🚨 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.