nitrofurantoin induced lung disease

Last edited 05/2023 and last reviewed 05/2023

Nitrofurantoin induced lung disease

• potential for acute pulmonary damage with nitrofurantoin is well-documented
  • Summary of Product Characteristics (SmPC) states that acute, subacute and chronic pulmonary adverse reactions have been observed in patients treated with nitrofurantoin (1)
  • pulmonary toxicity can be either acute or chronic
    • occurs in less than 1% of patients
    • is one of the commonest causes of drug-induced pulmonary disease, with potentially serious and fatal outcomes (2)
  • symptoms of acute pulmonary reactions usually include (1)
    • fever,
    • chills,
    • cough,
    • chest pain,
    • dyspnoea,
    • pulmonary infiltration with consolidation or pleural effusion on chest X-ray,
    • and eosinophilia
  • for subacute pulmonary reactions, fever and eosinophilia occur less often than in the acute form

If symptoms of pulmonary damage occur, nitrofurantoin should be discontinued immediately.

Advice for healthcare professionals:

• advise patients and caregivers to be vigilant for new or worsening respiratory symptoms while taking nitrofurantoin and promptly investigate any symptoms that may indicate a pulmonary adverse reaction
• pulmonary reactions may occur with short- or long-term use of nitrofurantoin, and increased vigilance for acute pulmonary reactions is required in the first week of treatment
• patients receiving long-term therapy, for example for recurrent urinary tract infections, should be closely monitored for new or worsening respiratory symptoms, especially if elderly
• immediately discontinue nitrofurantoin if new or worsening symptoms of pulmonary damage occur
• be vigilant for symptoms and signs of liver dysfunction in patients taking nitrofurantoin for any duration, but particularly with long-term use, and monitor patients periodically for signs of hepatitis and for changes in biochemical tests that would indicate hepatitis or liver injury
• use caution when prescribing nitrofurantoin in patients with pulmonary disease or hepatic dysfunction, which may mask the signs and symptoms of adverse reactions
• advise patients to read carefully the advice in the Patient Information Leaflet about symptoms of possible pulmonary and hepatic reactions and to seek medical advice if they experience these symptoms
• report suspected adverse drug reactions (ADRs) to the Yellow Card scheme

Reference:

• Drug Safety Update volume 16, issue 9: April 2023: 3.Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions
• Madani Y, Mann B. Nitrofurantoin-induced lung disease and prophylaxis of urinary tract infections. Prim Care Respir J. 2012 Sep;21(3):337-41. doi: 10.4104/pcrj.2012.00059. PMID: 22836745; PMCID: PMC6547957.