Nitrofurantoin

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Generic Name of Nitrofurantoin - Learn More

Nitrofurantoin

Nitrofurantoin Precaution - What You Need to Know

Before using nitrofurantoin, it is essential for patients to consult their healthcare provider, especially if they have any of the following conditions:
- Renal Impairment: Nitrofurantoin is contraindicated in patients with renal impairment (creatinine clearance <60 mL/min) as it may lead to an accumulation of the drug, increasing the risk of toxicity, including pulmonary toxicity and hepatotoxicity.
- Liver Disease: Caution is required in individuals with existing liver conditions. Nitrofurantoin can cause hepatotoxicity, which may be severe in patients with pre-existing liver disease.
- Pregnancy: Nitrofurantoin is generally not recommended during the first trimester of pregnancy due to potential teratogenic effects. It should only be used during pregnancy when absolutely necessary, particularly after the first trimester, and it should be avoided near delivery as it can cause hemolytic anemia in the newborn.
- Elderly Patients: In elderly patients, especially those with impaired kidney function, nitrofurantoin may pose a higher risk of adverse effects. The drug should be prescribed with caution and at a reduced dose if necessary.
- Peripheral Neuropathy: Nitrofurantoin may cause peripheral neuropathy in susceptible individuals, particularly those with diabetes, deficiency in vitamin B6, or long-term use. Patients with these conditions should be monitored closely for signs of nerve damage.
- Blood Disorders: Individuals with a history of glucose-6-phosphate dehydrogenase (G6PD) deficiency should avoid nitrofurantoin as it may induce hemolysis (destruction of red blood cells).

Nitrofurantoin Indication - Uses and Benefits

Nitrofurantoin is primarily used as an antibacterial for the treatment and prevention of urinary tract infections (UTIs) caused by susceptible organisms. The main indications include:
- Urinary Tract Infections (UTIs): Nitrofurantoin is commonly prescribed for uncomplicated lower UTIs, including cystitis (bladder infection). It is effective against a range of bacteria, particularly Escherichia coli (E. coli), the most common cause of UTIs.
- Prophylaxis of UTIs: It can also be used for the prevention of recurrent UTIs, especially in patients prone to frequent infections.
- Chronic UTI Management: In some cases, nitrofurantoin is used long-term to manage chronic or recurrent UTIs, particularly in patients with structural urinary tract abnormalities that predispose them to infections.

Nitrofurantoin Contraindications - Important Warnings

The following conditions represent contraindications to nitrofurantoin therapy:
- Renal Insufficiency: Nitrofurantoin should not be used in patients with significant renal impairment, including those with a creatinine clearance less than 60 mL/min, as the drug may not be properly excreted and could cause toxicity.
- Pregnancy (First Trimester): Nitrofurantoin should not be used during the first trimester of pregnancy, as it may cause teratogenic effects. It is also contraindicated near term (at or after 38 weeks) due to risks to the newborn.
- History of Nitrofurantoin Hypersensitivity: If a patient has a known allergy to nitrofurantoin or any of its excipients, it should be avoided.
- Liver Disease: Nitrofurantoin is contraindicated in patients with significant hepatic impairment, as it can exacerbate liver damage and cause liver failure.

Nitrofurantoin Side Effects - What to Expect

Common side effects of nitrofurantoin include:
- Gastrointestinal Distress: Nausea, vomiting, and abdominal pain are frequent, especially with higher doses. Taking the medication with food can help mitigate these effects.
- Headache: Some patients may experience mild headaches while on nitrofurantoin.
- Dizziness or Lightheadedness: This can occur, particularly when standing up quickly (orthostatic hypotension).
- Rash: A mild skin rash can develop, though it is generally not severe.

Serious side effects include:
- Pulmonary Toxicity: Chronic use or overdose of nitrofurantoin can lead to pulmonary fibrosis, interstitial lung disease, or acute hypersensitivity pneumonitis. Symptoms may include cough, shortness of breath, and chest pain.
- Hepatotoxicity: Nitrofurantoin can cause liver damage, which can be severe and include jaundice (yellowing of the skin and eyes), dark urine, and elevated liver enzymes.
- Peripheral Neuropathy: Nitrofurantoin has been linked to nerve damage, particularly with prolonged use. Symptoms include numbness, tingling, and weakness in the extremities.
- Hemolytic Anemia: In patients with G6PD deficiency, nitrofurantoin may induce hemolysis, leading to a reduction in red blood cells and causing fatigue, pallor, and jaundice.
- Allergic Reactions: Severe allergic reactions, including anaphylaxis, are rare but possible and require immediate medical attention.

Nitrofurantoin Pregnancy Category ID - Safety Information

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Nitrofurantoin Mode of Action - How It Works

Nitrofurantoin works by interfering with the bacterial cell’s enzyme systems that are necessary for its metabolism and survival. Its mechanism includes:
- Inhibition of Bacterial Enzyme Systems: Nitrofurantoin is reduced inside the bacterial cell, forming highly reactive metabolites that disrupt bacterial DNA, RNA, and cell wall synthesis. This leads to bacterial cell death or inhibition of growth.
- Bactericidal and Bacteriostatic Effects: It is bactericidal (kills bacteria) at higher concentrations and bacteriostatic (inhibits bacterial growth) at lower concentrations. It works primarily against Gram-positive and Gram-negative bacteria that cause urinary tract infections.

Nitrofurantoin Drug Interactions - What to Avoid

Nitrofurantoin can interact with several drugs and substances, potentially affecting its efficacy or increasing the risk of side effects:
- Antacids with Magnesium: Magnesium-containing antacids (e.g., Maalox, Mylanta) can reduce the absorption of nitrofurantoin, decreasing its effectiveness. It is advisable to avoid these antacids within 2 hours of taking nitrofurantoin.
- Probenecid: The use of probenecid (a drug used for gout) can increase nitrofurantoin levels in the blood, potentially increasing the risk of toxicity.
- Sulfonamides: The use of nitrofurantoin with sulfonamides can increase the risk of hemolytic anemia, particularly in patients with G6PD deficiency.
- Quinoline Antimalarials: Medications like chloroquine or quinine, when used with nitrofurantoin, can increase the risk of neuropathy.
- Oral Contraceptives: There is limited evidence of interaction, but some studies suggest that nitrofurantoin might reduce the effectiveness of oral contraceptives, leading to a potential risk of unintended pregnancy.

Nitrofurantoin Adult Dose - Recommended Dosage

The typical adult dosing regimen for nitrofurantoin varies depending on the type of infection:
- Acute Uncomplicated UTI: The usual dose is 100 mg every 12 hours for 5-7 days.
- Chronic UTI Prophylaxis: For long-term prevention of recurrent UTIs, the typical dose is 50-100 mg once daily at bedtime. This is often prescribed for several months, but it should be used with caution and under medical supervision.
- Renal Consideration: Nitrofurantoin should not be used in patients with renal impairment (creatinine clearance <60 mL/min) as it may lead to toxicity.

Nitrofurantoin Child Dose - Dosage for Children

The pediatric dosing of nitrofurantoin depends on the child’s age and weight:
- For Children 1 Month and Older: The typical dose is 1-2 mg/kg per day, divided into 2-4 doses, not exceeding 200 mg per day. This can be prescribed for the treatment of uncomplicated UTIs.
- For UTI Prophylaxis in Children: The dose for long-term prophylaxis is usually 1 mg/kg per day, taken at bedtime.

Nitrofurantoin Renal Dose - Dosage for Kidney Conditions

Nitrofurantoin is not recommended in patients with significant renal impairment:
- Creatinine Clearance <60 mL/min: In patients with impaired kidney function, nitrofurantoin is contraindicated due to the risk of accumulation and toxicity, particularly pulmonary and hepatic issues.
- Patients with mild renal impairment: Nitrofurantoin should be used with caution, and the physician may need to monitor renal function regularly.