change in membrane permeability allowing leakage of intracellular components. Nystatin exhibits no appreciable activity against bacteria, protozoa, or viruses.

INDICATIONS AND USAGE

Nystatin Oral Suspension is indicated for the treatment of candidiasis in the oral cavity.

CONTRAINDICATIONS

The preparation is contraindicated in patients with a history of hypersensitivity to any of its components.

PRECAUTIONS

General

This medication is not to be used for the treatment of systemic mycoses. Discontinue treatment if sensitization or irritation is reported during use.

Carcinogenesis, Mutagenesis, Impairment of Fertility

No long-term animal studies have been performed to evaluate carcinogenic potential. There also have been no studies to determine mutagenicity or whether this medication affects fertility in males or females.

Pregnancy

Teratogenic Effects Category C

Animal reproduction studies have not been conducted with nystatin oral suspension. It is also not known whether nystatin oral suspension can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Nystatin oral suspension should be given to a pregnant woman only if clearly needed.

Nursing Mothers

It is not known whether nystatin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when nystatin is administered to a nursing woman.

Pediatric Use

See DOSAGE AND ADMINISTRATION.

ADVERSE REACTIONS

Nystatin is well tolerated even with prolonged therapy. Oral irritation and sensitization have been reported. (See PRECAUTIONS: General).

Gastrointestinal: Diarrhea (including one case of bloody diarrhea), nausea, vomiting, gastrointestinal upset/disturbances.

Dermatologic: Rash, including urticaria has been reported rarely. Stevens-Johnson syndrome has been reported very rarely.

Other: Tachycardia, bronchospasm, facial swelling, and non-specific myalgia have also been rarely reported.

OVERDOSAGE

Oral doses of nystatin in excess of five million units daily have caused nausea and gastrointestinal upset. There have been no reports of serious toxic effects of superinfections (see CLINICAL PHARMACOLOGY, Pharmacokinetics).

DOSAGE AND ADMINISTRATION

INFANTS

2 mL (200, 000 units) four times daily (in infants and young children, use dropper to place one-half of dose in each side of mouth and avoid feeding for 5 to 10 minutes).

NOTE: Limited clinical studies in premature and low birth weight infants indicate that 1 mL four times daily is effective.

CHILDREN AND ADULTS

4-6 mL (400,000 to 600,000 units) four times daily (one-half of dose in each side of mouth). The preparation should be retained in the mouth as long as possible before swallowing.

Continue treatment for at least 48 hours after perioral symptoms have disappeared and cultures demonstrate eradication of Candida albicans.

HOW SUPPLIED

Nystatin Oral Suspension, USP, 100,000 USP
Nystatin U/mL, is available as a cherry-mint flavored, light creamy yellow, ready-to-use suspension in:

2 fl oz (60 mL) bottles with 0.5 mL, 1 mL, 1.5 mL, 2 mL calibrated dropper
NDC 51672-4117-4
1 Pint (473 mL) bottles
NDC 51672-4117-9
1 Gallon (3785 mL) bottles (For repackaging only)
NDC 51672-4117-0

Storage

Store at 20°-25°C (68°-77°F) [see USP Controlled Room Temperature]. Protect from freezing.

PHARMACIST: Dispense in a tight, light-resistant container as defined in USP.

Manufactured by: Taro Pharmaceutical Industries Ltd.,
Haifa Bay, Israel 26110

Distributed by: Taro Pharmaceuticals U.S.A., Inc.,
Hawthorne, N.Y. 10532

Issued: February, 2006
70564-0206-0

NYSTATIN  nystatin   suspension

Product Information Product Type HUMAN PRESCRIPTION DRUG NDC Product Code (Source) 51672-4117 Route of Administration ORAL DEA Schedule

INGREDIENTS Name (Active Moiety) Type Strength Nystatin (Nystatin) Active 100000 UNITS  In 1 MILLILITER alcohol Inactive   sucrose Inactive   water Inactive   glycerin Inactive   sodium citrate Inactive   magnesium aluminum silicate Inactive   flavors Inactive   saccharin sodium Inactive   xanthan gum Inactive   benzaldehyde Inactive   edetate calcium disodium Inactive   methylparaben Inactive   propylparaben Inactive

Product Characteristics Color      Score      Shape Size Flavor Imprint Code Contains

Packaging # NDC Package Description Multilevel Packaging 1 51672-4117-4 1 BOTTLE In 1 CARTON contains a BOTTLE, DROPPER 1 60 mL (MILLILITER) In 1 BOTTLE, DROPPER This package is contained within the CARTON (51672-4117-4) 2 51672-4117-9 473 mL (MILLILITER) In 1 BOTTLE None 3 51672-4117-0 3785 mL (MILLILITER) In 1 BOTTLE None

Revised: 09/2008Taro Pharmaceuticals U.S.A., Inc.