Renal function impairment nitrofurantoin

Anuria, oliguria, or significant impairment of renal function (creatinine clearance [Ccr] less than 60 mL/min or clinically significant elevated serum creatinine) hypersensitivity to nitrofurantoin. 

More than 140 cases of toxic polyneuropathy have been reported. The frequency depends on dose, tissue concentration, and renal function in up to 90% of cases polyneuropathy occurred in patients with renal insufficiency (32). Symptoms usually start 9-45 days (at the earliest 3 days) after beginning nitrofurantoin. The neuropathy starts peripherally, predominantly affects the limbs, and remains more severe distaUy. Initially, there is sensory loss with paresthesia. Later, motor loss develops, often with severe muscle atrophy. As a rule, no further deterioration occurs after withdrawal of nitrofurantoin, and there may be total regression (34% of cases) or partial regression (45% of cases) (32). In some severe cases there is residual disability. The motor loss resolves more slowly and less completely than the sensory impairment. Single cases of retrobulbar optic neuritis, lateral rectus muscle palsy, and facial nerve palsy have been reported (33). 

The main risk factor for toxic reactions to nitrofurantoin, especially poljmeuropathy and gastrointestinal sjmptoms, is impaired renal function (32). 

The oral dosage of nitrofurantoin for adults is 50-100 mg four times a day with meals and at bedtime. A single 50- to 100-mg dose at bedtime may be sufficient to prevent recurrences. A course of therapy should not exceed 14 days. Pregnant women, individuals with impaired renal function (creatinine clearance <40 mUmin), and children <1 month of age should not receive nitrofurantoin. 

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