From the Guidelines
When taking Macrobid (nitrofurantoin), it is crucial to watch out for several important side effects and precautions to minimize the risk of morbidity, mortality, and to maintain quality of life. The most common side effects include nausea, headache, dark yellow or brown urine, and loss of appetite, as reported in studies such as 1 and 2. More serious concerns to monitor include pulmonary reactions (shortness of breath, chest pain, cough), liver problems (yellowing of skin/eyes, abdominal pain), peripheral neuropathy (numbness or tingling in extremities), and severe allergic reactions.
Important Considerations
- Macrobid should be avoided if you have kidney impairment (creatinine clearance below 60 mL/min), are in the third trimester of pregnancy, or have G6PD deficiency, as these conditions may increase the risk of adverse effects 2.
- Take Macrobid with food to reduce stomach upset and complete the full prescribed course (typically 5-7 days for urinary tract infections) to ensure effective treatment and minimize the risk of resistance, as suggested by studies such as 1.
- Drink plenty of water while taking this medication to help prevent kidney stones and reduce the risk of urinary tract infections.
- Macrobid works by damaging bacterial DNA and is effective against many common urinary tract pathogens, but it concentrates in the urinary tract and isn't suitable for systemic infections, as reported in 1 and 2.
Drug Interactions
- Always inform your healthcare provider about other medications you're taking as Macrobid has several potential drug interactions, including interactions with antacids, sulfinpyrazone, and probenecid, which may affect its efficacy or increase the risk of side effects 2.
Monitoring and Follow-up
- Regular monitoring of liver function, kidney function, and blood counts is recommended to minimize the risk of adverse effects and ensure effective treatment.
- Patients should be advised to seek medical attention immediately if they experience any signs of serious side effects, such as pulmonary reactions, liver problems, or severe allergic reactions.
From the FDA Drug Label
ADVERSE REACTIONS: Respiratory: CHRONIC, SUBACUTE, OR ACUTE PULMONARY HYPERSENSITIVITY REACTIONS MAY OCCUR. Hepatic: Hepatic reactions, including hepatitis, cholestatic jaundice, chronic active hepatitis, and hepatic necrosis, occur rarely Neurologic: Peripheral neuropathy, which may become severe or irreversible, has occurred Dermatologic: Exfoliative dermatitis and erythema multiforme (including Stevens-Johnson syndrome) have been reported rarely. Allergic: A lupus-like syndrome associated with pulmonary reactions to nitrofurantoin has been reported Gastrointestinal: Nausea, emesis, and anorexia occur most often. Hematologic: Cyanosis secondary to methemoglobinemia has been reported rarely.
Things to watch out for when taking Macrobid (nitrofurantoin) include:
- Respiratory reactions: chronic, subacute, or acute pulmonary hypersensitivity reactions
- Hepatic reactions: hepatitis, cholestatic jaundice, chronic active hepatitis, and hepatic necrosis
- Neurologic reactions: peripheral neuropathy, which may become severe or irreversible
- Dermatologic reactions: exfoliative dermatitis, erythema multiforme, and Stevens-Johnson syndrome
- Allergic reactions: lupus-like syndrome, angioedema, and anaphylaxis
- Gastrointestinal reactions: nausea, emesis, anorexia, abdominal pain, and diarrhea
- Hematologic reactions: cyanosis secondary to methemoglobinemia, agranulocytosis, leukopenia, granulocytopenia, hemolytic anemia, and thrombocytopenia 3
From the Research
Things to Watch Out for When Taking Macrobid (Nitrofurantoin)
- Gastrointestinal symptoms such as diarrhea, abdominal pain, and nausea are common adverse events associated with nitrofurantoin use 4
- Hypersensitivity reactions, acute renal failure, skin rash, urticaria, and vomiting are also potential adverse events associated with trimethoprim-sulfamethoxazole, another antibiotic used to treat urinary tract infections, but not specifically with nitrofurantoin 5
- Nitrofurantoin is generally well-tolerated, with fewer side effects reported compared to other antibiotics such as trimethoprim-sulfamethoxazole 6
- Patients with renal impairment (creatinine clearance less than 30 mL/min) should use nitrofurantoin with caution, as it may accumulate to toxic levels in the body 7
- Central nervous system symptoms such as dizziness and headache have been reported in some patients taking nitrofurantoin 6
Special Considerations
- Nitrofurantoin is not recommended for patients with a history of hepatic dysfunction or pulmonary disease, as it may exacerbate these conditions 6
- Patients should be monitored for signs of hepatic or pulmonary toxicity while taking nitrofurantoin 6
- Nitrofurantoin may interact with other medications, such as antacids, sulfonamides, and fluoroquinolones, which may increase the risk of adverse events 6