Philippe Camus, M.D.

Dijon, France

Back

The Drug-Induced Respiratory Disease Website

Nitrofurantoin

The urinary antiseptic nitrofurantoin (NF) commonly causes pulmonary reactions (PMID 891588). Most commonly, dyspnea, fever and chest pain occur acutely after few days-to-one or two weeks on the medication, sometimes in the context of moderat eosinophilia, to resolve in a few days off the drug. Less often, NF is associated with subacute chronic interstitial pneumonitis mimicking BOOP or pulmonary fibrosis. Autoimmunity can be present in the form of ANA or ANCA antibodies. Risk increases if renal failure present (PMID 23660771)

I - Cardiac arrhythmia(s)/dysrhythmia(s) (AF, VT, VF, TdP) - QTc prolongation)

I.n

Respiratory arrest - Apnea

X - Pulmonary edema

X.b

Pulmonary edema, noncardiogenic (NCPE)

XII - Pericardial involvement

XII.g

Pleural/pericardial effusion, ANA positive (DI lupus)

XIV - Pleural involvement

XIV.a

Pleural effusion (uni or bilateral) (can accompany ILD induced by the drug)
XIV.d

Eosinophilic pleural effusion

XV - Chest pain

XV.a

Chest pain (acute or subacute), lone or prominent
XV.b

Pleuritic chest pain
XV.e

Pleuritis (can cause chest pain)

XVI - Hemorrhage - Bleeding - Hematoma(s)

XVI.c

Hematoma of/around central airway wall potentially causing UAO
XVI.e

Alveolar hemorrhage (AH), diffuse AH (DAH)

XXI - Mediastinal involvement/injury

XXI.a

Lymphadenopathy (intrathoracic)

XXII - Acute respiratory/cardiorespiratory failure

XXII.b

Acute lung injury - ARDS

XXIV - Interstitial lung disease - Pulmonary infiltrates - Pulmonary fibrosis

XXIV.a

Pneumonitis (ILD)
XXIV.b

Pneumonitis (ILD), acute and/or severe (may cause ARDS)
XXIV.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
XXIV.d

Acute eosinophilic pneumonia (AEP)
XXIV.f

Diffuse alveolar damage (DAD) imaging pattern
XXIV.h

Pulmonary fibrosis (may improve but partly following drug discontinuation)
XXIV.j

Organizing pneumonia (OP/BOOP) pattern (an area or areas of consolidation on imaging)
XXIV.ab

Chronic pneumonitis/ILD
XXIV.ah

Transient pulmonary opacities/infiltrates (see also under Iav)

XXV - Pulmonary function - Pulmonary physiology - PFTs

XXV.i

A restrictive lung function defect

XXVIII - Large airway involvement

XXVIII.o

A ‘tracheobronchitis’ clinical pattern

XXIX - Small airway involvement

XXIX.a

Bronchospasm - Wheezing - Asthma

XXX - Imaging features

XXX.u

Imaging: Reverse ventilation-perfusion mismatch

XXXVI - Autoimmune syndromes - Systemic reactions or conditions

XXXVI.a

Autoimmunity - An autoimmune condition (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)
XXXVI.b

Lupus - Lupus syndrome
XXXVI.f

Anaphylaxis - Anaphylactoid reaction (either of these can be fatal)
XXXVI.m

DRES syndrome - DRESS-like reaction - Drug hypersensitivity syndrome
XXXVI.u

Pulmonary vasculitis or capillaritis