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Nitrofurantoin during breastfeeding

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

A review states (1):

  • nitrofurantoin can be used with caution during breastfeeding
    • 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

Nitrofurantoin is used therapeutically in infants from 3 months old; the doses used are far greater than the amounts reported in breast milk (1)

A further review notes (2)

  • some have suggested a theoretical risk of hemolytic anemia in infants younger than 1 month owing to glutathione instability
    • however, this appears to be a conservative view, as studies have reported normalization of this phenomenon by the eighth day of life in both term and preterm infants (2)
  • individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiencies, on the other hand, might be at risk of hemolytic anemia with nitrofurantoin regardless of age
  • if the infant is older than 8 days and is unlikely to have a G6PD deficiency, then the use of nitrofurantoin might not be a reason to avoid breastfeeding

Notes:

  • evidence shows small but variable levels in breast milk, ranging from undetectable to 6.8% of the weight-adjusted maternal dose (1)
  • 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 (1)

Reference:

  • NHS Specialist Pharmacy Service (February 6th 2024). Using nitrofurantoin during breastfeeding
  • Zao J, Koren G, Bozzo P. Using nitrofurantoin while breastfeeding a newborn. Can Fam Physician. 2014 Jun;60(6):539-40.

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