Nitrofurantoin

Indications
 Oral
Acute uncomplicated urinary tract infections
Adult: 50-100 mg 4 times daily for 7 days. Dual-release preparation: 100 mg bid.
Child: >3 mth and older children: 3 mg/kg daily in 4 divided doses.
Oral
Prophylaxis of uncomplicated urinary tract infections
Adult: 50-100 mg at bedtime.
Child: >3 mth and older children: 1 mg/kg once daily.
Contraindications
 Severe renal impairment (anuria, oliguria, significantly elevated serum creatinine, CrCl <60 ml/min). Hypersensitivity to nitrofurans, G6PD deficiency, infants <3 mth. Pregnancy at term, during labour and delivery, or when the onset of labour is imminent.
Warnings / Precautions
 Elderly. Monitor hepatic and pulmonary function during prolonged therapy. Pre-existing pulmonary, hepatic, neurological, or allergic disorders, predisposition to peripheral neuropathy e.g. renal impairment, anaemia, DM, electrolyte imbalance, debility, vitamin B deficiency. Withdraw if signs of peripheral neuropathy occur. Lactation.
Adverse Reactions
 Nausea, vomiting, anorexia, abdominal pain, diarrhoea; headache, drowsiness, vertigo, dizziness, nystagmus, benign intracranial hypertension; rash, urticaria, pruritus, fever, sialadenitis, angioedema, erythema multiforme, exfoliative dermatitis, pancreatitis, lupus-like syndrome, myalgia, arthralgia; acute pulmonary sensitivity reactions; megaloblastic anaemia, leucopenia, granulocytopenia or agranulocytosis, thrombocytopenia, aplastic anaemia, haemolytic anaemia (in G6PD-deficient patients); transient alopecia; brownish discolouration of urine.
Potentially Fatal: Peripheral polyneuropathy, hepatotoxicity, anaphylaxis, Stevens-Johnson syndrome, interstitial pneumonitis, pulmonary fibrosis.
Overdose Reactions
 Symptoms include vomiting. Management is supportive; dialysable.
Drug Interactions
 Reduced excretion with probenecid or sulfinpyrazone. Absorption reduced by magnesium trisilicate. Antagonistic effects with quinolone antibacterials. Reduced effects with carbonic anhydrase inhibitors or urinary alkalinisers.
See Below for More nitrofurantoin Drug Interactions
Lab Interactions
 False-positive test for urinary glucose using cupric sulfate solution.
Food Interactions
 Food may increase bioavailability and prolong therapeutic concentrations in urine.
Mechanism of Actions
 Nitrofurantoin interferes with cell metabolism and cell wall synthesis by inhibiting several enzyme systems including acetyl coenzyme A. It is bactericidal to most gram-positive and gram-negative urinary tract pathogens.
Absorption: Readily absorbed from the GI tract. Food may increase bioavailability and prolong the duration of therapeutic urinary concentrations.
Distribution: Concentrations in blood and body tissues are low; crosses the placenta and the blood-brain barrier and distributes in breast milk (trace amounts).
Metabolism: Hepatic and in most body tissues.
Excretion: Via urine (30-40% of a dose excreted rapidly as unchanged drug); some tubular reabsorption may occur in acid urine. Plasma half-life: 0.3-1 hr.
Administration
 Should be taken with food. (Take w/ or immediately after meals.)
Storage Conditions
 Oral: Store at 15-30°C (59-86°F).
ATC Classification
 J01XE01 - nitrofurantoin ; Belongs to the class of nitrofuran derivative antibacterials. Used in the systemic treatment of infections.
Storage
 Oral: Store at 15-30°C (59-86°F).
Available As
  • Nitrofurantoin 100 mg
  • Nitrofurantoin 50 mg

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