Nitrofurantoin side effects

List of Side Effects
Gastrointestinal Central nervous system Neurologic Respiratory Hepatic Metabolic Allergic Dermatologic Hematologic Ears, eyes, nose, throat Miscellaneous
 * Chronic pulmonary reactions
 * Subacute pulmonary reactions
 * Acute pulmonary reactions
 * Cardiovascular
 * Cyanosis

Gastrointestinal
Diarrhea, dyspepsia, abdominal pain, anorexia, constipation, emesis, flatulence, nausea, sialadenitis, parotiditis, pancreatitis. There have been sporadic reports of pseudomembranous colitis with the use of Nitrofurantoin. The onset of pseudomembranous colitis symptoms may occur during or after antimicrobial treatment. Return to top

Central nervous system
Dizziness; drowsiness; headache; malaise; nystagmus; peripheral neuropathy. Return to top

Neurologic
Dizziness, drowsiness, amblyopia, asthenia, vertigo, nystagmus. Peripheral neuropathy, which may become severe or irreversible, has occurred. Fatalities have been reported. Conditions such as renal impairment (creatinine clearance under 60 mL per minute or clinically significant elevated serum creatinine), anemia, diabetes mellitus, electrolyte imbalance, vitamin B deficiency, and debilitating diseases may increase the possibility of peripheral neuropathy. Benign intracranial hypertension (pseudotumor cerebri), confusion, depression, optic neuritis, and psychotic reactions have been reported rarely. Bulging fontanels, as a sign of benign intracranial hypertension in infants, have been reported rarely. Return to top

Respiratory
Chronic, subacute, or acute pulmonary hypersensitivity reactions may occur with the use of Nitrofurantoin.

Chronic pulmonary reactions
Chronic pulmonary reactions generally occur in patients who have received continuous treatment for six months or longer. Malaise, dyspnea on exertion, cough and altered pulmonary function are common manifestations which can occur insidiously. Radiologic and histologic findings of diffuse interstitial pneumonitis or fibrosis, or both, are also common manifestations of the chronic pulmonary reaction. Fever is rarely prominent.

The severity of chronic pulmonary reactions and their degree of resolution appear to be related to the duration of therapy after the first clinical signs appear. Pulmonary function may be impaired permanently, even after cessation of therapy. The risk is greater when chronic pulmonary reactions are not recognized early. Return to top

Subacute pulmonary reactions
In subacute pulmonary reactions, fever and eosinophilia occur less often than in the acute form. Upon cessation of therapy, recovery may require several months. If the symptoms are not recognized as being drug-related and Nitrofurantoin therapy is not stopped, the symptoms may become more severe. Return to top

Acute pulmonary reactions
Acute pulmonary reactions are commonly manifested by fever, chills, cough, chest pain, dyspnea, pulmonary infiltration with consolidation or pleural effusion on x-ray, and eosinophilia. Acute reactions usually occur within the first week of treatment and are reversible with cessation of therapy. Resolution often is dramatic. Return to top

Cardiovascular
Changes in EKG (e.g., non-specific ST/T wave changes, bundle branch block) have been reported in association with pulmonary reactions. Return to top

Cyanosis
Cyanosis has been reported rarely. Return to top

Hepatic
Cholestatic jaundice; chronic active hepatitis; hepatic necrosis; hepatitis; hepatotoxicity; increased AST and ALT; increased bilirubin and alkaline phosphatase; jaundice; permanent liver dysfunction. Return to top

Metabolic
Increased serum phosphorous. Return to top

Allergic
Pruritus, urticaria. Lupus-like syndrome associated with pulmonary reaction to Nitrofurantoin has been reported. Also, angioedema; maculopapular, erythematous, or eczematous eruptions; anaphylaxis; arthralgia; myalgia; drug fever; and chills have been reported. Hypersensitivity reactions represent the most frequent spontaneously-reported adverse events in worldwide postmarketing experience with Nitrofurantoin formulations. Return to top

Dermatologic
Alopecia; angioedema; erythema multiforme (including Stevens-Johnson syndrome); exfoliative dermatitis; maculopapular, erythematous, or eczematous eruption; photosensitivity; pruritus; urticaria. Return to top

Hematologic
Agranulocytosis; aplastic anemia; decreased hemoglobin; eosinophilia; granulocytopenia; hemolytic anemia from G-6-PD deficiency; leukopenia; megaloblastic anemia; thrombocytopenia. Cyanosis secondary to methemoglobinemia has been reported rarely. Return to top

Ears, eyes, nose, throat
Optic neuritis (postmarketing). Return to top

Miscellaneous
Fever, chills, malaise, headache, anaphylaxis, arthralgia, asthmatic attack in patient with history of asthma, benign intracranial hypertension, drug fever, muscular aches. As with other antimicrobial agents, superinfections caused by resistant organisms, e.g., Pseudomonas species or Candida species, can occur. Return to top