These visual disturbances are usually reversible; however, nitrofurantoin mono mac 100mg caps used treat cases of prolonged visual disturbance have been reported with some occurring after Clomid discontinuation. Talc should not be used for pleurodesis in patients with nonmalignant pleural effusions. The recommended adult dose for treating urinary tract infections is 50-100 mg 4 times daily (Macrodantin, Furadantin) or 100 mg every 12 hours (Macrobid) for 7.
Clinical data | |
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Trade names | Macrobid, Macrodantin and others |
AHFS/Drugs.com | Monograph |
MedlinePlus | a682291 |
Pregnancy category | |
Routes of administration | by mouth |
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Pharmacokinetic data | |
Bioavailability | 40% |
Metabolism | liver (75%) |
Elimination half-life | 20 minutes |
Excretion | urine and bile |
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PubChemCID | |
DrugBank |
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ChemSpider | |
UNII | |
KEGG | |
ChEBI |
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ECHA InfoCard | |
Chemical and physical data | |
Formula | C8H6N4O5 |
Molar mass | 238.16 g·mol−1 |
3D model (JSmol) | |
Melting point | 270 to 272 °C (518 to 522 °F) (decomp.) |
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(what is this?)(verify) |
Nitrofurantoin, sold under the trade name Macrobid among others, is an antibiotic used to treat bladder infections.[1] It is not effective for kidney infections.[1] It is taken by mouth.[1]
Common side effects include nausea, loss of appetite, diarrhea, and headaches.[1] Rarely numbness, lung problems, or liver problems may occur.[1] It should not be used in people with kidney problems.[1] While it appears to be generally safe during pregnancy it should not be used near delivery.[1][2] It works by slowing growth rather than killing bacteria.[1]
Nitrofurantoin was first sold in 1953.[3] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[4] It is available as a generic medication.[1] The wholesale cost in the developing world is between 0.10 and 9.20 USD for a course of treatment.[5] In the United States, the wholesale cost is about 8 USD for this amount as of 2018.[6] In 2016 it was the 186th most prescribed medication in the United States with more than 3 million prescriptions.[7]
- 1Medical uses
- 2Adverse effects
- 3Pharmacology
- 7Society and culture
Medical uses[edit]
100 mg Macrobid, Canada
Current uses include the treatment of uncomplicated urinary tract infections (UTIs) and prophylaxis against UTIs in people prone to recurrent UTIs.[8]
Increasing bacterial antibiotic resistance to other commonly used agents, such as fluoroquinolones and trimethoprim/sulfamethoxazole, has led to increased interest in using nitrofurantoin.[9][10] The efficacy of nitrofurantoin in treating UTIs combined with a low rate of bacterial resistance to this agent makes it one of the first-line agents for treating uncomplicated UTIs as recommended by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.[11]
Nitrofurantoin is not recommended for the treatment of pyelonephritis,[11]prostatitis,[12] and intra-abdominal abscess,[13] because of extremely poor tissue penetration and low blood levels.
Antibacterial activity[edit]
Nitrofurantoin has been shown to have good activity against:
- Citrobacter species
- Klebsiella species
- Bacillus subtilis species
It is used in the treatment of infections caused by these organisms.[14]
Many or all strains of the following genera are resistant to nitrofurantoin:[14]
Antibiotic susceptibility testing should always be performed to further elucidate the resistance profile of the particular strain of bacteria causing infection.
Pregnancy[edit]
Nitrofurantoin is pregnancy category B.[8] It is one of the few drugs commonly used in pregnancy to treat UTIs.[15] Other drugs used for UTIs in pregnancy include cephalexin, amoxicillin, and pivmecillinam. The drug should not be given to women in late pregnancy due to the potential risk of hemolytic anemia in the newborn, as the newborn has not yet developed the enzymatic pathways necessary for glutathione metabolism and the drug may cause oxidative damage to the red blood cells. Newborns of women given this drug late in pregnancy had a higher risk of developing neonatal jaundice.[16]
Several trials on the safety and teratogenicity of nitrofurantoin in pregnancy have shown mixed results. A retrospective study in 2009 claimed that several birth defects, such as hypoplastic left heart syndrome, ophthalmic malformations, cleft lip and cleft palate, and atrial septal defect, were more common in neonates exposed to nitrofurantoin during pregnancy.[17] A meta analysis of four out of twenty-two available studies on the safety of nitrofurantoin found no increased risk.[18] A case-control study in 1998 found an increased risk of craniosynostosis after exposure to 'nitrosatable' drugs.[19] A more recent 2013 population-based cohort study which used women registered in the Norwegian Prescription Database and linked the subjects to a birth outcomes database, however, found no increased risk of major malformations in neonates born to women who took nitrofurantoin in early pregnancy.[16] Many of the studies showing increased risk of nitrofurantoin had limitations and relied on patients' recall of the antibiotics they took during pregnancy rather than objective data, which may have led to recall bias. Nevertheless, in light of these conflicting data, the American College of Obstetrics and Gynecology (ACOG) recommends using antibiotics only for appropriate indications and for the shortest effective duration.[20]
Adverse effects[edit]
The most common side effects with nitrofurantoin are nausea, headache, and flatulence. Less common adverse events (occurring in less than 1% of those taking the drug) include:[8]
- Gastrointestinal: diarrhea, dyspepsia, abdominal pain, constipation, emesis
- Neurologic: dizziness, drowsiness, amblyopia
- Respiratory: acute pulmonary hypersensitivity reaction
- Allergic: pruritus, urticaria
- Dermatologic: hair loss
- Miscellaneous: fever, chills, malaise
Patients should be informed that nitrofurantoin colours urine brown; this is completely harmless.[8]
Some of the more serious but rare side effects of nitrofurantoin have been a cause of concern. These include pulmonary reactions, hepatotoxicity, and neuropathy.
Pulmonary toxicity[edit]
The pulmonary toxicity caused by nitrofurantoin can be categorized into acute, subacute, and chronic pulmonary reactions. The acute and subacute reactions are thought to be due to a hypersensitivity reaction and often resolve when the drug is discontinued. Acute reactions have been estimated to occur in about one in 5000 women who take the drug.[21][22] These reactions usually develop 3–8 days after the first dose of nitrofurantoin, but may occur from a few hours to a few weeks after starting the drug. Symptoms include fever, dyspnea, chills, cough, pleuritic chest pain, headache, back pain, and epigastric pain. Chest radiograph will often show unilateral or bilateral infiltrates similar to pulmonary edema. Treatment includes discontinuation of the nitrofurantoin, which should result in symptom improvement within 24 hours.[23]
Chronic pulmonary reactions caused by nitrofurantoin include diffuse interstitial pneumonitis, pulmonary fibrosis, or both.[8] This uncommon reaction may occur 1 month to 6 years after starting the drug and is usually related to its total lifetime dose.[citation needed] This reaction manifests with progressive shortness of breath.[24] It is important to recognize nitrofurantoin as possible cause of symptoms and discontinue the drug when the suspicion of pulmonary side effects arises as it can be reversible if the drug is stopped early.[22]
Hepatotoxicity[edit]
Hepatic reactions, including hepatitis, cholestatic jaundice, chronic active hepatitis, and hepatic necrosis, occur rarely. The onset of chronic active hepatitis may be insidious, and patients should be monitored periodically for changes in biochemical tests that would indicate liver injury.[8] These reactions usually occur after exposure to the drug for more than 6 weeks. If signs of liver failure are observed in a patient taking nitrofurantoin, the drug should be discontinued. Re-challenge with the drug at a later date is not recommended, as the reaction may have a hypersensitivity component and recur when the drug is resumed.[25]
Neuropathy[edit]
Neuropathy is a rare side effect of taking nitrofurantoin. Patients may experience numbness and tingling in a stocking-glove pattern, which may or may not improve upon discontinuation of the drug.[26]
Contraindications[edit]
Nitrofurantoin is contraindicated in patients with decreased renal function (CrCl < 60 ml/min) due to systemic accumulation and subtherapeutic levels reached in the urinary tract.[8] However, a retrospective chart review suggests the data for this cutoff are slim and a cutoff of CrCl < 40 ml/min would be more appropriate.[27] Many of the severe side effects of this drug are more common in the elderly and those with renal impairment, as this causes the drug to be retained in the body and reach higher systemic levels. Thus, the drug is not recommended for the elderly population according to 2012 AGS Beers criteria.[28]
Nitrofurantoin is also contraindicated in babies up to the age of one month, as they have immature enzyme systems in their red blood cells (glutathione instability), so nitrofurantoin must not be used because it can cause haemolytic anaemia. For the same reason, nitrofurantoin should not be given to pregnant women after 38 weeks of pregnancy. Nitrofurantoin is contraindicated in patients with glucose-6-phosphate dehydrogenase deficiency because of risk of intravascularhemolysis resulting in anemia.[8]
Pharmacology[edit]
Organisms are said to be susceptible to nitrofurantoin if their minimum inhibitory concentration is 32 μg/ml or less. The peak blood concentration of nitrofurantoin following an oral dose of nitrofurantoin 100 mg, is less than 1 μg/ml and may be undetectable. Its bioavailability is about 90% and the urinary excretion is 40%[29][full citation needed] tissue penetration is negligible; the drug is well concentrated in the urine: 75% of the dose is rapidly metabolised by the liver, but 25% of the dose is excreted in the urine unchanged, reliably achieving levels of 200 μg/ml or more. In studies of dogs, the majority of urinary excretion is through glomerular filtration with some tubular secretion.[30] There is also tubular absorption which is increased with urine acidification.[30] However the activity of nitrofurantoin is also pH dependent and mean inhibitory concentration rises sharply with increased pH above 6.[30] Nitrofurantoin cannot be used to treat infections other than simple cystitis.
At the concentrations achieved in urine (>100 μg/ml), nitrofurantoin is a bactericide. It is bacteriostatic against most susceptible organisms at concentrations less than 32 μg/ml.[8]
Nitrofurantoin and the quinolone antibiotics are mutually antagonistic in vitro. It is not known whether this is of clinical significance, but the combination should be avoided.[8]
Resistance to nitrofurantoin may be chromosomal or plasmid-mediated and involves inhibition of nitrofuran reductase.[31] Acquired resistance in E. coli continues to be rare.
Nitrofurantoin and its metabolites are excreted mainly by the kidneys. In renal impairment, the concentration achieved in urine may be subtherapeutic. Nitrofurantoin should not be used in patients with a creatinine clearance of 60 ml/min or less. However, a retrospective chart review may suggest nitrofurantoin is not contraindicated in this population.[32]
Formulations[edit]
There are two formulations of nitrofurantoin.
- Macrocrystals - (Macrodantin, Furadantin) - 25, 50, or 100 mg capsules - taken once every 6 hours
- Monohydrate/macrocrystals - (Macrobid) - 100 mg capsules - taken once every 12 hours or 2 times a day[33] (written on prescriptions as BID, which is the last part of the trade name MacroBID). It is 75% monohydrate and 25% macrocrystals.[34]
Mechanism of action[edit]
Nitrofurantoin is concentrated in the urine, leading to higher and more effective levels in the urinary tract than in other tissues or compartments.[22] With a 100 mg oral dose, plasma levels are typically less than 1 µg/ml while in the urine it reaches 200 µg/ml.[35]
The mechanism of action is unique and complex. The drug works by damaging bacterial DNA, since its reduced form is highly reactive.[8] This is made possible by the rapid reduction of nitrofurantoin inside the bacterial cell by flavoproteins (nitrofuran reductase) to multiple reactive intermediates that attack ribosomal proteins, DNA,[36] respiration, pyruvate metabolism and other macromolecules within the cell. Nitrofurantoin exerts greater effects on bacterial cells than mammalian cells because bacterial cells activate the drug more rapidly. It is not known which of the actions of nitrofurantoin is primarily responsible for its bactericidal activity. The broad mechanism of action for this drug likely is responsible for the low development of resistance to its effects, as the drug affects many different processes important to the bacterial cell.[8]
History[edit]
Nitrofurantoin has been available for the treatment of lower urinary tract infections (UTIs) since 1953.[3]
Animal feed[edit]
Residues from the breakdown of nitrofuran veterinary antibiotics, including nitrofurantoin, have been found in chicken in Vietnam, China, Brazil, and Thailand.[37] The European Union banned the use of nitrofurans in food producing animals by classifying it in ANNEX IV (list of pharmacologically active substances for which no maximum residue limits can be fixed) of the Council Regulation 2377/90. The Food and Drug Administration (FDA) of the United States has prohibited furaltadone since February 1985 and withdrew the approval for the other nitrofuran drugs (except some topical uses) in January 1992. The topical use of furazolidone and nitrofurazone was prohibited in 2002. Australia prohibited the use of nitrofurans in food production in 1992. Japan did not allocate MRLs for nitrofurans leading to the implementation of a 'zero tolerance or no residue standard'. In Thailand, the Ministry of Health issued in 2001 Proclamation No. 231 MRL of veterinary drug in food which did not allocate MRL for nitrofurans. The Ministry of Agriculture and Cooperatives had already prohibited importation and use of furazolidone and nitrofurazone in animal feed in 1999 which was extended to all nitrofurans in 2002. Several metabolites of nitrofurans, such as furazolidone, furaltadone and nitrofurazone cause cancer or genetic damage in rats.[37]
Society and culture[edit]
Cost[edit]
It is available as a generic medication.[1] The wholesale cost in the developing world is between 0.10 and 9.20 USD for a course of treatment.[5] In the United States, the wholesale cost is about 8 USD for this amount as of 2018.[6]
The cost of the liquid formulation of nitrofurantoin in the U.S. became controversial after a 400% price increase. There are two manufacturers of the liquid formulation in the U.S., Casper Pharma and Nostrum Laboratories. In 2018, Casper increased their price to $2,800. In response to Casper, Nostrum increased their price from $474.75 to $2,392. In the U.K., a slightly larger bottle costs £446.95. In an interview with the Financial Times, Nirmal Mulye, Nostrum chief executive, said that there was a 'moral requirement to sell the product at the highest price.' He defended Martin Shkreli, and said, 'This is a capitalist economy and if you can’t make money you can’t stay in business.' Mulye also attacked the U.S. Food and Drug Administration as 'incompetent and corrupt.' There is a shortage of liquid nitrofurantoin, because the FDA implemented new rules on impurities, he said. Mulye dismissed the new rules on impurities as a 'piece of nonsense.'[38]
FDA commissioner Scott Gottlieb tweeted a response: '[T]here’s no moral imperative to price gouge and take advantage of patients. FDA will continue to promote competition so speculators and those with no regard to public health consequences can’t take advantage of patients who need medicine.'[39]
Trade names[edit]
Nitrofurantoin is marketed under many names in countries worldwide.[40]
References[edit]
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- ^ abGupta, K.; Hooton, T. M.; Naber, K. G.; Wullt, B.; Colgan, R.; Miller, L. G.; Moran, G. J.; Nicolle, L. E.; Raz, R.; Schaeffer, A. J.; Soper, D. E. (2011). 'International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases'. Clinical Infectious Diseases. 52 (5): e103–e120. doi:10.1093/cid/ciq257. PMID21292654.
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- ^Goemaere NN, Grijm K, van Hal PT, den Bakker MA (2008). 'Nitrofurantoin-induced pulmonary fibrosis: a case report'. Journal of Medical Case Reports. 2 (1): 169. doi:10.1186/1752-1947-2-169. PMC2408600. PMID18495029.
- ^Amit, G; Cohen, P; Ackerman, Z (Mar 2002). 'Nitrofurantoin-induced chronic active hepatitis'. The Israel Medical Association Journal : IMAJ. 4 (3): 184–6. PMID11908259.
- ^Tan, IL; Polydefkis, MJ; Ebenezer, GJ; Hauer, P; McArthur, JC (February 2012). 'Peripheral nerve toxic effects of nitrofurantoin'. Archives of Neurology. 69 (2): 265–8. doi:10.1001/archneurol.2011.1120. PMID22332195.
- ^Oplinger, M; Andrews, CO (Jan 2013). 'Nitrofurantoin contraindication in patients with a creatinine clearance below 60 mL/min: looking for the evidence'. The Annals of Pharmacotherapy. 47 (1): 106–11. doi:10.1345/aph.1R352. PMID23341159.
- ^American Geriatrics Society 2012 Beers Criteria Update Expert Panel (Apr 2012). 'American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults'. Journal of the American Geriatrics Society. 60 (4): 616–31. doi:10.1111/j.1532-5415.2012.03923.x. PMC3571677. PMID22376048.
- ^Antibiot. Chemother. 1978, 25, 233–252
- ^ abcShah (1989). 'Reappraisal of the risk/benefit of nitrofurantoin: review of toxicity and efficacy'. Adverse Drug Reactions and Acute Poisoning Reviews. 8 (4): 183–201. PMID2694823.
- ^McCalla DR, Kaiser C, Green MH (1978). 'Genetics of nitrofurazone resistance in Escherichia coli'. J Bacteriol. 133: 10–16.
- ^Bains A, Buna D, Hoag NA (2009). 'A retrospective review assessing the efficacy and safety of nitrofurantoin in renal impairment'. Canadian Pharmacists Journal. 142 (5): 248–252. doi:10.3821/1913-701X-142.5.248.
- ^'Drugs for bacterial infections'. Treatment Guidelines from the Medical Letter. 11 (131): 65–74. July 2013. PMID23797768.
- ^'Nitrofurantoin Capsules - FDA prescribing information, side effects and uses'. Drugs.com. Retrieved 28 November 2017.
- ^Blass, Benjamin (2015-04-24). Basic Principles of Drug Discovery and Development. p. 513. ISBN9780124115255.
- ^Tu Y, McCalla DR (1975). 'Effect of activated nitrofurans on DNA'. Biochim Biophys Acta. 402 (2): 142–49. doi:10.1016/0005-2787(75)90032-5.
- ^ abFAO: Nitrofuran studyArchived 2008-12-04 at the Wayback Machine
- ^Pharma chief defends 400% drug price rise as a ‘moral requirement’, David Crow, Financial Times, Sept. 11, 2018
- ^Hiltzik, Michael. 'Drug executive: It's a 'moral requirement' to charge patients the highest price'. latimes.com. Retrieved 14 September 2018.
- ^drugs.comArchived 2015-05-18 at the Wayback Machine, Nitrofurantoin listings, page accessed May 2, 2015
External links[edit]
- nitrofurantoin (Rx) - Medscape
Retrieved from 'https://en.wikipedia.org/w/index.php?title=Nitrofurantoin&oldid=899693945'
- Nitrofurantoin oral capsule is available as both generic and brand-name drugs. Brand-names: Macrobid and Macrodantin.
- Nitrofurantoin is also available in an oral suspension.
- Nitrofurantoin oral capsule is used to prevent and treat urinary tract infections that are caused by certain bacteria.
- Lung inflammation warning: This drug may cause lung inflammation. This is a rare side effect and is more likely to happen if you take the drug for longer than 6 months. Symptoms of lung inflammation can include tiredness, fever, chills, cough, chest pain, and shortness of breath. If you have any of these symptoms, contact your doctor right away.
- Liver problems warning: This drug may cause liver inflammation or liver injury. If you’re taking nitrofurantoin for long-term therapy, your doctor will monitor your liver with blood tests. Tell your doctor if you have symptoms of liver problems while taking this drug. These include itching, yellowing of your skin or the whites of your eyes, nausea, vomiting, dark urine, and loss of appetite.
- Nerve damage warning: This drug may cause nerve damage. This damage can cause numbness and pain, especially in your hands and feet.
- Red blood cell damage warning: This drug may cause hemolysis (a type of red blood cell damage). Symptoms of hemolysis include tiredness, weakness, and pale skin. Hemolysis goes away after you stop taking this drug.
- Diarrhea warning: This drug may cause mild or severe diarrhea. Tell your doctor right away if you have diarrhea while taking this drug. If your diarrhea is mild, it may stop after you stop taking this drug. If your diarrhea is more severe, it may not stop after you stop taking this drug, and you could be at risk of severe dehydration. If you have severe diarrhea, your doctor may give you fluids and treat the bacteria causing your diarrhea with antibiotics.
Nitrofurantoin is a prescription drug that comes as an oral capsule and an oral suspension.
Nitrofurantoin oral capsule is available as the brand-name drugs Macrobid and Macrodantin. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.
Why it’s used
Nitrofurantoin oral capsule treats and prevents urinary tract infections that are caused by certain types of bacteria.
How it works
Nitrofurantoin belongs to a class of drugs called antimicrobials or antibiotics. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.
Nitrofurantoin helps kill the bacteria that cause urinary tract infections. It only works against certain types of bacteria.
Nitrofurantoin oral capsule may cause drowsiness. It may also cause other side effects.
More common side effects
The more common side effects of nitrofurantoin can include:
- nausea
- vomiting
- loss of appetite
- stomach pain
- diarrhea
- numbness in your hands and feet
- pain in your hands and feet
- weakness
- dizziness
- headache
- drowsiness
If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.
Serious side effects
Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:
- Lung inflammation. Symptoms can include:
- tiredness
- shortness of breath
- fever
- chills
- cough
- chest pain
- Liver problems. Symptoms can include:
- itching
- yellowing of your skin or the whites of your eyes
- nausea or vomiting
- dark urine
- loss of appetite
- Nerve damage. Symptoms can include:
- numbness or tingling in your hands and feet
- muscle weakness
- Hemolysis (red blood cell damage). Symptoms can include:
- tiredness
- weakness
- pale skin
Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
Nitrofurantoin oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.
To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.
Examples of drugs that can cause interactions with nitrofurantoin are listed below.
Drugs you should not use with nitrofurantoin
Do not take these drugs with nitrofurantoin.Examples of these drugs include:
- Antacids such as Gaviscon that contain magnesium trisilicate: These drugs can make nitrofurantoin less effective.
- Probenecid and sulfinpyrazone: Taking these drugs while you’re taking nitrofurantoin may cause harmful levels of nitrofurantoin to build up in your blood. High levels of this drug in your body raise your risk of side effects, while reduced levels in your urine can make the drug less effective.
Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Nitrofurantoin oral capsule comes with several warnings.
Allergy warning
Nitrofurantoin can cause a severe allergic reaction. Symptoms can include:
- trouble breathing
- swelling of your throat or tongue
If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.
Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).
Warnings for people with certain health conditions
For people with kidney disease: If you have a history of kidney disease, you may not be able to clear nitrofurantoin from your body well. This could lead to a buildup of nitrofurantoin. This raises your risk of side effects.
For people with liver disease: You should not use nitrofurantoin. It can make your liver damage worse.
Warnings for other groups
For pregnant women: During weeks 0–37 of pregnancy, nitrofurantoin is a category B pregnancy drug. That means two things:
- Research in animals has not shown a risk to the fetus when the mother takes the drug.
- There aren’t enough studies done in humans to show if the drug poses a risk to the fetus.
Talk to your doctor if you’re pregnant or plan to become pregnant. Animal studies do not always predict the way humans would respond.
Nitrofurantoin can cause red blood cell problems in a newborn. For this reason, women who are pregnant should not take this drug:
- when they are at term (38–42 weeks of pregnancy),
- during labor and delivery
- if they think they are in labor
Call your doctor if you become pregnant while taking this drug.
For women who are breastfeeding: Nitrofurantoin may pass into breast milk and cause side effects in a child who is breastfed. Talk to your doctor about breastfeeding your child. You may need to decide whether to stop breastfeeding or stop taking this medication.
For seniors: The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. If you’re older than 65 years, nitrofurantoin may not be a good choice for you.
For children: Do not use any form of nitrofurantoin in infants younger than 1 month. Macrodantin and its generic form are safe for use in children older than 1 month. Macrobid and its generic form have not been studied in children younger than 12 years of age. They should not be used in this age group.
This dosage information is for nitrofurantoin oral capsule. All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:
- your age
- the condition being treated
- how severe your condition is
- other medical conditions you have
- how you react to the first dose
Forms and strengths
Generic: Nitrofurantoin
- Form: oral capsule (generic for Macrobid)
- Strength: 100 mg (75 mg nitrofurantoin monohydrate and 25 mg nitrofurantoin macrocrystals)
- Form: oral capsule (generic for Macrodantin)
- Strengths: 25 mg, 50 mg, 100 mg
Brand: Macrobid
- Form: oral capsule
- Strength: 100 mg (75 mg nitrofurantoin monohydrate and 25 mg nitrofurantoin macrocrystals)
Brand: Macrodantin
- Form: oral capsule
- Strengths: 25 mg, 50 mg, 100 mg
Dosage for treatment of urinary tract infections
Adult dosage (ages 18–64 years)
- Macrodantin and its generic form: 50–100 mg four times per day. Length of treatment varies.
- Macrobid and its generic forms: 100 mg every 12 hours for 7 days.
Child dosage (ages 12–17 years)
- Macrodantin and its generic form: 5–7 mg/kg of body weight per day in four divided doses. Length of treatment may vary.
- Macrobid and its generic form: 100 mg every 12 hours for 7 days.
Child dosage (ages 1 month–11 years)
- Macrodantin and its generic form: 5–7 mg/kg of body weight per day in four divided doses. Length of treatment may vary.
- Macrobid and its generic form: These drugs have not been studied in children younger than 12 years. They should not be used in this age group.
Child dosage (ages 0–1 month)
- Macrodantin and its generic form: These drugs should not be used in children younger than 1 month.
- Macrobid and its generic form: These drugs have not been studied in children younger than 12 years. They should not be used in this age group.
Senior dosage (ages 65 years and older)
The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. Your doctor may start you on a lowered dosage or a different treatment schedule. This can help keep levels of this drug from building up too much in your body.
Dosage for prevention of urinary tract infections
Adult dosage (ages 18–64 years)
- Macrodantin and its generic form: 50–100 mg at bedtime.
- Macrobid and its generic form: These drugs are not used for the prevention of urinary tract infections.
Child dosage (ages 1 month–17 years)
- Macrodantin and its generic form: 1 mg/kg of body weight once per day or divided into two doses per day.
- Macrobid and its generic form: These drugs are not used for the prevention of urinary tract infection.
Child dosage (ages 0–1 month)
- Macrodantin and its generic form: These drugs should not be used in children younger than 1 month.
- Macrobid and its generic form: These drugs are not used for the prevention of urinary tract infections.
Senior dosage (ages 65 years and older)
The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. Your doctor may start you on a lowered dosage or a different treatment schedule. This can help keep levels of this drug from building up too much in your body.
Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.
Nitrofurantoin oral capsule is used for short-term treatment of urinary tract infections. The brand-name drug Macrodantin and its generic form may also be used for long-term prevention of urinary tract infections.
This drug comes with serious risks if you don’t take it as prescribed.
If you stop taking the drug suddenly or don’t take it at all: Your urinary tract infection may not go away and may get worse. If you stop taking this drug suddenly, the bacteria that caused your urinary tract infection could become resistant to this drug. That means it won’t work for you anymore.
If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. The bacteria that caused your urinary tract infection could become resistant to this drug. That means it won’t work for you anymore. For this drug to work well, a certain amount needs to be in your body at all times.
If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:
- nausea
- vomiting
If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.
What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.
How to tell if the drug is working: The symptoms of your urinary tract infection should get better.
Keep these considerations in mind if your doctor prescribes nitrofurantoin oral capsule for you.
General
Take nitrofurantoin with food. This may help reduce upset stomach and allow the drug to work better.
Storage
- Store nitrofurantoin at a temperature between 68°F and 77°F (20°C and 25°C). Macrobid and generic Macrobid can be stored between 59°F and 86°F (15°C and 30°C).
- Keep nitrofurantoin away from light.
- Don’t store this medication in moist or damp areas, such as bathrooms.
Refills
A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.
Travel
When traveling with your medication:
- Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
- Don’t worry about airport X-ray machines. They can’t hurt your medication.
- You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
- Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.
Clinical monitoring
Your doctor may monitor you during your treatment. If you are taking nitrofurantoin for long-term prevention of urinary tract infections, your doctor may do blood tests from time to time. These tests check your liver and kidney function.
There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.