Drug Update: Nitrofurantoin

Medicines Optimisation have been informed of the immediate discontinuation of Macrodantin 50mg capsules (£3.66 for 30 capsules). They will be replaced with a generic nitrofurantoin 50mg capsule (£13.92 for 30 capsules), however this is an almost four-fold increase in price. There are no other generic capsules on the market.

Across the North East and Cumbria we currently advise prescribers to use nitrofurantoin capsules rather than tablets as this is currently the most cost-effective option, however because of the price increase this will create a cost pressure of an additional £850,000 across the region. Switching to tablets could cost an additional £1.9million.

The following nitrofurantion products are currently available:

Preparation Price Estimated additional cost across NE and Cumbria CCGs
Nitrofurantoin 100mg MR tablets (Macrobid) (14) £9.50 £540,000
Nitrofurantoin 50mg capsules (new generic preparation) (30) £13.92 £840,000
Nitrofurantoin 50mg tablets (28) £24.35 £1,925,000

 In simple UTIs current HPA antimicrobial prescribing guidelines recommend 3 days’ treatment with either trimethoprim or nitrofurantoin.

If nitrofurantoin is clinically indicated then clinicians may wish to consider prescribing 100mg modified-release formulation given BD, which is now less expensive than the 50mg standard-release capsules at £4.07 for 3 days’ supply.