Diflucan vs. Nystatin

• Diflucan (fluconazole) and nystatin are anti-fungal medications used to treat different types of Candida infections.
• Diflucan is used to treat vaginal, oral, and esophageal fungal infections caused by Candida; urinary tract infections, peritonitis, pneumonia and disseminated infections caused by Candida; cryptococcal meningitis; and to prevent Candida infections in patients treated with chemotherapy or radiation after bone marrow transplantation.
• Nystatin oral tablets and capsules are used for treating intestinal candidiasis.
• Brand names for nystatin include Nyamyc, Nystop, and Nyata.
• Side effects of Diflucan and nystatin that are similar include nausea, stomach/abdominal pain, diarrhea, and rash.
• Side effects of Diflucan that are different from nystatin include headache, indigestion, dizziness, low blood potassium (hypokalemia), and changes in taste.
• Side effects nystatin of that are different from Diflucan include vomiting and allergic reactions.

Diflucan (fluconazole) is an anti-fungal medication related to clotrimazole (Lotrimin), ketoconazole (Nizoral), itraconazole (Sporanox), and miconazole (Micatin, Monistat). Diflucan prevents growth of fungi by preventing production of the membranes that surround fungal cells. Diflucan is used to treat vaginal, oral, and esophageal fungal infections caused by Candida; urinary tract infections, peritonitis, pneumonia and disseminated infections caused by Candida; cryptococcal meningitis; and to prevent Candida infections in patients treated with chemotherapy or radiation after bone marrow transplantation.

Nystatin is an oral anti-fungal medication. Nystatin oral tablets and capsules are used for treating intestinal candidiasis. Nystatin works by binding to sterols in the walls of fungal cells, disturbing the function of the cell wall. The fungal cells eventually lose their contents, leading to their death and improvement of the fungal infection.

Diflucan

Common side effects of fluconazole include

• headache,
• nausea, and
• abdominal pain.

Other important side effects include

• diarrhea,
• dyspepsia,
• dizziness,
• reduced blood levels of potassium,
• rash, and
• taste disturbance.

Possible serious side effects include

• seizures,
• reduced number of white blood cells,
• reduced number of blood platelets, and
• toxic epidermal necrolysis.

Rarely, serious allergic reactions, including angioedema (swelling of tissues), may also occur. Liver dysfunction (jaundice, hepatitis) and abnormal heartbeats have been associated with fluconazole. Stevens-Johnson syndrome has also been reported.

Nystatin

Common side effects of nystatin tablets and capsules include:

• Diarrhea
• Nausea
• Stomach pain
• Vomiting

Other side effects of nystatin include:

• Contact dermatitis
• Allergic reactions

Possible serious side effects of nystatin include:

• Stevens-Johnson syndrome

Diflucan

• The usual adult dose is 50-400 mg daily depending on the type of infection. Although symptoms of oral Candida infections may subside in a few days, treatment is continued for 2 weeks.
• Esophageal Candida infections are treated for 3 weeks or longer.
• Treatment of cryptococcal meningitis may last for 10-12 weeks after cerebrospinal fluid cultures become negative.

Nystatin

• The recommended dose for treating intestinal candidiasis is 500,000 to 1,000,000 units (1 to 2 tablets) every 8 hours.

Diflucan

• Hydrochlorothiazide increases the blood concentration of fluconazole by 40%. However, dosage modification is not recommended when both drugs are combined.
• Rifampin (Rifadin, Rimactane, Rifadin, Rifater, Rifamate) reduces the blood concentration of oral fluconazole, probably by increasing the elimination of fluconazole in the liver; therefore, reducing the effectiveness of fluconazole.
• Fluconazole may increase the concentration of warfarin (Coumadin, Jantoven) in blood by reducing the elimination of warfarin. Therefore, the effect of warfarin may increase, leading to an increased tendency to bleed.
• Fluconazole also increases the concentration of the following drugs in the blood, and as a result, the risk of side effects of these drugs may increase. These drugs include:
  • phenytoin (Dilantin),
  • cyclosporine,
  • zidovudine (Retrovir),
  • saquinavir (Invirase),
  • theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphyl, Slo-Phyllin),
  • tolbutamide,
  • glyburide (Micronase, Diabeta, Glynase),
  • glipizide,
  • triazolam (Glucotrol),
  • midazolam (Versed),
  • celecoxib (Celebrex),
  • fentanyl (Sublimaze),
  • atorvastatin (Lipitor),
  • simvastatin (Zocor), and
  • lovastatin (Mevacor).
• As a result, the risk of side effects from the above drugs may increase.
• Combining fluconazole with amiodarone (Cordarone), pimozide (Orap), bepridil (Vascor) or other drugs that affect heart rhythm may increase the risk of abnormal heart rhythms.

Nystatin

• There are no significant drug interactions with nystatin oral tablets and capsules.

Diflucan

• There are no adequate studies of Diflucan in pregnant women. There are reports of harmful effects to the fetus when high dose fluconazole was administered to pregnant women for a few months. Use of fluconazole during pregnancy is not recommended.
• Diflucan is secreted in breast milk at concentrations similar to the mother's blood level. However, fluconazole is used for treating neonates with fungal infections and for treating lactation associated Candida infections. Available evidence suggests that use of fluconazole during breastfeeding has little risk.

Nystatin

• There are no adequate studies done with nystatin to determine safe and effective use in pregnant women.
• It is not known whether nystatin enters breast milk; therefore, it is best for nursing mothers to be cautious before breastfeeding.