Published: 5 June 2025
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Short-term nitrofurantoin use can cause hepatic reactions
Published: 5 June 2025
Prescriber Update 46(2):
27
June 2025
Hepatic reactions are well-known adverse reactions associated with long-term use of nitrofurantoin. However, they have also been reported with short-term use. The New Zealand nitrofurantoin data sheets are being updated to reflect this risk.
Nitrofurantoin is a bactericidal antibiotic indicated for the treatment and prophylaxis of urinary tract infections. There are two products approved in New Zealand: Nifuran (immediate release tablets) and Macrobid (modified release capsules). Refer to the nitrofurantoin data sheets for full prescribing information.
Serious hepatic reactions1
Nitrofurantoin can cause serious hepatic reactions, such as hepatitis, cholestatic jaundice, chronic active hepatitis, autoimmune hepatitis and hepatic necrosis, with some cases being fatal.
These reactions can occur with both short-term and long-term use. Cholestatic jaundice is typically associated with short-term use, while chronic active hepatitis, which can progress to hepatic necrosis, is generally linked to long-term use.
Nitrofurantoin is contraindicated in those who have previously experienced hepatic adverse reactions to nitrofurantoin. It may be used with caution in patients with known hepatic dysfunction. Consider regular monitoring of liver function, especially for patients on long-term therapy. Discontinue nitrofurantoin if signs and symptoms of hepatotoxicity occur.
Educate patients and caregivers about the signs and symptoms of hepatic dysfunction, such as yellowing of the skin or eyes, upper right abdominal pain, dark urine and pale or grey-coloured stools, itching or joint pain and swelling, and advise them to seek immediate medical advice if they occur.
New Zealand case reports
From 1 January 2010 to 31 March 2025, there were 25 cases of hepatobiliary disorders reported in association with nitrofurantoin. The reported adverse reactions included hepatitis (11 reports), jaundice (6), hepatic cirrhosis (4), cholestatic hepatitis (3), hepatic necrosis (1) and autoimmune hepatitis (1). In 15 of the 25 cases, the hepatic reactions occurred within 7 days of starting treatment.
Reference
- Te Arai BioFarma Limited. 2025. Macrobid New Zealand Data Sheet 23 March 2025. URL: www.medsafe.govt.nz/profs/Datasheet/m/macrobidcap.pdf (accessed 10 April 2025).
