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principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data.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.