From the FDA Drug Label
Hepatic: Hepatic reactions, including hepatitis, cholestatic jaundice, chronic active hepatitis, and hepatic necrosis, occur rarely Laboratory Adverse Events: The following laboratory adverse events have been reported with the use of nitrofurantoin: increased AST (SGOT), increased ALT (SGPT)
Macrodantin (nitrofurantoin) can increase liver function tests (LFTs), as evidenced by reports of increased AST (SGOT) and ALT (SGPT) in the drug label 1 and 1. Key points to consider:
- Hepatic reactions, including hepatitis and hepatic necrosis, can occur rarely
- Increased LFTs, such as AST and ALT, have been reported with the use of nitrofurantoin It is essential to monitor LFTs in patients taking Macrodantin, especially those with pre-existing liver conditions or risk factors for liver disease.
From the Research
Yes, Macrodantin (nitrofurantoin) can increase liver function tests (LFTs). This antibiotic, commonly used to treat urinary tract infections, has been associated with both acute and chronic liver injury in some patients, as reported in a study published in 2014 2. Acute hepatotoxicity typically occurs within the first few weeks of treatment and presents with elevated transaminases (ALT, AST), while chronic liver injury may develop after months or years of therapy and can resemble autoimmune hepatitis.
Key Points to Consider
- The risk of liver injury appears to be higher in elderly patients, those with pre-existing liver disease, and with prolonged use.
- The mechanism involves both direct toxicity to hepatocytes and immune-mediated liver damage.
- If a patient on nitrofurantoin develops symptoms such as fatigue, nausea, abdominal pain, jaundice, or unexplained elevated LFTs, the medication should be discontinued immediately and liver function monitored.
- Most cases of acute liver injury resolve within weeks after stopping the medication, though chronic cases may take longer to improve.
- Healthcare providers should consider baseline LFTs before starting long-term nitrofurantoin therapy and monitor periodically during treatment, as suggested by the study 2.
Monitoring and Management
- Regular monitoring of LFTs is crucial in patients on long-term nitrofurantoin therapy.
- Patients should be educated on the signs and symptoms of liver injury and instructed to seek medical attention if they experience any unusual symptoms.
- In cases of suspected hepatotoxicity, nitrofurantoin should be discontinued, and alternative treatments considered.
- The use of corticosteroids in the management of severe cases of nitrofurantoin-induced hepatotoxicity is still a topic of debate, and their utility has not been proven, as noted in the study 2.