Nitrofurantoin

Renal impairment

• Check renal function before starting nitrofurantoin, especially in the elderly.
• The antibacterial efficacy of nitrofurantoin depends on adequate renal secretion into the urinary tract. Therefore, there is reduced efficacy of nitrofurantoin in renal impairment.
• Avoid if eGFR less than 45mL/min/1.73m².
  • A short course (3-7 days) may be used with caution in patients with an eGFR between 30-44mL/min/1.73m².
• HD/HDF/High Flux/PD - Contra-indicated.

Hepatic impairment
Use with caution; cholestatic jaundice and chronic active hepatitis reported.

Pregnancy

Safe to use in pregnancy, however it is contra-indicated in patients at term (including during labour and delivery) due to possibility of haemolytic anaemia in the foetus or newborn infant.

Breastfeeding

Avoid; only small amounts in milk but enough to produce haemolysis in G6PD-deficient infants. Discuss with pharmacy.

Adverse effects has been reported with nitrofurantoin see Nitrofurantoin MHRA drug safety updates

Closely monitor for signs of pulmonary, hepatic, neurological, haematological, and gastrointestinal side effects during treatment.

1. Summary of Product Characteristics (SPC) for Nitrofurantoin 50mg Capsules. Accessed via www.medicines.org.uk 26/03/18. Last updated 24/11/14
2. The Renal Drug Database. Nitrofurantoin. Accessed via renaldrugdatabase.com 26/03/18. Last updated 16/11/17
3. BNF online accessed via www.medicinescomplete.com 8/1/19; last updated 11/12/18
4. MHRA. Drug Safety update (February 2015) Nitrofurantoin now contraindicated in most patients with an estimated glomerular filtration rate (eGFR) of less than 45 ml/min/1.73m2. Accessed at https://www.gov.uk/drug-safety-update/nitrofurantoin-now-contraindicated-in-most-patients-with-an-estimated-glomerular-filtration-rate-egfr-of-less-than-45-ml-min-1-73m2
5. MHRA. Drug Safety udpate (April 2023) Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions. Accessed at Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions - GOV.UK (www.gov.uk)