nitrofurantoin induced agranulocytosis

Last edited 01/2023 and last reviewed 05/2023

Nitrofurantoin induced agranulocytosis

Idiosyncratic drug-induced agranulocytosis is a rare life-threatening adverse reaction characterised by an absolute neutrophil count <500 cells/muL of blood

A review noted (1):

• with respect to cases of agranulocytosis associated with use of nitrofurantoin
  • agranulocytosis seemed to occur independently of renal function, but creatinine clearance <60 mL/min would be a risk factor
• monitoring the total WBC, granulocyte count, and renal function may prevent agranulocytosis in patients treated with nitrofurantoin

A more recent review notes (2):

• agranulocytosis is described as a possible adverse effect with unknown frequency in the summary of product characteristics of nitrofurantoin, but few cases worldwide have been reported

According to worldwide adverse drug reaction data, approximately 0.0004% of nitrofurantoin treatments have resulted in hematologic reactions (3).

Reference:

• Roberts AD, Neelamegam M. Agranulocytosis associated with nitrofurantoin therapy. Ann Pharmacother. 2005 Jan;39(1):198.
• Lopes V et al. Nitrofurantoin-induced agranulocytosis. BMJ Case Reports CP 2021;14:e246788.
• D'Arcy PF. Nitrofurantoin. Drug Intell Clin Pharm. 1985 Jul-Aug;19(7-8):540-7.