Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Cream, External: Nystatin 100,000 units and triamcinolone acetonide 0.1% (15 g, 30 g, 60 g)
Ointment, External: Nystatin 100,000 units and triamcinolone acetonide 0.1% (15 g, 30 g, 60 g)
Pharmacology
Mechanism of Action
See individual agents.
Use: Labeled Indications
Treatment of cutaneous candidiasis
Contraindications
Hypersensitivity to nystatin, triamcinolone, or any component of the formulation
Dosage and Administration
Dosing: Adult
Cutaneous Candida: Topical: Apply sparingly to affected area(s) twice daily. Therapy should be discontinued when control is achieved or if symptoms persist for >25 days of therapy.
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Refer to adult dosing.
Administration
External use only; do not use on open or weeping wounds; do not use with occlusive dressings.
Storage
Store at 15°C to 30°C (59°F to 86°F). Avoid freezing.
Drug Interactions
Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Avoid combination
Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Monitor therapy
Deferasirox: Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Monitor therapy
Hyaluronidase: Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Consider therapy modification
Progesterone: Antifungal Agents (Vaginal) may diminish the therapeutic effect of Progesterone. Avoid combination
Ritodrine: Corticosteroids may enhance the adverse/toxic effect of Ritodrine. Monitor therapy
Adverse Reactions
Frequency not defined.
Central nervous system: Localized burning
Dermatologic: Acne vulgaris, allergic dermatitis, atrophic striae, folliculitis, hypertrichosis, hypopigmentation, maceration of the skin, miliaria, perioral dermatitis, skin atrophy, xeroderma
Infection: Secondary infection
Local: Local irritation, local pruritus
Warnings/Precautions
Concerns related to adverse effects:
- Adrenal suppression: Systemic absorption of topical corticosteroids may cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.
- Dermatitis: Cutaneous hypersensitivity/contact dermatitis to individual ingredients has been reported; instruct patients to seek medical attention.
- Infection: Steroids may mask infection or enhance existing infection; prolonged use may result in secondary infections due to immunosuppression.
- Kaposi's sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi's sarcoma (case reports); if noted, discontinuation of therapy should be considered.
- Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing's syndrome, hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas.
Special populations:
- Pediatric: Children may absorb proportionally larger amounts of corticosteroids after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing's syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients.
Monitoring Parameters
Urinary free cortisol test, morning plasma cortisol test, and ACTH stimulation test may be used to evaluate HPA axis suppression; signs of improving or worsening Candida or new bacterial infection
Pregnancy
Pregnancy Risk Factor
C
Pregnancy Considerations
See individual agents.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience burning, itching, or dry skin. Have patient report immediately to prescriber signs of high blood sugar (confusion, fatigue, increased thirst, increased hunger, passing a lot of urine, flushing, fast breathing, or breath that smells like fruit), signs of adrenal gland problems (severe nausea, vomiting, severe dizziness, passing out, muscle weakness, severe fatigue, mood changes, lack of appetite, or weight loss), signs of Cushing’s disease (weight gain in upper back or abdomen; moon face; severe headache; or slow healing), signs of skin changes (acne, stretch marks, slow healing, or hair growth), skin discoloration, skin thinning, or severe skin irritation (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
