This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Go to /pro/cpd-dashboard page

This page is worth 0.05 CPD credits. CPD dashboard

Go to /account/subscription-details page

This page is worth 0.05 CPD credits. Upgrade to Pro

Nitrofurantoin induced liver disease

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Nitrofurantoin can rarely cause hepatic reactions, including (1)

  • cholestatic jaundice,
  • chronic active hepatitis,
  • autoimmune hepatitis,
  • and hepatic necrosis
  • nitrofurantoin should be discontinued immediately if hepatitis occurs.

The onset of hepatitis may be gradual and may not have obvious symptoms at first (1)

  • is important to monitor patients periodically for changes in biochemical tests that could indicate hepatic dysfunction and for clinical signs or symptoms of liver abnormality, especially in patients taking long-term nitrofurantoin

Nitrofurantoin-induced acute liver injury generally presents days to weeks after initiation of the drug (2)

  • is characterized by a predominant hepatocellular enzyme elevation with possible symptoms of fever, rash, jaundice, abdominal pain, nausea, malaise, and anorexia

Chronic injury is more insidious and usually presents after 6 months of therapy (2)

Advice for healthcare professionals:

  • advise patients and caregivers to be vigilant for new or worsening respiratory symptoms while taking nitrofurantoin and promptly investigate any symptoms that may indicate a pulmonary adverse reaction
  • pulmonary reactions may occur with short- or long-term use of nitrofurantoin, and increased vigilance for acute pulmonary reactions is required in the first week of treatment
  • patients receiving long-term therapy, for example for recurrent urinary tract infections, should be closely monitored for new or worsening respiratory symptoms, especially if elderly
  • immediately discontinue nitrofurantoin if new or worsening symptoms of pulmonary damage occur
  • be vigilant for symptoms and signs of liver dysfunction in patients taking nitrofurantoin for any duration, but particularly with long-term use, and monitor patients periodically for signs of hepatitis and for changes in biochemical tests that would indicate hepatitis or liver injury
  • use caution when prescribing nitrofurantoin in patients with pulmonary disease or hepatic dysfunction, which may mask the signs and symptoms of adverse reactions
  • advise patients to read carefully the advice in the Patient Information Leaflet about symptoms of possible pulmonary and hepatic reactions and to seek medical advice if they experience these symptoms
  • report suspected adverse drug reactions (ADRs) to the Yellow Card scheme

Reference:

  • Drug Safety Update volume 16, issue 9: April 2023: 3.Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions
  • Luk T, Edwards BD, Bates D, Evernden C, Edwards J. Nitrofurantoin-induced liver failure: A fatal yet forgotten complication. Can Fam Physician. 2021 May;67(5):342-344. doi: 10.46747/cfp.6705342. PMID: 33980626; PMCID: PMC8115952.

Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.