Nystatin Versus Diflucan – Autism Antifungal Therapy

Posted on 22 October 2009 by admin

I am often asked the about the difference between a medication such as Nystatin and a medication such as Diflucan and their effects on yeast and what are some of the things you need to be aware of when using these medications. Both Nystatin and Diflucan are considered antifungals which mean they have an eradication or inhibiting or killing effect against yeast organisms, specifically candida.  We know that candida is a big problem for many kids on the spectrum. We commonly treat using Nystatin and/or Diflucan to lower the levels of candida to bring on improvement in behavior. We know yeast can increase stimming behaviors, silly, goofy and giddy behaviors, and other negative behaviors. Nystatin is considered a local antifungal.  It inhibits the overgrowth of colonies of yeast that line the digestive system. There is no significant absorption of Nystatin into the bloodstream so it can be taken long term with no major concern.  It can be taken for months or years in many cases. Think of Nystatin like Pepto Bismal, Pepto Bismal coats the stomach and Nystatin coats the inner lining of the digestive tract.  Because it coats the lining of the digestive tract, generally we need to take it several times a day to keep that coat in place.  So, 3, 4 or even 5 times a day is ideal, even though that is difficult to do. Minimally 3 times per day, preferably 4 and Nystatin becomes quite effective. In comparison, Diflucan is considered a systemic antifungal which means when you take it orally it will be absorbed into the blood stream within about 2 hours. It also has a local effect in the digestive system as well but it is absorbed into the body and is metabolized in the liver. So there is the potential for risk of liver stress with long term use.  So if your child is taking Diflucan you will want to run blood work every 6 8 weeks in my experience to check for liver stress.  What you can do with Diflucan is you  can take it for a short time like 2 weeks, 3 weeks or 4 weeks and then take a couple week break and cycle back to it and in many cases that works well. There are other medications that fall into the same category as Diflucan called Nizoral, Lamisil and Sporonox. The primary ones I use in my practice are Diflucan and Nizoral and both are systemic and so with use over a prolonged period of time, you do need to check liver enzymes function. Nystatin really doesn’t need to have the liver function tests because it just stays in the GI tract.  As a recap, both Nystatin and Diflucan are antifungal medications. Nystatin has a local effect with minimal systemic absorption, if at all. Diflucan is a systemic antifungal so you do need to do liver tests to check for liver function periodically.

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10 Comments For This Post

  1. Holly L Says:

    Our daughter was recovered from autism using diet and live probiotics. We did use all of these anti-fungals and we continue with Nystatin, but it wasn’t until we removed ALL sugars from her diet and started giving her coconut kefir, a live fermented drink, that she fully recovered. We even tried many of the probiotic capsules but they were not as effective as the kefir. I would encourage anyone with an autistic child to get them on a GF/CF low carb diet, remove sugars and drink coconut kefir!

  2. Nancy Taylor Says:

    I have a 17 yr old son he is dual diagnosed with Down Syndrome and Autism, we are starting a treatment for candidas(yeast overgrowth symptoms) with Nystatin and I think that the dr. has prescribed too low of a doseage for him, what doseage would you recommend?
    The dr. has prescribed Nystatin oral liquid 100,000 units 1 tsp 3X daily what is the normal doseage for a teenager with Autism that weighs 200lbs.??? I can find that it is a common treatment but no advice about the doseage or duration to use it.

  3. Angela Walde Says:

    My 6 year old daughter with Aspergers is GFCF and on a limited sugar diet, however, we don’t restrict carbs. After seriously limiting sugar intake her itching subsided drastically. We then started Nystatin and eventually the itching was gone altogether. I’m not sure if it was the Nystatin or the diet or both that alleviated the itching. While on Nystatin we did not see a change in her behaviour but noticed when she had too much sugar her itching started to come back.
    She finished a 6 month dose of Nystatin at the end of Aug and started Diflucan the 4th of Sept. Her itching started back up again shortly after starting the Diflucan and is now as bad as it was when we first started to treat it? Also, the last week her beahviour has changed drastically for the worse. She is very hyper and irritable and crying and having tantrums. This is not and never has been normal for her. We did have two big sugar breaches since starting the Diflucan. I’m wondering if this is Die Off or is it a result of stopping the Nystin or is it a reaction to the Diflucan? My DAN doctor says keep her on the Diflucan (we have 14 days left) and give her charcoal, Ibuprofen (3 times a day) and benedryl at night. If it’s die off I want to stick it out but I hate to put her through this. We haven’t done a liver function test in over a year. Should we have done that before starting the Diflucan and should we do one now or wait until we finish the course.
    Thanks for any helpful advice.

  4. Elizabeth Banda Says:

    Yes if you do use the antifungals and still continue with the sugars it will not make much of a difference. Good to hear about your daughter but i am sure the antifungals have helped also because just the diet without antifungals i don’t think it would be that effective.

  5. janell janicki Says:

    Good info on the various anti fungals, thank you. You state that liver enzymes should be tested if using prolonged use of Diflucan. What do you consider prolonged use?

  6. Erika Says:

    We are doing Nystatin (supposed to be doing it 3 x a day) for my son. My problem is, how do I fit in zinc and probiotics, too? They all seem to need to be taken seperately….

  7. Carissa Says:

    My son has also started a round of Nystatin. He is almost 4yrs old and is about 60lbs. He takes 1 tsp 4x’s a day.
    We have noticed a few changes in him….but after reading some of the other comments on here I think that we could be seeing better results. The doctor never told me that I should cut out sugar while using the anti-fungal.
    We tried a gluten free diet and saw no changes in him. She did a blood test and said that he had a slight reaction to gluten and casein and to try one, the other or both. We started with gluten had no changes.
    Maybe now I will try no sugar and see what kind of results we get!

  8. autism Says:

    Prolonged use can be months, if not years

  9. autism Says:

    Nystatin is not dosed based on weight. However, for most dosing levels I like 500,000 units three times daily for 30 days or longer. It is not uncommon for me to have kids on Nystatin for months at a time

  10. Kris Says:

    I have found great results by removing sugar, so no candy, cookies (obviously) but also no fruit juices and stay away from high sugar fruits like oranges. We drink unsweetened coconut and almond milk sweetened with a packet of Stevia. I also found problems with barley malt in pretzels and bread, so anything with barley malt/ malted barley is out.

    I have heard from many ASD parents that results are much better following the diet, than just probiotic or antifungals alone. I saw results with the diet alone, but results are best re-establishing intestinal bacteria with a spore forming antifungal probiotic, something like either Threelac or Symbion. Work up to around 4 packets or capsules a day and stay there long term, 1-2 years. We also use Candex in the am and pm as a yeast (cell wall) eating enzyme.

    In the early stages- when we had a slip in the no sugar diet, my older son’s facial tic would start to resurface and my ASD son would stutter and get constipated. The diet/ probiotic or even diet/ antifungal takes 1-2 years to really work and lower yeast in most cases. I know a lot of info out there talks about 30 or 90 day diet/treatments, but the yeast will likely return if treatment is not of a longer duration. It’s the yeast that is at the heart of ASD problems, clear up the yeast and the battle is pretty much won. All the best!!

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