Furazolidone Disease Interactions

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

Furazolidone may inhibit alcohol dehydrogenase and occasionally precipitate a disulfiram-like reaction in patients who consume alcohol while taking the medication. Symptoms may include nausea, vomiting, flushing, sweating, headache, abdominal cramps, dyspnea, chest tightness, and hypotension. Patients should be instructed to avoid alcohol-containing products during therapy and for at least 4 days after the last dose. Therapy with furazolidone should be administered cautiously in patients who might be prone to acute alcohol intake. An alternative therapy may be appropriate.

Furazolidone may cause mild, reversible hemolytic anemia in the presence of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Therapy with furazolidone should be administered cautiously in patients with G-6-PD deficiency. The drug should be discontinued if hemolytic anemia occurs during therapy.