Can You Drink Alcohol While on Macrobid (Nitrofurantoin)?

Nitrofurantoin, also known as Macrobid, is a medication prescribed to help treat urinary tract infections (UTIs). UTIs are common infections of the bladder, kidneys, and the tubes related to them.

UTIs are especially common in women, but anyone can get them. The main cause of UTIs is bacteria; bacteria from the rectum or other parts of the skin enter the urethra and then travel into the urinary tract. [1]

The most common symptoms of a UTI are:

• The feeling of needing to urinate more than normal
• Pain when urinating
• The sudden urge to urinate
• A full feeling in the bladder most of the time
• Lower stomach pain
• Smelly urine or dark urine
• Blood in your urine
• Feeling unwell and tired
• A high temperature
• Pain in your back and sides
• Confusion and agitation

Lower UTIs are not usually a major medical concern. However, upper UTIs can damage the kidneys if left untreated. UTIs are usually treated with antibiotics, and symptoms should subside within the first week of treatment.

Patients should also take painkillers for discomfort and pain whilst staying well hydrated.

Nitrofurantoin is an antibiotic that is filtered by the body into the urine. This filtration works to treat the UTI as the medication is concentrated at the site of infection.

Information on Nitrofurantoin

Certain antibiotics are not suitable for some individuals, but most adults and children can take nitrofurantoin, such as those pregnant and breastfeeding.

What makes someone unsuitable for nitrofurantoin?

• If you have historically had an allergic reaction to nitrofurantoin
• If you suffer from porphyria (blood disorder)
• If you have a glucose-6-phosphate dehydrogenase deficiency (G6PD)
• If you have kidney disease
• If you have diabetes
• If you have a condition that causes weakness, such as anaemia or vitamin B deficiency

The common side effects of nitrofurantoin are: [2]

• Nausea and vomiting
• Diarrhoea
• Loss of appetite
• Dizziness
• Tiredness
• Headaches

If the medication causes a cough, high temperature, unexplained bleeding or bruises, pale poo and dark urine, contact your doctor immediately.

Alcohol and Antibiotics

Drinking alcohol whilst taking a Macrobid like nitrofurantoin doesn’t render the medication ineffective, but it will take longer to recover from the UTI, and there will be health risks from combining the two.

People will always ask about drinking alcohol whilst on medication, and the advice is usually the same. You will be advised not to drink alcohol or take other unknown medication at the same time unless your doctor has deemed it safe.

There are multiple reasons why you shouldn’t drink alcohol whilst taking this medication:

• Dehydration
• Enhanced side effects
• A longer period of recovery
• Liver function

Alcohol dehydrates you. As a diuretic, alcohol causes the body to remove fluid through the renal system. After you consume alcohol, the contents pass through the stomach and small intestine into the bloodstream.

If you are drinking on an empty stomach, alcohol enters the bloodstream much faster (within minutes) than if you had eaten before or during drinking.

Once in the bloodstream, alcohol travels everywhere, including your brain and lungs. This is why a breathalyser is used when driving, as alcohol is noticeable when someone exhales.

The body can metabolise alcohol at the rate of one unit per hour. Once the alcohol is metabolised by enzymes in the liver, alcohol is converted into acetaldehyde. The liver then turns this toxic substance into acetate.

Acetate and other waste/toxins are removed from the body naturally. Water is removed from the body faster than the process of alcohol metabolism, increasing blood alcohol concentration. Alcohol promotes water loss through urine, which is why you often ‘break the seal’ when you drink.

Drinking alcohol, a diuretic, whilst you are struggling to combat infection may be a problem. Staying hydrated helps battle and prevent UTIs, as water dilutes urine and helps flush the infection from your system.

Drinking alcohol whilst taking medication may also worsen the side effects. In this case, alcohol may exacerbate nausea and vomiting, dizziness, and headaches.

Mixing alcohol and medication may also intensify the effects of both of these substances. For example, medication and alcohol both cause dizziness and drowsiness. This can increase the risk of harm, accidents, and falls. [3]

The alcohol will not render the medication ineffective as such, but it will diminish the body’s ability to fight any infection. This will increase the length of time that the patient suffers from the UTI and may affect how their body processes and metabolises the medication. [4]

The body requires a strong immune system, proper nutrition, rest, and energy to be able to fight infection properly. Drinking alcohol interrupts this process, as it can interfere with diet, sleeping patterns, hydration, and energy.

Consuming alcohol whilst taking Macrobid will certainly cause an upset stomach. Mixing these two might also cause patients to feel sick and vomit, even when taken with food.

Taking nitrofurantoin whilst drinking alcohol should be avoided, as it will delay the improvement in the patient’s health, exacerbate side effects, and cause significant dehydration.

The Effects on the Liver

Drinking alcohol whilst taking medication such as nitrofurantoin can cause damage to the liver. The liver is an organ that you cannot live without.

The liver regulates the chemical levels of the blood, excreting bile and carrying waste products away from the liver. The liver breaks down, balances, and creates different substances.

Both alcohol and drugs are metabolised and broken down in the liver using specific enzymes. Drinking alcohol can interfere with the metabolism of the medication. [5]

Medication and alcohol may inflame the liver and, if left untreated, may lead to toxic hepatitis. This can be caused by alcohol, drugs, and nutritional supplements.

This can occur when patients take too much medication, drink heavily for long periods, or mix too many substances.

Mild forms of toxic hepatitis may not have any symptoms, but the common signs when noticed are:

• Jaundice (yellowing of the skin)
• Itching
• Fatigue
• Abdominal pain
• A lack of appetite
• Nausea
• Vomiting
• Fever
• Weight loss
• Dark urine

Inflammation of the liver can lead to liver failure, proving fatal if left untreated. This can be made worse by the following:

• Liver disease
• Hepatitis
• Age
• Alcohol consumption
• Prescription medication
• Gender (women metabolise toxins slower than men)
• Genetic mutations
• Industrial toxins

To prevent toxic hepatitis and liver damage such as cirrhosis, you should only take prescription and over-the-counter drugs when necessary.

Further, only take as much as you require, as exceeding the recommended amount will leave you susceptible to toxins.

Do not mix alcohol with drugs due to the interaction in the liver; both alcohol and medication are metabolised by the same enzymes and can cause too much work for the liver.

Summary

Urinary tract infections (UTIs) are bacterial infections. These are usually treated quickly and efficiently by a prescription medication such as Macrobid.

This bacterial infection will often cause adverse effects on the body, such as the constant need to urinate and always feeling as though you have a full bladder.

Most UTIs are harmless, but if severe infections are left untreated, the bacterial infection may cause bladder infections, kidney infections, and other severe medical issues. 

Healthcare providers are likely to prescribe you nitrofurantoin, advising you to take nitrofurantoin with food and to avoid other medication and alcohol. Nitrofurantoin may cause stomach upset, dizziness, headaches, and other symptoms, so be sure to discuss your medical history before you are prescribed medication.

The reason alcohol and medication are not advised to be consumed together is due to the following reasons:

• Drug interactions in the liver
• Enhanced effects of alcohol and medication
• Dehydration
• Recovery and the immune system

This is genuine medical advice and should be followed closely. Excessive alcohol consumption affects sleep patterns, diet, mental health, and the body’s ability to metabolise substances such as nitrofurantoin.

Patients should drink alcohol in moderation and reach out for help and different treatment options if this is a difficult task. Medication is prescribed to treat and prevent the growth of bacteria, and alcohol prevents this process from working properly.

The cessation of alcohol (complete limitation of alcohol) will help your body fight the infection to the best of its ability.

Healthcare professionals will state that the interaction between medication and alcohol depends on the amount of alcohol being consumed. To be safe, it is best to stay sober whilst on this short course of antibiotics.

References

[1] https://www.nhsinform.scot/illnesses-and-conditions/kidneys-bladder-and-prostate/urinary-tract-infection-uti#:~:text=Urinary%20tract%20infections%20(UTIs)%20are,regularly%20(called%20recurrent%20UTIs).

[2] Side effects of Macrobid (Nitrofurantoin), Warnings, Uses https://www.rxlist.com/macrobid-side-effects-drug-center.htm

[3] https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines

[4] Alcohol and the immune system https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590612/

[5] Medicines and alcohol: Health Direct, Australian Government; 2022 [22/3/2022].

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