Patient/caregiver was educated on contraindications for using Nitrofurantoin as follows:
- The unmetabolized portion of Nitrofurantoin along with the metabolites is excreted in the urine. Individuals with renal disease cannot excrete these active metabolites normally, which allows them to stay in blood circulation for longer time, resulting in toxicity and consequent side-effects. Individuals in toxicity with Nitrofurantoin can present with anemia, shortness of breath, cough, chest pain, neuropathy with tingling and numbness in the extremities, dark urine, yellowing of skin and eyes, nausea and vomiting, poor metabolism, and fatigue. So, Nitrofurantoin could be avoided in individuals with renal dysfunction and an alternative antibiotic considered or used with caution, with close monitoring for renal functions and development of any toxic symptoms.
- Prolonged use of Nitrofurantoin, as discussed above, can result in elevated levels of bilirubin. In pregnant women, elevated bilirubin can cross the placental barrier, enter the fetal circulation, and get deposited in the brain, thus resulting in permanent fetal brain damage. So, Nitrofurantoin is contraindicated in pregnant women, especially in the last trimester, to prevent permanent fetal brain damage.
