Yes: Tablet and suspension

Antibiotic, Miscellaneous

Prevention and treatment of urinary tract infections caused by susceptible gram-negative and some gram-positive organisms; Pseudomonas, Serratia, and most species of Proteus are generally resistant to nitrofurantoin

B

Hypersensitivity to nitrofurantoin or any component; renal impairment; infants <1 month (due to the possibility of hemolytic anemia)

Use with caution in patients with G-6-PD deficiency, patients with anemia, vitamin B deficiency, diabetes mellitus or electrolyte abnormalities; therapeutic concentrations of nitrofurantoin are not attained in urine of patients with Cl_cr <40 mL/minute (elderly); use with caution if prolonged therapy is anticipated due to possible pulmonary toxicity; acute, subacute, or chronic (usually after 6 months of therapy) pulmonary reactions have been observed in patients treated with nitrofurantoin; if these occur, discontinue therapy; monitor closely for malaise, dyspnea, cough, fever, radiologic evidence of diffuse interstitial pneumonitis or fibrosis

Percentage unknown: Chest pains, chills, fever, fatigue, drowsiness, headache, dizziness, rash, itching, lupus-like syndrome, exfoliative dermatitis, stomach upset, diarrhea, loss of appetite/vomiting/nausea (most common), sore throat, hemolytic anemia, hepatitis, hypersensitivity, increased LFTs, weakness, paresthesia, numbness, arthralgia, cough, dyspnea, hypersensitivity, C. difficile-colitis

Symptoms of overdose include vomiting

Supportive care only

Decreased effect: Antacids, especially magnesium salts, decrease absorption of nitrofurantoin; nitrofurantoin may antagonize effects of norfloxacin

Increased toxicity: Probenecid (decreases renal excretion of nitrofurantoin); anticholinergic drugs increase absorption of nitrofurantoin

Inhibits several bacterial enzyme systems including acetyl coenzyme A interfering with metabolism and possibly cell wall synthesis

Absorption: Well absorbed from GI tract; the macrocrystalline form is absorbed more slowly due to slower dissolution, but causes less GI distress

Distribution: V_d: 0.8 L/kg; crosses the placenta; appears in breast milk

Protein binding: ~40%

Metabolism: 60% of drug metabolized by body tissues throughout the body, with exception of plasma, to inactive metabolites

Bioavailability: Increased by presence of food

Half-life: 20-60 minutes; prolonged with renal impairment

Elimination: As metabolites and unchanged drug (40%) in urine and small amounts in bile; renal excretion via glomerular filtration and tubular secretion

Oral:

Chronic therapy: 1-2 mg/kg/day in divided doses every 12-24 hours; maximum dose: 100 mg/day

Adults: 50-100 mg/dose every 6 hours

Macrocrystal/monohydrate: 100 mg twice daily

Prophylaxis or chronic therapy: 50-100 mg/dose at bedtime

Dosing adjustment in renal impairment: Cl_cr <50 mL/minute: Avoid use

Avoid use in hemo and peritoneal dialysis and continuous arteriovenous or venovenous hemofiltration (CAVH/CAVHD)

Alcohol: Avoid use

Signs of pulmonary reaction, signs of numbness or tingling of the extremities, periodic liver function tests

Causes false-positive urine glucose with Clinitest®

May cause drowsiness or dizziness

Concurrent use with anticholinergic/antiparkinsonian medications may increase the absorption of nitrofurantoin

No information available to require special precautions

No effects or complications reported

Take per recommended schedule, at regular intervals around-the-clock. Complete full course of therapy; do not skip doses. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). Diabetics should consult prescriber if using Clinitest® for glucose testing. Nitrofurantoin may discolor urine dark yellow or brown (normal). You may experience nausea or vomiting or GI upset (small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); fatigue, drowsiness, blurred vision (use caution when driving or engaging in tasks that require alertness until response to drug is known). Report chest pains or palpitations; pain on urination or blood in urine; skin rash; muscle weakness, pain, or tremors; excessive fatigue or weakness; other persistent adverse effects; or if condition does not improve.

Higher peak serum levels may cause increased GI upset; administer around-the-clock rather than 4 times/day, 3 times/day, etc, (ie, 12-6-12-6, not 9-1-5-9) to promote less variation in peak and trough serum levels; therapeutic concentrations of nitrofurantoin are not attained in the urine of patients with Cl_cr <40 mL/minute

Monitor for signs of pulmonary reaction, signs of numbness or tingling of the extremities, periodic liver function tests

Capsule: 50 mg, 100 mg

Capsule:

Macrocrystal: 25 mg, 50 mg, 100 mg

Macrocrystal/monohydrate: 100 mg

Suspension, oral: 25 mg/5 mL (470 mL)

Brendstrup L, Hjelt K, Petersen KE, et al, "Nitrofurantoin Versus Trimethoprim Prophylaxis in Recurrent Urinary Tract Infections in Children," Acta Paediatr Scand, 1990. 79(12):1225-34.

Burgert SJ, Burke JP, and Box TD, "Reversible Nitrofurantoin-Induced Chronic Active Hepatitis and Hepatic Cirrhosis in a Patient Awaiting Liver Transplantation," Transplantation, 1995, 59(3):448-9.

Coraggio MJ, Gross TP, and Roscelli JD, "Nitrofurantoin Toxicity in Children," Pediatr Infect Dis J, 1989, 8(3):163-6.

D'Arcy PF, "Nitrofurantoin," Drug Intell Clin Pharm, 1985, 19(7-8):540-7.

Penn RG and Griffin HP, "Adverse Reactions to Nitrofurantoin in the United Kingdom, Sweden, and Holland," Br Med J (Clin Res Ed), 1982, 284(6327):1440-2.