Nitrofurantoin Shortage: What Providers and Prescribers Need to Know in 2026

Nitrofurantoin remains a cornerstone of uncomplicated UTI treatment — endorsed as first-line therapy by the Infectious Diseases Society of America (IDSA) and valued for its exceptionally low resistance profile. However, supply disruptions have complicated prescribing decisions over the past several years. Here's a comprehensive update for clinicians.

Provider Briefing: Current Status

As of early 2026, the Nitrofurantoin supply picture is mixed by formulation:

• Capsules (generic and brand): Generally available. Multiple generic manufacturers produce Nitrofurantoin monohydrate/macrocrystals (Macrobid equivalent) and macrocrystalline (Macrodantin equivalent) capsules. Supply is adequate at the wholesale level, though individual pharmacy stock-outs can occur.
• Oral suspension (Furadantin equivalent): Remains constrained. Somerset Therapeutics, a primary supplier, had the product on back order through early January 2026. Limited alternative sources exist for the liquid formulation.

The oral suspension shortage disproportionately affects pediatric patients and adults who cannot swallow capsules — populations that may need compounding solutions or formulation switches.

Shortage Timeline

Nitrofurantoin oral suspension has experienced recurring availability issues since 2023:

• 2023: Initial reports of oral suspension supply disruptions due to manufacturing delays
• 2024: Shortage persisted with limited manufacturers; ASHP added Nitrofurantoin oral suspension to its shortage list
• 2025: Intermittent availability; Somerset Therapeutics back-ordered product with rolling estimated resupply dates
• Early 2026: Somerset estimated resupply for early January 2026; capsule formulations remained generally available throughout

Capsule formulations have experienced only spot shortages at the pharmacy level — typically localized and short-lived rather than systemic supply failures.

Prescribing Implications

The current supply environment creates several considerations for prescribers:

Formulation Selection

When prescribing Nitrofurantoin, specifying Macrobid (monohydrate/macrocrystals) 100 mg capsules twice daily for 5 days is the most reliably fillable prescription. This formulation is produced by multiple generics manufacturers and is widely stocked.

If your patient requires a liquid formulation, confirm availability before prescribing. Consider:

• Contacting the patient's pharmacy to verify stock
• Using Medfinder for Providers to identify pharmacies with current inventory
• Compounding as a backup option for patients who cannot swallow capsules

Alternative Agents

When Nitrofurantoin is unavailable, evidence-based alternatives for uncomplicated cystitis include:

• Trimethoprim-Sulfamethoxazole (TMP-SMX): 160/800 mg BID × 3 days. Note: IDSA recommends using only if local E. coli resistance rates are <20%. E. coli resistance to TMP-SMX exceeds 20% in many U.S. regions.
• Fosfomycin: 3 g single dose. Convenient but potentially less effective than multi-day regimens. Higher cost (~$35-75 with coupons).
• Cephalexin: 500 mg BID × 7 days. Second-line option; broader spectrum with greater impact on bowel flora. Higher E. coli resistance rates.
• Trimethoprim alone: 100 mg BID × 3 days. Option for sulfa-allergic patients; similar resistance concerns as TMP-SMX.

Special Populations

Remind clinical staff of key Nitrofurantoin prescribing considerations:

• Renal impairment: Contraindicated if CrCl <60 mL/min (inadequate urinary concentration, increased toxicity risk)
• Elderly patients: Beers Criteria flags Nitrofurantoin as potentially inappropriate in adults ≥65 due to pulmonary toxicity, hepatotoxicity, and peripheral neuropathy risk — particularly with long-term use
• Pregnancy: Generally safe in early pregnancy; contraindicated at term (38-42 weeks) due to risk of neonatal hemolytic anemia
• G6PD deficiency: Risk of hemolytic anemia; use alternative agents
• Long-term prophylaxis: Monitor for pulmonary reactions (acute pneumonitis, chronic interstitial pneumonia/fibrosis) and hepatotoxicity; periodic liver function testing recommended

Availability Picture

From a practical standpoint, most patients prescribed Nitrofurantoin capsules can fill their prescriptions with minimal difficulty. The key challenges are:

• Geographic variability: Urban pharmacies generally maintain better stock than rural locations
• Pharmacy chain differences: Independent pharmacies may source inventory more flexibly than large chains with centralized ordering
• Timing: Pharmacy restocks typically align with weekly wholesale deliveries; patients filling prescriptions late in the week may encounter temporary gaps

Cost and Access

Nitrofurantoin remains one of the most cost-effective UTI treatments available:

• Generic capsules with coupons: $3-$10 for a 5-7 day course
• Average cash price: ~$43 without coupons
• Brand Macrobid: $50-$200+ cash price
• Insurance coverage: Tier 1 on most formularies; typically $0-$15 copay; no prior authorization required

For patients reporting cost barriers, recommend free discount cards from GoodRx, SingleCare, or RxSaver. No manufacturer patient assistance programs exist specifically for generic Nitrofurantoin, but general assistance through NeedyMeds and RxAssist may help uninsured patients.

Tools and Resources

To help your patients navigate availability challenges:

• Medfinder for Providers — Real-time pharmacy inventory lookup to help patients find Nitrofurantoin in stock nearby
• ASHP Drug Shortage Database — Current shortage status and manufacturer updates
• FDA Drug Shortage Database — Regulatory perspective on supply disruptions

Consider sharing our patient guide to finding Nitrofurantoin with affected patients.

Looking Ahead

The Nitrofurantoin capsule supply appears stable heading further into 2026. The oral suspension market remains vulnerable due to limited manufacturer diversity. Prescribers should:

• Default to capsule formulations when clinically appropriate
• Maintain awareness of local availability patterns
• Have alternative regimens ready for patients who cannot access Nitrofurantoin
• Monitor ASHP and FDA shortage databases for updates

Final Thoughts

Nitrofurantoin's low resistance rates, proven efficacy, and favorable cost profile make it an essential tool in UTI management. While supply challenges — particularly for the oral suspension — require clinical awareness and flexibility, the capsule formulations remain broadly accessible. Leveraging tools like Medfinder and staying informed about the latest shortage updates can help you keep your patients on the right therapy without unnecessary delays.