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Diflucan vs Nystatin
Introduction
For patients with fungal infections such as thrush or candidiasis, certain antifungal medications can help to eliminate the infection and manage symptoms. Diflucan and Nystatin are two such drugs that are commonly prescribed for these conditions. They each work by interfering with the formation of the fungal cell membrane, thereby disrupting its growth. Diflucan, also known as fluconazole, is a triazole antifungal medication that inhibits the fungal cytochrome P450 enzyme 14α-demethylase, leading to accumulation of 14α-methyl sterols in fungi and decreased levels of ergosterol which is vital for their cellular membranes. On the other hand, Nystatin binds to sterols in the fungal cell membrane causing an increase in cellular permeability allowing leakage of intracellular components.
Diflucan vs Nystatin Side By Side
| Attribute | Diflucan | Nystatin |
|---|---|---|
| Brand Name | Diflucan | Nystatin |
| Contraindications | Allergic reactions, use of certain statins for cholesterol control, certain ergot alkaloids for migraines, liver disease. | Allergic reactions. |
| Cost | For brand name, approximately $140 for 10 tablets. Generic ranges from about $12–$75. | Brand name oral suspension approximately $35–$65 for a 473ml bottle. Generic around $20-$45 per bottle. |
| Generic Name | Fluconazole | Nystatin |
| Most Serious Side Effect | Signs of liver problems, severe rash, irregular heartbeat, unusual bleeding or bruising, extreme fatigue. | Signs of an allergic reaction such as hives; difficulty breathing; swelling of the face, lips, tongue or throat. |
| Severe Drug Interactions | Statins for cholesterol control, certain ergot alkaloids for migraines. | Not specifically mentioned, but always consult with a healthcare provider. |
| Typical Dose | 150 mg once for some infections; severe cases may start at 400 mg on the first day followed by 200 mg/day. | 1-2 ml (100,000 to 200,000 units) four times a day for oral suspension. For intestinal infections, up to 4-6 ml divided into three doses per day. |
What is Diflucan?
Fluconazole (the generic name for Diflucan) is a triazole antifungal medication, first approved by the FDA in 1990. It has been a mainstay treatment for systemic fungal infections and yeast infections such as candidiasis. Diflucan works by stopping fungi from producing a substance called ergosterol, which is an essential component of fungal cell membranes, eventually causing the cells to leak and die off.
Nystatin, on the other hand, was developed in 1950 as one of polyene group of antifungals. Nystatin works similarly by binding to ergosterol and disrupting the fungal cell membrane but it's primarily used topically or orally due to its poor absorption into systemic circulation.
While both medications are effective against fungus-related conditions like thrush or skin infections caused by Candida species, their usages differ depending on the extent of infection because Fluconazole can be absorbed systemically while Nystatin cannot. The side-effect profiles also vary; with fluconazole having potential effects on liver function while nystatin generally showcases minor side effects like mouth irritation when used as oral suspension.
What conditions is Diflucan approved to treat?
Diflucan is approved for the treatment of various types of fungal infections:
- Vaginal yeast infections, also known as candidal vulvovaginitis
- Systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia
- Cryptococcal meningitis.
Nystatin, on the other hand, has a narrower field of use:
- Intestinal candidiasis
- Oral thrush which is an oral yeast infection
How does Diflucan help with these illnesses?
Diflucan, also known as fluconazole, aids in combating fungal infections by hindering the production of ergosterol, a crucial component of fungal cell membranes. In doing so, it causes holes to form within these membranes which leads to essential cellular components leaking out resulting in the death of the fungi. Ergosterol is not found in human cells; therefore its inhibition does not affect us negatively and allows Diflucan to selectively target the cause of infection.
On the other hand, Nystatin works slightly differently but has a similar end result - it binds directly with sterols found in fungal cell membranes leading to changes in their permeability causing leakage and eventual death of the pathogenic fungi. Both drugs are effective against a variety of yeasts and other fungi. The choice between Diflucan and Nystatin may depend on factors such as patient's medical history, specific type or location of infection, potential side effects or interactions with other medications being taken simultaneously.
What is Nystatin?
Nystatin is a polyene antifungal medication that can be used to treat various forms of candidiasis, including oral thrush and skin infections. It was first discovered in 1950 and became commercially available in the late 1950s. Nystatin works by binding to sterols in the cell membrane of susceptible fungi, leading to changes in membrane permeability and ultimately cell death.
Unlike Diflucan (fluconazole), which is systemic and can reach deep-seated or systemic fungal infections, Nystatin does not have strong systemic absorption when given orally - it acts primarily locally on the skin or mucous membranes. This means its side effect profile differs from that of fluconazole; for example, it rarely causes liver toxicity, a potential issue with fluconazole. Its local action makes Nystatin particularly suitable for treating localized yeast infections such as oral thrush or intertrigo.
What conditions is Nystatin approved to treat?
Nystatin is a well-regarded antifungal medication used to treat various fungal infections. The following are some of the conditions that Nystatin can be prescribed for:
- Candidiasis of the skin
- Oral thrush, which is a yeast infection in the mouth
- Intestinal candidiasis.
Moreover, unlike Diflucan (fluconazole), Nystatin works mainly in the intestinal tract and isn't absorbed into your bloodstream. This makes it a great choice for those who prefer or require localized treatment.
How does Nystatin help with these illnesses?
Nystatin is an antifungal medication that works by binding to sterols in the fungal cell membrane, disrupting its integrity and leading to leakage of cellular contents. This results in the death of the fungus and relief from infection symptoms for the patient. It's particularly effective against Candida species, which cause conditions like thrush and yeast infections. Nystatin primarily acts locally in areas where it is applied or taken, such as the mouth or intestines. Unlike Diflucan (fluconazole) which travels through bloodstream to reach deep-seated systemic infections, Nystatin's action is more limited but also tends to have fewer side effects making it a suitable choice for mild localized infections or when patients cannot tolerate other antifungals such as Diflucan.
How effective are both Diflucan and Nystatin?
Both fluconazole (Diflucan) and nystatin are proven effective in treating fungal infections, with their initial approval by the FDA occurring within a decade of each other. They function differently; fluconazole is an azole antifungal that works by inhibiting the synthesis of ergosterol, a key component of fungal cell membranes, while nystatin belongs to polyene class and binds directly to ergosterol causing disruption of membrane integrity.
The effectiveness of both drugs was studied in various studies over time. A 1992 study comparing single-dose oral fluconazole against topical nystatin found that both treatments were similarly effective at treating vaginal candidiasis. However, patients treated with Diflucan showed faster symptom resolution than those given Nystatin.
A review conducted in 2004 concluded the efficacy of fluconazole starts from day one and has fewer side effects compared to many other antifungals making it one of the most widely prescribed systemic antifungal globally. It's also well tolerated among different age groups including elderly populations as well as pregnant women under certain circumstances.
On another note, a comprehensive analysis done in 2016 indicated that Nystatin seems potentially more effective than placebo when used topically for Candida infections involving skin or mucous membranes but its effectiveness varies depending on infection site and severity. Despite being considered first-line treatment for some conditions like oral thrush or diaper dermatitis due to its safety profile especially in infants, significant research concludes data supporting Nystatins' stand-alone treatment is less solid than Fluconazole's because it’s often co-prescribed alongside another drug due to resistance concerns.
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At what dose is Diflucan typically prescribed?
Oral dosages of Diflucan for treating fungal infections typically start at 150 mg once, with certain severe cases requiring an initial dose of 400 mg on the first day followed by 200 mg/day thereafter. For children and infants, the dosage is determined based on weight and usually falls into a range of 3-12 mg/kg body weight per day. The duration of treatment depends on the nature and severity of the infection. Nystatin oral suspension is commonly prescribed as an alternative to Diflucan, particularly for oral thrush or other milder forms of candidiasis. Dosage typically starts at 1 mL (100,000 units) four times daily in adults while children receive half this amount or less depending upon their age and weight - under medical supervision it can be increased if symptoms persist after several days.
At what dose is Nystatin typically prescribed?
Nystatin treatment typically starts at a dosage of 1-2 ml (100,000 to 200,000 units) four times a day. The medication is usually held in the mouth and swished around before swallowing for as long as possible. This allows the medicine to come into direct contact with the infected area. For intestinal infections, the dose can be increased up to 4-6 ml (400,000 - 600,000 units), divided into three doses per day if there is no response after several days of treatment at lower dosages. Always follow your doctor's instructions when taking Nystatin or any other prescribed medication.
What are the most common side effects for Diflucan?
Common side effects associated with Diflucan and Nystatin, two antifungal medications widely used to treat different types of fungal infections, include:
- Headache
- Changes in the sense of taste
- Upset stomach, nausea or vomiting
- Diarrhea or constipation
- Rash or skin irritation (more common with topical forms of Nystatin)
- Stomach discomfort/pain
- Increased thirst (with prolonged use)
Remember that these are potential side effects and not all patients experience them. If you encounter any unusual symptoms while taking either medication, consult your healthcare provider immediately for advice.
Are there any potential serious side effects for Diflucan?
While Diflucan and Nystatin are both commonly used to treat fungal infections, they can cause different side effects. For Diflucan, some rare but severe side effects may include:
- Signs of liver problems: nausea or vomiting that doesn't stop, loss of appetite, stomach pain on the upper right side, yellowing of your skin or the whites of your eyes (jaundice), dark urine.
- Severe rash: Itching or hives; swelling in your face or hands; swelling or tingling in the mouth or throat; chest tightness; trouble breathing
- Irregular heartbeat: Fast, pounding heartbeats
- Unusual bleeding or bruising
- Extreme fatigue
For Nystatin oral suspension users might experience:
- Allergic reactions like skin rash (hives), itching/swelling especially in the face/tongue/throat/neck area.
- Trouble swallowing
- Stomach pain/cramping/bloating -Severe diarrhea
In case you notice any such symptoms while using either drug it is important to contact a healthcare professional immediately.
What are the most common side effects for Nystatin?
Nystatin, a frequently prescribed antifungal medication, can potentially cause the following side effects:
- Mouth irritation or mouth sores
- Unpleasant taste in your mouth
- Nausea or upset stomach
- Diarrhea
- Skin rash if used topically While serious side effects are rare with this medication, it's still important to monitor yourself for any discomfort or adverse reactions. Always consult your doctor if you experience persistent symptoms that concern you.
Are there any potential serious side effects for Nystatin?
Nystatin, while generally safe and effective, may occasionally cause severe side effects. These could include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of the face, lips, tongue or throat
- Severe itching or skin rash
- Unusual changes in mood or behavior
- Confusion or dizziness
- Seeing halos around lights or blurred vision
- Fast heartbeats If you experience any of these symptoms after taking Nystatin, it is crucial to immediately seek medical attention. As with all medications, these potential risks should be weighed against the benefits under a healthcare professional's guidance.
Contraindications for Diflucan and Nystatin?
Both Diflucan and Nystatin, along with most other antifungal medications, may cause an allergic reaction in some people. If you notice a rash, itching/swelling (especially of the face/tongue/throat), severe dizziness or trouble breathing after taking these drugs, please seek immediate medical attention.
Neither Diflucan nor Nystatin should be taken if you are using certain types of medication such as statins for cholesterol control or certain ergot alkaloids used to treat migraines. Always tell your physician which medications you are taking; these will require a period of about 2 weeks to clear from the system to prevent dangerous interactions with Diflucan and Nystatin.
Additionally, both drugs can have serious side effects on the liver. Therefore those with liver disease should discuss this risk carefully with their doctor before starting treatment.
How much do Diflucan and Nystatin cost?
For the brand name versions of these antifungal drugs:
- The price for Diflucan (fluconazole), comes in a standard dose of 150 mg per tablet. A pack of 10 tablets can cost on average around $140, which works out to about $14/day depending on your dose.
- Nystatin oral suspension, used to treat fungal infections in the mouth, costs approximately $35–$65 for a 473ml bottle. If taking the typical dosage (1 ml four times daily), this equates to roughly $0.30–$0.55/day.
This indicates that if you're using similar dosages, Diflucan is significantly more expensive than Nystatin.
When considering generic versions:
- Fluconazole (generic Diflucan) prices vary by dosage and quantity but typically range from about $12–$75 for varying strengths and quantities, translating into an approximate daily cost between just over a dollar up to several dollars per day.
- Generic nystatin suspension is less expensive than its brand-name counterpart at approximately $20-$45 per bottle or around $0.17-$0.38 per day based on typical usage.
Please remember that while cost considerations are important due to budget constraints, they should not be the sole factor when choosing medication - effectiveness and suitability for your specific situation are also vital factors.
Popularity of Diflucan and Nystatin
Fluconazole, most commonly known by its brand name Diflucan, is a widely used antifungal medication that was prescribed to about 6.3 million people in the US in 2020. Fluconazole accounted for roughly 14% of all systemic antifungal prescriptions within the country. The drug has been increasing gradually in prevalence since it first gained FDA approval back in 1990.
Nystatin, available under several brand names such as Mycostatin and Nyamyc among others, has had approximately steady prescription rates over the last decade with around 4.5 million prescriptions filled in the USA during 2020 alone. Nystatin accounts for just under 10% of overall systemic antifungal prescriptions but holds a significant market share when considering topical or oral applications due to its safety profile and efficacy against Candida infections particularly those affecting mouth (oral thrush) and skin.
Conclusion
Both Diflucan (fluconazole) and Nystatin have well-established records of usage in patients with fungal infections, supported by considerable clinical studies indicating their efficacy over placebo treatments. In some situations, these antifungal drugs may be used together for a more robust approach to treatment, but this combination needs careful consideration by a medical professional due to potential interactions. The two medications work differently: Diflucan is systemic and works throughout the body while Nystatin works locally within the gut or on the skin.
Diflucan is often considered a first-line treatment option for serious systemic fungal infections like candidiasis because it can travel through your bloodstream to reach various parts of your body. On the other hand, Nystatin would usually be used as an adjunct therapy or in cases where patients did not respond well to fluconazole or when localized treatment is sufficient such as oral thrush or superficial skin infections.
Both drugs are available in generic form which offers substantial savings especially for out-of-pocket payments. Both medications might need an adjustment period since effects may not show immediately after starting them.
The side effect profile between these two antifungals differs somewhat; both are generally tolerable but Diflucan can sometimes lead to liver toxicity unlike Nystatin that mainly causes gastrointestinal upset. For both drugs, patients must closely monitor any new symptoms after beginning treatment and should seek immediate medical help if they observe severe reactions like difficulty breathing or jaundice.
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Refrences
- Consolaro, M., Martins, H., da Silva, M., Paiva, L., & Svidzinski, T. (2012). Efficacy of Fluconazole and Nystatin in the Treatment of Vaginal Candida Species. Acta Dermato Venereologica. Medical Journals Sweden AB.http://doi.org/10.2340/00015555-1194
- Lee, W., & Lee, D. G. (2018, February 1). A novel mechanism of fluconazole: fungicidal activity through dose-dependent apoptotic responses in Candida albicans. Microbiology. Microbiology Society.http://doi.org/10.1099/mic.0.000589
- Pons, V., Greenspan, D., Lozada‐Nur, F., McPhail, L., Gallant, J. E., Tunkel, A., … Green, S. (1997, June). Oropharyngeal Candidiasis in Patients with AIDS: Randomized Comparison of Fluconazole Versus Nystatin Oral Suspensions. Clinical Infectious Diseases. Oxford University Press (OUP).http://doi.org/10.1086/513664
- Goins, R. A., Ascher, D., Waecker, N., Arnold, J., & Moorefield, E. (2002, December). Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants. The Pediatric Infectious Disease Journal. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/00006454-200212000-00017
- Kneale, M., Bartholomew, J. S., Davies, E., & Denning, D. W. (2016, August 10). Global access to antifungal therapy and its variable cost. Journal of Antimicrobial Chemotherapy. Oxford University Press (OUP).http://doi.org/10.1093/jac/dkw325