Nursing Teaching on Contraindications for Nitrofurantoin Use

Nurse educated the patient and caregiver on the contraindications for using Nitrofurantoin as follows:

1. Prolonged use of Nitrofurantoin can result in deficiency of enzyme systems needed to maintain the integrity of red blood cells. This can result in poor red blood cell integrity, predisposing the cells to lysis, contributing to development of hemolytic anemia. This breakdown of red blood cells, secondary to Nitrofurantoin intake, can result in elevated levels of the yellow pigment, bilirubin, in the blood. This can result in signs and symptoms of jaundice, such as, itching, dark urine, yellowing of skin and eyes, nausea and vomiting, poor metabolism, and fatigue. Secondary to breakdown of red blood cells and consequent anemia, individuals can also present with pallor of skin, episodes of confusion, dizziness, exacerbated shortness of breath, and compromised endurance. Nitrofurantoin is contraindicated in individuals with history of hemolytic anemia or used with extreme caution, with close watch maintained for development of symptoms of jaundice and anemia.
2. Do not take Nitrofurantoin, if you ever manifested any allergic response to intake of Nitrofurantoin. Discuss your history of allergic response to this medication with your physician, without fail.
3. Nitrofurantoin is significantly metabolized in the liver and if liver function is deficient, the metabolism of Nitrofurantoin can be compromised. This can lead to increased blood levels of the medication for longer periods of time, resulting in increased risk for side-effects and consequent toxicity. Also, long term Nitrofurantoin intake also can lead to hepatic injury, thus compromising liver function. Hepatic injury and altered liver function can also result in increased bilirubin levels in the body and signs and symptoms of jaundice. Individuals can present with itching, dark urine, yellowing of skin and eyes, nausea and vomiting, poor metabolism, and fatigue. So, Nitrofurantoin could be avoided in individuals with hepatic dysfunction and an alternative antibiotic considered or used with caution, with close monitoring for liver functions and development of any toxic symptoms.
4. In the event of any current manifestations of any allergic response with this medication, report it to your physician or other health care personnel immediately, to check regarding your safety with continuing on intake of this medication.
5. Nitrofurantoin, especially with prolonged use, carries the risk for compromised lung function, leading to episodes of exacerbation of shortness of breath, cough, and chest pain. So, Nitrofurantoin could be avoided for a safer antibiotic or used with extreme caution, in individuals with history of compromised lung function and chronic lung disease.
6. Nitrofurantoin needs acid medium in the stomach for better absorption. When used concurrently, antacids containing aluminum, magnesium, and bicarbonate, as ingredients, can compromise the acid medium in the stomach and reduce the absorption of Nitrofurantoin. This can compromise the therapeutic effects of the antibiotic. So, Nitrofurantoin could be avoided for a safer antibiotic in individuals taking antacids containing aluminum, magnesium, and bicarbonate or used with extreme caution, by spacing Nitrofurantoin out by at least 2 hours from these products, to avoid the complication of poor antibiotic absorption and compromised therapeutic benefit.
7. 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.
8. 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.