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The Drug-Induced Cardiotoxicity Website and App

Nitrofurantoin

Specialities: General Practice · Infectious diseases · Pulmonary medicine · Urology

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)

Frequency - Incidence

Incidence of cardiac adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for cardiac adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

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

II.n

Respiratory arrest - Apnea

X - Pulmonary edema - ALI/ARDS

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 DI-LDs)
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

XVI.c

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

Alveolar hemorrhage (AH), diffuse AH (DAH)

XX - Vasculitis

XX.d

Vasculitis, pulmonary (w/wo AH), extrapulmonary, systemic: ANCA-positive

XXI - Mediastinal involvement/injury

XXI.a

Lymphadenopathy (intrathoracic)

XXII - Acute respiratory/cardiorespiratory failure

XXII.b

ARDS - Acute lung injury

XXIV - Interstitial lung disease - Pulmonary infiltrates - Pulmonary fibrosis

XXIV.a

Pneumonitis (interstitial lung disease/ILD)
XXIV.b

Pneumonitis (ILD), acute and/or severe (may produce the ARDS pattern)
XXIV.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
XXIV.d

Acute eosinophilic pneumonia (AEP)
XXIV.f

Diffuse alveolar damage (DAD) (see alsoo under IIb and XVf)
XXIV.h

Pulmonary fibrosis
XXIV.k

Organizing pneumonia pattern (an area or areas of consolidation on imaging)
XXIV.ac

Chronic pneumonitis
XXIV.ai

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 including UAO

XXVIII.o

Tracheobronchitis-like clinical pattern

XXIX - Small airway involvement

XXIX.a

Bronchospasm - Wheezing - Asthma

XXX - Imaging features

XXX.l

Imaging: Ground-glass opacities (GGO) / shadowing
XXX.u

Imaging: Reverse ventilation-perfusion mismatch
XXX.z

Imaging: Intrathoracic lymph node enlargement

XXXVI - Autoimmune syndromes - Systemic reactions or conditions

XXXVI.a

Autoimmunity-Autoimmune conditions (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)
XXXVI.b

Lupus - Lupus syndrome (see also Vd)
XXXVI.f

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

DRES syndrome - DRESS-like reaction
XXXVI.u

Pulmonary vasculitis or capillaritis