Nitrofurantoin Side Effects
Some side effects of nitrofurantoin may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to nitrofurantoin: oral capsule, oral suspension, oral tablet
Along with its needed effects, nitrofurantoin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking nitrofurantoin:More common
- Changes in facial skin color
- chest pain
- general feeling of discomfort or illness
- joint or muscle pain
- shortness of breath
- skin rash
- sudden trouble in swallowing or breathing
- swelling of the face, mouth, hands, or feet
- troubled breathing
- Black, tarry stools
- blood in the urine or stools
- burning, numbness, tingling, or painful sensations
- pinpoint red spots on the skin
- sore throat
- unsteadiness or awkwardness
- unusual bleeding or bruising
- unusual tiredness or weakness
- weakness in the arms, hands, legs, or feet
- Abdominal or stomach pain
- blistering, peeling, or loosening of the skin and mucous membranes
- blue-yellow color blindness
- bluish color of the fingernails, lips, skin, palms, or nail beds
- blurred vision or loss of vision, with or without eye pain
- bulging soft spot on the head of an infant
- change in the ability to see colors, especially blue or yellow
- cracks in the skin
- darkening of the urine
- decreased vision
- diarrhea, watery and severe, which may also be bloody
- eye pain
- general tiredness and weakness
- light-colored stools
- loss of appetite
- loss of heat from the body
- mental depression
- mood or mental changes
- nausea or vomiting
- pale skin
- pale stools
- red skin lesions, often with a purple center
- red, irritated eyes
- red, swollen skin
- red, thickened, or scaly skin
- skin rash
- sores, ulcers, or white spots on the lips or in the mouth
- swollen or painful glands
- tenderness of salivary glands
- unpleasant breath odor
- upper right abdominal pain
- visual changes
- vomiting of blood
- wheezing or tightness in the chest
- yellow eyes or skin
Some side effects of nitrofurantoin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- Dizziness or lightheadedness
- feeling of constant movement of self or surroundings
- lack or loss of strength
- loss of hair, temporary
- sensation of spinning
- uncontrolled eye movements
For Healthcare Professionals
Applies to nitrofurantoin: compounding powder, oral capsule, oral suspension
Gastrointestinal side effects have included nausea, vomiting, anorexia, diarrhea, and abdominal pain. These adverse effects occur more frequently with Furadantin (R), the crystalline form of the drug. Administration of the drug with food reduces gastrointestinal intolerance. Sialadenitis, pancreatitis, parotitis (rare), and pseudomembranous colitis have also been reported.
Comparative studies of the gastrointestinal adverse effects of the crystalline form (Furadantin (R)) and the macrocrystalline form (Macrodantin (R)) reported up to 34% gastrointestinal intolerance with the crystalline form and up to 13% with the macrocrystalline form. In patients who were unable to tolerate Furadantin (R), 80% were able to tolerate Macrodantin (R).
Pancreatitis due to nitrofurantoin has been reported. In one case the patient experienced cholestatic jaundice secondary to edema of the pancreas.
Respiratory side effects associated with nitrofurantoin therapy have occurred as both acute and chronic events. Acute pulmonary reactions have manifested as a type of hypersensitivity, and have occurred rapidly in patients who were previously sensitized. Of one group of 447 pulmonary reactions reported, 89% were of the acute type. Patients will commonly have eosinophilia. Lung changes generally include alveolar infiltrates. Alveolar hemorrhage and death have been reported. Symptoms generally resolved within 24 to 48 hours after nitrofurantoin is discontinued.
Chronic pulmonary reactions occur after six months of therapy and are generally more severe. Biopsy often reveals interstitial fibrosis. Eosinophilia is less common. Positive antinuclear antibodies are reported in up to 66% of patients, and patients commonly exhibit abnormal liver function tests. Resolution of symptoms usually occurs over a few months, although deaths have been reported. It has been suggested that the mechanism of this reaction is a combination of drug toxicity and an immune reaction.
Respiratory system side effects have included both acute and chronic pulmonary toxicity. Acute toxicity has occurred from within a few hours to 3 weeks after therapy was started and consisted of dyspnea, cough, fever, and chills. Chronic toxicity has generally occurred after 6 months of therapy and has presented with an insidious onset of dyspnea, cough, malaise, and fatigue. Cyanosis (rare), alveolar infiltrates, alveolar hemorrhage (including fatal cases), interstitial fibrosis, and pneumonitis have been reported. Nitrofurantoin-induced bronchiolitis obliterans with organizing pneumonia has been reported.
Cardiovascular side effects have included changes in EKG (such as nonspecific ST/T wave changes or bundle branch block) associated with pulmonary reactions.
Most acute hepatic reactions are self-limiting and resolve within a few days. Patients who experience chronic reactions often have positive antinuclear antibodies (77%) and may develop chronic active hepatitis or hepatic necrosis. Liver function tests generally return to normal after a few months, although deaths due to hepatic failure have been reported.
Hepatotoxicity with concurrent pulmonary effects following the use of nitrofurantoin has been reported and may be mediated by the immune system. A case of hepatotoxicity accompanied by elevations in serum immune globulins (IgG) has been reported. The authors theorized that cytotoxic T cells (CD8) were involved in the liver damage. They postulated that the antigen-antibody complex was removed when the drug was discontinued as evidenced by the patient's rapidly corrected liver enzyme levels.
Hepatic side effects have included elevated transaminase levels, hepatitis (including fatal cases), elevated bilirubin, cholestatic jaundice, and hepatic necrosis. Hepatotoxicity with concurrent pulmonary reactions has occurred rarely. Hepatic toxicity has occurred more often following lengthy therapy (6 months or more) and has presented with jaundice, abdominal pain, malaise, nausea, and anorexia.
Peripheral neuropathy may develop after a few days to several months of therapy. There is no consistent relationship between the dose, length of therapy, and neuropathy development. In a review of 100 cases of peripheral neuropathy, 34 experienced total regression, 45 had partial regression, 13 had no change, and 8 died. Nitrofurantoin therapy in those at risk is not recommended.
Nervous system side effects have included headache and dizziness. Less frequently, severe and debilitating peripheral neuropathy due to nitrofurantoin may occur. Neuropathy generally begins as paresthesia of the lower extremities and the hands and progresses to muscle weakness and wasting. Patients at risk include the elderly and those with renal impairment, anemia, vitamin B12 deficiency, diabetes, or debilitating diseases. Vertigo, cerebellar dysfunction, benign intracranial hypertension (pseudotumor cerebri), and confusion have been reported rarely.
Hematologic side effects have included hemolytic anemia, leukopenia, agranulocytosis, granulocytopenia, megaloblastic anemia, cyanosis secondary to methemoglobinemia, eosinophilia, decreased hemoglobin, glucose-6-phosphate dehydrogenase deficiency anemia, thrombocytopenia, and aplastic anemia.
Hypersensitivity side effects have included lupus-like syndrome, angioedema, eruptions (maculopapular, erythematous, and eczematous), anaphylaxis, arthralgia, myalgia, drug fever, and chills.
Dermatologic side effects have included exfoliative dermatitis, erythema multiforme, and Stevens-Johnson syndrome.
Ocular side effects have included amblyopia, diplopia, nystagmus, and optic neuritis. Retinopathy due to intraretinal crystals has been reported in a patient with a nine year history of nitrofurantoin use.
Other side effects have included systemic lupus erythematous-like reactions (rare), asthenia, fever, chills, and superinfections due to resistant organisms.
Renal side effects have rarely included acute interstitial nephritis.
Psychiatric side effects have rarely included depression and psychotic reactions.
Metabolic side effects have included increased serum phosphorus, alkaline phosphatase, lactate dehydrogenase, and creatine phosphokinase.
Genitourinary side effects have included dark discoloration of urine.
More nitrofurantoin resources
- nitrofurantoin MedFacts Consumer Leaflet (Wolters Kluwer)
- nitrofurantoin Advanced Consumer (Micromedex) - Includes Dosage Information
- Nitrofurantoin Professional Patient Advice (Wolters Kluwer)
- Nitrofurantoin Monograph (AHFS DI)
- Furadantin Prescribing Information (FDA)
- Furadantin suspension MedFacts Consumer Leaflet (Wolters Kluwer)
- Macrobid Prescribing Information (FDA)
- Macrobid Consumer Overview
- Macrodantin Prescribing Information (FDA)
- Macrodantin MedFacts Consumer Leaflet (Wolters Kluwer)
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