From the Guidelines
Nitrofurantoin (Macrobid) is contraindicated in patients with severe kidney impairment, pregnant women at term, those with known hypersensitivity, G6PD deficiency, infants under one month of age, and patients with a history of cholestatic jaundice or hepatic dysfunction associated with previous nitrofurantoin use. The contraindications for Nitrofurantoin (Macrobid) are based on the potential for ineffective treatment and increased risk of toxicity in certain patient populations.
Key Contraindications
- Severe kidney impairment (creatinine clearance less than 30 mL/min) due to the risk of ineffective treatment and increased toxicity 1
- Pregnant women at term (38-42 weeks), during labor and delivery, or when the onset of labor is imminent due to the risk of hemolytic anemia in the newborn 1
- Patients with known hypersensitivity to nitrofurantoin or other components of the medication
- Those with G6PD deficiency due to the risk of hemolytic anemia
- Infants under one month of age due to the risk of hemolytic anemia
- Patients with a history of cholestatic jaundice or hepatic dysfunction associated with previous nitrofurantoin use These contraindications are supported by the most recent guidelines, including the 2024 European Association of Urology guidelines on urological infections 1.
Rationale
The rationale for these contraindications is based on the pharmacokinetics of nitrofurantoin, which is concentrated in the urine through kidney function. When kidneys are not working properly, the drug can accumulate in the bloodstream, causing toxicity while not reaching effective concentrations in the urine where it needs to work against urinary tract infections.
Clinical Implications
In clinical practice, it is essential to carefully evaluate patients for these contraindications before prescribing Nitrofurantoin (Macrobid) to minimize the risk of adverse effects and ensure effective treatment of urinary tract infections.
From the FDA Drug Label
CONTRDUCTED INFORMATION IS NOT PROVIDED IN THE LABEL, BUT THE FOLLOWING WARNINGS MAY IMPLY CONTRAINDICATIONS: Hepatic reactions, including hepatitis, cholestatic jaundice, chronic active hepatitis, and hepatic necrosis, occur rarely Peripheral neuropathy, which may become severe or irreversible, has occurred Fatalities have been reported. Conditions such as renal impairment (creatinine clearance under 60 mL per minute or clinically significant elevated serum creatinine), anemia, diabetes mellitus, electrolyte imbalance, vitamin B deficiency, and debilitating diseases may increase the possibility of peripheral neuropathy The FDA drug label does not answer the question.
From the Research
Contraindications for Nitrofurantoin (Macrobid)
- Nitrofurantoin is contraindicated in pregnant women at term and in neonates 2, 3
- Patients with known sensitivity to oxidant drugs, notably glucose-6-phosphate dehydrogenase (G6PD) deficiency, are at risk of haemolytic anaemia 2, 3, 4
- Nitrofurantoin is contraindicated in patients with a creatinine clearance (Clcr) less than 60 mL/min, although recent updates suggest it may be used in patients with a Clcr greater than or equal to 30 mL/min 5, 6
- Patients with renal impairment, particularly those with a Clcr less than 30 mL/min, should use nitrofurantoin with caution 5, 6