Nitrofurantoin, adverse drug reaction

Lactation Nitrofurantoin has been detected in human breast milk in trace amounts. Because of the potential for serious adverse reactions from nitrofurantoin in nursing infants younger than 1 month of age, decide whether to discontinue breast-feeding or to discontinue the drug, taking into account the importance of the drug to the mother. 

Drug-related adverse events are rare with nitrofurantoin and occur in fewer patients than with co-trimoxazole or trimethoprim, for example (1-3). The frequency of certain adverse reactions varies in different geographical areas (4,5). Lung reactions are more prevalent in Scandinavia and South Africa than in the UK, whereas polyneuropathies or gastrointestinal reactions are more frequent in the UK than in Sweden. These discrepancies are unexplained. 

Allergic skin reactions occur in 1-2% of patients who take nitrofurantoin and comprise about 21% of all adverse reactions to nitrofurantoin (5,71). They often occur with other reactions, such as drug fever, lung, or hver reactions. The lesions can present as pruritus, as macular, maculopapular, or vesicular rashes, urticaria, angioedema, or erjdhema multiforme (72). The frequency of serious cutaneous reactions (erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis) after nitrofurantoin has been estimated to be 7 cases per 100 000 exposed individuals (71). 

It was suggested that the reduced gut motility caused by these drugs allows the nitrofurantoin to dissolve more completely so that it is absorbed by the gut more easily. Whether this is of any clinical importance is uncertain but it could possibly increase the incidence of dose-related adverse reactions. So far there appear to be no reports of any problems arising from concurrent use. 

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