For guidance on the management of oral candidiasis in palliative care see 16.10 Mouth care in palliative care.

Nystatin

• Oral suspension 100,000units/ml (£1.80 = 30ml)

Indications

• Oral candidiasis

Miconazole

• Oromucosal gel sugar free 20mg/g (£5.26 = 15g)

Indications

• Oral candidiasis

Notes

1. Stock shortage (14 May 2024): Miconazole 20mg/g oromucosal gel sugar free is unavailable
   1. Anticipated re-supply date is July 2026.
   2. The Specialist Pharmacy Service (SPS) recommends the following:
      1. consider prescribing nystatin 100,000units/ml oral suspension, where appropriate
      2. consider prescribing fluconazole capsules or oral suspension for more severe infections
      3. where the above are not appropriate, advice should be sought from specialists
      4. patient/carers should be advised on the change and counselled on how to administer the dose.
2. Miconazole greatly enhances the anti-coagulation effect of warfarin, avoid concomitant use. Refer also to MHRA Drug Safety Update June 2016.
3. Refer to the BNF or manufacturer's Summary of Product Characteristics (SPC) for a full list of interactions with miconazole.

Oral fluconazole may be considered following failure or contraindication to topical treatments see 5.2.1 Triazole antifungals.