Nitrofurantoin: Reminder of Pulmonary and Hepatic Risks

Overview

  • 💊 Broad-Spectrum Antibacterial: Used for adults, children, and infants over 3 months for treating and preventing uncomplicated UTIs or pyelonephritis.
  • 📅 Duration: Treatment lasts 3 to 7 days; some may use a daily dose for recurrent UTIs.

Potential Risks

  • 🫁 Pulmonary Reactions:
  • Acute: Fever, chills, cough, chest pain, dyspnoea, pulmonary infiltration, pleural effusion, eosinophilia.
  • Subacute/Chronic: Documented pulmonary damage.
  • 🩸 Hepatic Reactions:
  • Rare but Serious: Cholestatic jaundice, chronic active hepatitis, autoimmune hepatitis, hepatic necrosis.

Important Update

  • 📅 April 2023: MHRA issued a drug safety update.
  • ⚠️ Alert: Be vigilant for pulmonary and hepatic adverse reactions.
  • 📝 Case Reports: Acute pulmonary damage and respiratory failure reported; another case of long-term pulmonary damage.

Hepatic Reactions

  • 🧐 Vigilance: Monitor for signs of liver dysfunction, especially in long-term use.
  • 🧪 Biochemical Tests: Watch for changes indicating hepatitis or liver injury.
  • ⛔ Immediate Action: Discontinue nitrofurantoin if hepatitis occurs.

Advice for Healthcare Professionals

  • ⚠️ Caution: Use carefully in patients with pulmonary disease or hepatic dysfunction.
  • 📖 Patient Information: Ensure patients read the leaflet on possible symptoms and seek medical advice if they occur.
  • 🟨 Yellow Card Scheme: Report suspected adverse drug reactions.

Advice for Patients and Caregivers

  • 🫁 Lung Symptoms: Seek medical help if you experience trouble breathing, shortness of breath, lingering cough, coughing up blood or mucus, or chest pain.
  • 🩸 Liver Symptoms: Seek medical help if you develop yellowing of the skin or eyes, upper right abdominal pain, dark urine, pale stools, itching, or joint pain.

Pulmonary Damage

  • ⏳ Monitoring: Long or short-term use can cause damage; closely monitor especially elderly patients on long-term therapy.
  • 🚨 Action: Discontinue nitrofurantoin immediately if pulmonary damage symptoms occur.

References:

1. MHRA (2023). Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions, Drug Saftey Update. Available at Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions – GOV.UK (www.gov.uk). Accessed 3 April 2024).

2. Summary of Product Characteristics and Patient Information Leaflets. (2024). Nitrofurantoin. Available at https://www.medicines.org.uk/emc/search?q=Nitrofurantoin+ . Accessed 3 April 2024.

3. Yellow Card Scheme (2024). Yellow Card reporting site, Medicines and Healthcare Products Regulatory Agency. Available at https://yellowcard.mhra.gov.uk/. Accessed 3 April 2024.

Author

  • Director, The Medicines Management Team

    Mohammed Rashad is a pharmacist and Director at The Medicines Management Team (TMMT), an award-winning provider of pharmacy services supporting over 85 Primary Care Networks (PCNs) and 250 GP practices across the UK. He works at scale with practices and PCNs to reduce workload, improve access, and deliver key targets such as QOF. Mohammed combines clinical expertise with strategic leadership to redesign how primary care operates. He leads on digital innovation, implementing performance dashboards, optimising workflows, and using data to drive smarter decisions. His work focuses on building scalable, high-performing models that deliver measurable impact. He regularly shares practical insights on improving efficiency, workforce productivity, and patient outcomes across primary care.

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