From the FDA Drug Label
ADVERSE REACTIONS: Respiratory: CHRONIC, SUBACUTE, OR ACUTE PULMONARY HYPERSENSITIVITY REACTIONS MAY OCCUR. Allergic: A lupus-like syndrome associated with pulmonary reactions to nitrofurantoin has been reported Also, angioedema; maculopapular, erythematous, or eczematous eruptions; pruritus; urticaria; anaphylaxis; arthralgia; myalgia; drug fever; chills; and vasculitis (sometimes associated with pulmonary reactions) have been reported.
The use of nitrofurantoin in asthmatic patients may be associated with an increased risk of pulmonary hypersensitivity reactions, including acute and chronic pulmonary reactions.
- These reactions can be severe and may require cessation of therapy.
- Anaphylaxis has also been reported with the use of nitrofurantoin. Given the potential for severe pulmonary reactions, the use of nitrofurantoin in asthmatic patients should be approached with caution 1.
From the Research
Macrobid (nitrofurantoin) is generally safe for asthmatic patients, but it's essential to monitor for potential pulmonary reactions, especially with long-term use. The medication primarily works in the urinary tract to treat urinary tract infections and has minimal systemic effects that would impact the respiratory system. According to the most recent and highest quality study available, which is not directly related to Macrobid but discusses asthma management, the focus should be on minimizing potential respiratory side effects and closely monitoring patients with asthma 2. The typical dosage for Macrobid is 100 mg twice daily for 5-7 days for uncomplicated urinary tract infections. However, it's crucial to note that nitrofurantoin can rarely cause pulmonary reactions, including acute pneumonitis and chronic interstitial pneumonia, which could potentially exacerbate respiratory symptoms in someone with asthma. These reactions are uncommon but more likely with long-term use. Patients with asthma taking Macrobid should be monitored for new or worsening respiratory symptoms such as cough, shortness of breath, or chest pain. If such symptoms develop, the medication should be discontinued, and the patient should seek medical attention. Alternative antibiotics may be considered if there are concerns about respiratory side effects in a particular asthmatic patient with severe or unstable disease.
Some key points to consider when managing asthmatic patients with Macrobid include:
- Monitoring for potential pulmonary reactions, especially with long-term use
- Closely observing patients with asthma for new or worsening respiratory symptoms
- Discontinuing the medication and seeking medical attention if symptoms develop
- Considering alternative antibiotics if concerns about respiratory side effects arise
- Focusing on minimizing potential respiratory side effects and closely monitoring patients with asthma, as suggested by the most recent and highest quality study available 2.
It's also important to note that the provided evidence does not directly address the safety of Macrobid in asthmatic patients, but rather discusses various aspects of asthma management and treatment. Therefore, the recommendation to use Macrobid in asthmatic patients is based on the medication's mechanism of action and potential side effects, rather than direct evidence from the provided studies.