DECEMBER 01, 2005
Martin A. Erickson III, RPh

Q: I was wondering whether you know how to compound nystatin suspension using stevia, with no sugar allowed.

A: s question is asked frequently. The patient may be undergoing a whole-body Candida infection. In such cases, nystatin is given without sugar; in fact, sugars are eliminated from the patient's diet as much as possible.

For Nystatin for Oral Suspension, use Nystatin, Powder, USP (formerly Nystatin for Extemporaneous Preparation of Oral Suspension USP). This product is pure nystatin and is provided in convenient dispensing quantities, sometimes with a dose spoon. The product is dispensed in the sealed container. The patient is instructed to refrigerate the product. Once opened, the product has a finite expiration date (usually 90 days when refrigerated).

Extemporaneous preparation of the suspension is accomplished by adding the powder to water (or sometimes to a beverage). Nystatin has a very short half-life in an aqueous medium where sucrose is not present.

The pharmacist should not attempt to compound a sugar-free suspension of nystatin.

Commercially prepared nystatin suspension is stored at room temperature; sucrose in the suspension stabilizes the nystatin.

Mr. Erickson is director of professional affairs at Gallipot Inc.

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