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Using nitrofurantoin during breastfeeding

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Topics: Infection and infectious diseasesNitrofurantoinRenal and urologic disordersSafety in Breastfeeding

Nitrofurantoin can be used during breastfeeding. Recommendations apply to full term and healthy infants.

Contents
  1. General considerations
  2. Recommendations
    1. Choice considerations
    2. Infant monitoring
    3. Further information
  3. Patient Information
  4. Contact us
  5. About our recommendations
  6. Bibliography

General considerations

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.

Recommendations

Nitrofurantoin can be used with caution during breastfeeding. This includes modified release preparations and when used for longer term prophylaxis.

Choice considerations

Treatment choice should primarily be directed at adequately treating the infection, with suitability in breastfeeding a secondary consideration.

Infant monitoring

Although unlikely to occur, monitor the infant for gastrointestinal disturbances and oral candida infection, especially if used in higher doses.

Further information

Published evidence shows small but variable levels in breast milk, ranging from undetectable to 6.8% of the weight-adjusted maternal dose.

Avoid using nitrofurantoin if the infant has known glucose-6-phosphate dehydrogenase (G6PD) deficiency, hyperbilirubinaemia, or jaundice due to the risk of haemolytic anaemia and kernicterus.

Nitrofurantoin is used therapeutically in infants from 3 months old; the doses used are far greater than the amounts reported in breast milk.

Patient Information

The NHS website provides advice for patients on the use of specific medicines in breastfeeding.

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS), our specialist breastfeeding medicines advice service if you need support in the following situations:

  • you need further advice
  • the infant is unwell or premature
  • multiple medicines are being taken

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.

Bibliography

Full referencing is available on request.

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