Antifungal medication for oral thrush over the counter

1. About nystatin

Nystatin is an antifungal medicine. It's used to treat or prevent infections caused by a fungus (or yeast). These include:

• oral thrush
• skin infections

Nystatin kills the fungus and gets rid of the infection. It can also be used to stop you getting an infection.

Nystatin is only available on prescription.

It comes as a liquid (suspension) that you swirl around your mouth and then swallow. It also comes mixed with steroids, antiseptics or antibacterials as a cream or ointment.

2. Key facts

• You usually take nystatin liquid 4 times a day after meals and before bedtime.
• It's important not to eat or drink for 30 minutes after taking the liquid.
• Nystatin usually starts to work after 2 days.
• It's important to continue to take or use nystatin for 2 days after your condition is better. This will help to stop it coming back again.
• Creams and ointments containing nystatin are known by the brand names Trimovate, Timodine or Nystaform HC.

3. Who can and cannot take nystatin

Most adults and children, including babies, can take nystatin liquid or use nystatin cream and ointments.

Nystatin is not suitable for everyone. To make sure nystatin is safe for you, tell a pharmacist or doctor if:

• you have ever had an allergic reaction to nystatin or any other medicine in the past (including any ingredients in the cream or ointment)
• you cannot digest some sugars – the liquid has a small amount of sucrose in it
• you have tuberculosis (TB) of the skin – you may not be able to use the cream or ointment

4. How and when to take nystatin

It's important to take the medicine for as long as your doctor recommends. If you stop taking it too soon, the infection can come back.

Dosage for nystatin liquid

The usual dose (for adults, babies and children) to:

• treat oral thrush is 1ml, taken 4 times a day. Leave at least 3 hours between doses. If your doctor recommends something different, follow their advice.
• prevent oral thrush is 1ml, taken once or twice a day

How to take nystatin liquid

People usually take nystatin liquid for around 1 week to treat oral thrush.

It's best to take it after a meal or some food. However, do not mix it with food or water or any other drink.

1. Shake the bottle well.
2. Take the lid off and measure out the right amount using an oral syringe, medicine spoon or dropper. Do not use a kitchen teaspoon as it will not give you the right amount.
3. Put the medicine in your mouth.
4. Keep it in your mouth for at least 30 seconds if possible, using it like a mouthwash before you swallow it.
5. Do not eat or drink anything for 30 minutes after taking it. This stops you washing the medicine out of your mouth too soon.

It may be difficult to get your child to keep it in their mouth, but encourage them to do this if you can. Do not worry if they cannot. The medicine will still help even if they swallow it quickly.

Nystatin cream or ointment

Nystatin is also available in creams and ointments mixed with other ingredients. Your doctor will decide which is best for you.

You will usually apply a cream or ointment 2 or 3 times a day, for a maximum of 7 days. The amount you use will depend on the skin condition you have. Your doctor or pharmacist will tell you how much to use and how long to use it for.

What if I forget to take a dose?

If you forget a dose, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just skip the missed dose and take your next one as normal.

Do not take a double dose to make up for a missed dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicines.

What if I take too much?

Nystatin is generally very safe. Taking too much is unlikely to harm you or your child.

If you're worried, speak to your pharmacist or doctor.

If your nystatin cream or ointment contains a strong steroid called clobetasol, talk to your pharmacist or doctor. They'll be able to tell you if you've used too much.

5. Side effects of nystatin

Like all medicines, nystatin can cause side effects, but most people have no side effects or only minor ones.

Common side effects

If you're taking nystatin liquid, talk to your pharmacist or doctor if these side effects bother you or do not go away:

• diarrhoea
• feeling or being sick (nausea or vomiting)

If you're using nystatin cream or ointment, stop using the product and talk to your pharmacist or doctor if:

• you have a rash or itchy, dry or swollen skin where you have applied it
• you get a new infection

Your pharmacist or doctor may be able to recommend a different medicine.

Serious allergic reaction

It happens rarely but it is possible to have a serious allergic reaction (anaphylaxis) to nystatin.

Immediate action required: Call 999 or go to A&E if:

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you're wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of nystatin. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects of nystatin

What to do about:

• diarrhoea – drink lots of fluids, such as water or squash. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
• feeling or being sick – stick to simple meals and do not eat rich or spicy food. If you are being sick, try small, frequent sips of water to avoid dehydration. Make sure you take nystatin liquid after a meal or snack.

7. Pregnancy and breastfeeding

Nystatin and pregnancy

It's usually safe to take nystatin while you're pregnant or trying for a baby.

Talk to your doctor if you're using a nystatin cream or ointment mixed with other ingredients. They will be able to tell you if the other ingredients are safe to use while you're pregnant.

Nystatin and breastfeeding

It's usually safe to take nystatin liquid while you're breastfeeding.

Talk to your doctor if you're using a nystatin cream or ointment mixed with other ingredients. Your doctor will be able to tell you if the other ingredients are safe while you're breastfeeding.

If you're using nystatin cream or ointment on your breasts, wash it off your breasts before feeding your baby. Then wash your hands before you touch your nipple to your baby's mouth.

If your baby is being treated for oral thrush, you can carry on breastfeeding, but you'll need to be treated at the same time. If you have prescribed nystatin cream or ointment, apply it around your nipples after each time you breastfeed.

Non-urgent advice: Tell your doctor if you're:

• trying to get pregnant
• already pregnant
• breastfeeding

8. Cautions with other medicines

Nystatin liquid, cream or ointment are generally OK to use when taking other medicines, including painkillers.

Talk to your pharmacist or doctor if you're using a nystatin cream or ointment mixed with other ingredients. They'll be able to tell you if the other ingredients are safe to take with other medicines.

Mixing nystatin with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements with nystatin. They're not tested in the same way as prescription medicines.

Important: Important

Tell a pharmacist or doctor if you're taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about nystatin

How does nystatin work?

Nystatin is an antifungal medicine and not an antibiotic.

It makes holes in the cell membrane of the fungus and the contents leak out. This kills the fungus and treats the infection.

If you're taking nystatin to prevent an infection, the medicine kills any fungus as it starts to appear.

How long does it take to work?

It depends on the type of infection you have. Some will take longer to get better.

Nystatin liquid will start to work after around 2 days. Keep taking it even after you start to feel better. Take it for as long as your doctor tells you to, as it can take time to kill all the fungus.

If you're using a nystatin cream or ointment mixed with other ingredients, talk to your pharmacist or doctor about how long it will take to work. You may need to use it for 7 to 14 days, it will depend on your skin condition.

What if it does not work?

If you're taking nystatin liquid or using the cream or ointment, talk to your doctor if there is no improvement in your condition after 7 days.

Your doctor may ask you to take nystatin for longer or they may prescribe a different antifungal treatment.

Talk to your doctor if your symptoms get worse at any time.

How long will I take it for?

It usually takes nystatin liquid around a week to treat oral thrush, you'll need to continue taking it for 2 days after this to make sure all the fungus has been killed. Take it for as long as your doctor advised.

If you're using nystatin to prevent oral thrush, your doctor will tell how long to take it for.

If you're using nystatin cream or ointment mixed with other ingredients, you may only need to use it for 7 to 14 days but it will depend on your skin condition. Your doctor will tell you how long to take it for.

Can I take nystatin for a long time?

People usually only take nystatin for around a week to clear the infection.

If you're using a nystatin cream or ointment mixed with other ingredients, only use for longer than 7 days if your doctor tells you to.

If your doctor says it's OK, you may need to use it for a long time to prevent a fungal infection.

Are there other antifungal treatments?

There are many different antifungal medicines. Some are available to buy from a pharmacy, others are prescription only.

Other medicines to treat oral thrush include:

• miconazole
• fluconazole

Doctors usually prescribe miconazole first to treat oral thrush. They may prescribe nystatin if miconazole is not suitable.

Miconazole is available as an oral gel that you can get on prescription or buy from a pharmacy.

Your doctor may prescribe fluconazole if miconazole or nystatin have not treated your oral thrush, or if your infection is severe.

Fluconazole comes as a capsule or liquid that you swallow, your body absorbs it for it to work. This means that it affects more of your body and has a stronger effect. It also means that it's more likely to give you side effects or affect other medicines you're taking.

Your doctor or pharmacist will recommend the right treatment for you.

Other antifungal creams and ointments that treat skin infections caused by a fungus include:

• clotrimazole
• miconazole
• ketoconazole

These medicines are available either on their own or mixed with other ingredients such as steroids to reduce swelling (inflammation).

You can buy some of these creams or ointments from a pharmacy but stronger products need to be prescribed by a doctor.

Will it affect my fertility?

There's no clear evidence to suggest that nystatin will reduce fertility in either men or women.

Can I drink alcohol with it?

Yes, you can drink alcohol while using nystatin. Alcohol does not affect how this medicine works.

However, if you're taking nystatin liquid, do not drink anything for 30 minutes after taking it. This is to stop you washing the medicine out of your mouth too soon.

Is there any food or drink I need to avoid?

There are no specific types of food or drink you need to avoid while taking nystatin.

However, do not eat or drink anything for 30 minutes after taking nystatin liquid. This is to stop you washing the medicine out of your mouth too soon.

Can I drive or ride a bike?

Yes, you can. Nystatin does not affect your ability to drive or ride a bike.