From the Guidelines
Nitrofurantoin can cause liver injury, although the rates are extremely low, reported to be 0.0003%. This risk should be discussed with patients prior to prescribing, especially for long-term prophylaxis 1. The potential for hepatic toxicity is a serious consideration, and patients should be monitored for symptoms such as yellowing of the skin or eyes, dark urine, upper right abdominal pain, or unusual fatigue.
- The liver damage associated with nitrofurantoin can be reversible once the medication is stopped, but recovery from chronic injury may take months.
- Elderly patients, those with pre-existing liver disease, and women may be at higher risk of liver injury from nitrofurantoin.
- The risk of liver injury increases with prolonged use and higher doses of nitrofurantoin, highlighting the need for careful prescribing and monitoring 1.
- It is essential for patients to contact their healthcare provider immediately if they develop symptoms of liver injury while taking nitrofurantoin.
- Nitrofurantoin works by damaging bacterial DNA, but in some individuals, it can trigger an immune-mediated reaction in the liver or cause direct toxicity to liver cells, leading to liver injury 1.
From the FDA Drug Label
Hepatic reactions, including hepatitis, cholestatic jaundice, chronic active hepatitis, and hepatic necrosis, occur rarely
Yes, nitrofurantoin can cause liver injury, including hepatitis, cholestatic jaundice, chronic active hepatitis, and hepatic necrosis, although these reactions are rare 2.
From the Research
Nitrofurantoin and Liver Injury
- Nitrofurantoin, a commonly prescribed antibiotic for urinary tract infections, has been associated with liver injury, including hepatotoxicity and autoimmune-like hepatitis 3, 4, 5, 6, 7.
- The mechanism of hepatotoxicity is poorly understood but is believed to be the result of an immunologic process or a direct cytotoxic reaction 4.
- Prolonged exposure to nitrofurantoin, female sex, advanced age, and reduced renal function may increase the risk of developing hepatotoxicity 4.
Clinical Characteristics of Nitrofurantoin-Induced Liver Injury
- Hepatocellular damage is the most frequent pattern of liver injury, and nearly half of the patients may have an asymptomatic presentation 3.
- The median time to resolution of liver injury is approximately 81 days, and most patients recover within six months 3.
- However, some patients may develop nitrofurantoin-induced autoimmune-like hepatitis, which can require immunosuppressive treatment to achieve normalization of liver enzymes 3.
Management and Prevention of Nitrofurantoin-Induced Liver Injury
- Clinicians should be aware of the risk of liver injury associated with nitrofurantoin use, especially in high-risk patients, and weigh the risks and benefits of the medication before initiating therapy 4.
- Regular monitoring of liver function tests and prompt discontinuation of nitrofurantoin in cases of suspected liver injury are essential for preventing severe complications 4, 7.