Swish And Spit Or Swish And Swallow Nystatin Suspension?

In our latest question and answer, the pharmacist discusses if you should spit or swallow nystatin suspension.

Question

Will Nystatin suspension work with swish and spit for thrush? Also, how long do you hold Nystatin in the mouth for?

Asked by cookie On Sep 30, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Sep 30, 2022
Last updated Sep 30, 2022

Key points

  • Nystatin can be spit or swallowed, but the general recommendation is to swallow if you can in case your fungal infection has spread to your throat and esophagus.
  • Nystatin, even when swallowed, is very well tolerated and generally only causes mild side effects, if they occur at all.

Answer

Thanks so much for reaching out to us, and great question!

What Is Nystatin?

Nystatin is an antifungal drug used for a number of indications, including:

  • Intestinal candidiasis (overgrowth of the Candida yeast in the small and large intestines)
  • Cutaneous and mucocutaneous candidiasis, including candidal diaper dermatitis (skin fungal infection)
  • Oropharyngeal candidiasis (thrush)

Your question concerns using Nystatin for an oral fungal infection (thrush).

How Is Nystatin Dosed For Thrush?

Nystatin suspension should be dosed at 400,000 to 600,000 units (4 to 6 mL), swished in the mouth four times daily (every 6 hours or so), for at least one to two minutes for 7 to 14 days. Each dose should be divided so that one-half of each dose is placed in each side of the mouth. This ensures all the affected areas have been reached. Continue treatment for at least 48 hours after symptoms are resolved.

It is also important to not eat or drink for about 30 minutes after using nystatin. This allows the drug to remain in contact with the affected areas, and not be washed away prematurely.

Do You Spit Or Swallow Nystatin Suspension?

Getting to your question here, nystatin suspension can be spit or swallowed but, it is most commonly recommended to be swallowed, which is best practice.

An oral thrush infection can be present in many different parts of the mouth, as well as in the back of the mouth, the throat and esophagus. If you spit out nystatin, there is a chance that all the affected areas won't come into contact with the antifungal, which is vital for it to work. Swallowing nystatin ensures all the affected areas come in to contact with the drug.

The prescribing information for nystatin specifically states to swallow:

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.

Nystatin is generally a very well tolerated drug, even when swallowed. The drug is very poorly absorbed and almost the entire dose you take is excreted in feces, unchanged. It may cause mild side effects, such as nausea, vomiting, diarrhea and upset stomach, but that generally is the extent of it.

In terms of how long to swish nystatin before swallowing, you should swish it around for at least one to two minutes. Generally, the longer the better, but more than a few minutes isn't necessary as long as you consistently dose four times daily, for 7 to 14 days.

Final Words

Thanks again for your question and I hope this helped!

References

  • Nystatin Prescribing Information, AccessFDA
  • Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants, PubMed
  • Nystatin Monograph, PubChem

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 11 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Feel free to send him an email at Hello@HelloPharmacist.com! You can also connect with Dr. Brian Staiger on LinkedIn.

Recent Questions