Published: June 2012

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Nitrofurantoin - Do the Benefits Outweigh the Risks Long-Term?

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Prescriber Update 33(2): 17-18
June 2012

Reports of suspected adverse reactions to the Centre for Adverse Reactions Monitoring (CARM) show that long-term (greater than six months) use of nitrofurantoin is associated with pulmonary toxicity.

CARM have received over 60 reports of serious pulmonary reactions following the use of nitrofurantoin. Pulmonary reports include pulmonary fibrosis (20), interstitial pneumonia (13), pulmonary infiltration (9) and interstitial lung disease (8). All of these conditions can have severe or fatal consequences^1,2. Pulmonary function may be permanently impaired even after treatment has been discontinued.

Nitrofurantoin is indicated for the treatment and prophylaxis of urinary tract infections. Long-term prophylaxis therapy is deemed as up to six months³. However, data provided by PHARMAC suggests that up to 5% of patients may be taking nitrofurantoin for longer than six months. Nitrofurantoin should not be prescribed beyond six months unless the expected benefits clearly outweigh the risks.

If the benefits of long-term use for an individual patient are considered to outweigh the risks, patients should be instructed to report the development of persistent cough or shortness of breath. Nitrofurantoin should be discontinued at the first signs of pulmonary toxicity³.

References

1. Lin DC, Bhally H. 2007. Nitrofurantoin-induced interstitial lung disease. New Zealand Medical Journal 120: U2753.
2. Medsafe. 2002. Pulmonary reactions with nitrofurantoin. Prescriber Update 23: 24-5. URL: www.medsafe.govt.nz/profs/PUarticles/nitrofurant.htm (accessed 24 May 2012).
3. W M Bamford & Company Limited. 2004. Nifuran Data Sheet 9 November 2004. URL: www.medsafe.govt.nz/profs/Datasheet/n/Nifurantab.pdf (Adobe PDF document 100KB) (accessed 24 May 2012).