The Drug-Induced Respiratory Disease Website and App

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)

Frequency - Incidence

Incidence of respiratory 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 respiratory 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

I - Interstitial/parenchymal lung disease

I.a

Pneumonitis (interstitial lung disease/ILD)

I.b

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

I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.d

Acute eosinophilic pneumonia (AEP)

I.e

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

I.g

Pulmonary fibrosis

I.m

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

I.s

An imaging pattern consistent with DIP

I.w

Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence

I.ay

Chronic pneumonitis

XLI - Pulmonary edema - Acute lung injury - ARDS

XLI.a

Pulmonary edema, noncardiogenic (NCPE)

XLI.d

Transient pulmonary opacities/infiltrates (see also under Iav)

XLI.e

ARDS - Acute lung injury

XLII - Pulmonary/alveolar./airway hemorrhage/bleeding

XLII.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

XLIII - Airway involvement

XLIII.a

Bronchospasm - Wheezing - Asthma

XLIII.q

Tracheobronchitis-like clinical pattern

XLIV - Central-large-upper airway (incl. pharyngeal-nasal) involvement

XLIV.b

Hematoma of/around central airway wall potentially causing UAO

XLV - Pleural and/or pericardial involvement

XLV.a

Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

XLV.b

Eosinophilic pleural effusion

XLV.d

Pleural/pericardial effusion, ANA positive (DI lupus)

XLV.i

Pleuritis (can cause chest pain)

XLVI - Pulmonary vasculopathy

XLVI.d

Pulmonary vasculitis or capillaritis

XLVII - Mediastinal involvement

XLVII.a

Lymphadenopathy (intrathoracic)

XLVIII - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

XLVIII.i

Respiratory arrest - Apnea

XLIX - Systemic/Distant conditions, syndromes and reactions

XLIX.a

DRES syndrome - DRESS-like reaction

XLIX.d

Lupus - Lupus syndrome (see also Vd)

XLIX.e

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

XLIX.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)

XLIX.u

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

L - Miscellaneous

L.b

Chest pain (acute or subacute), lone or prominent

L.c

Pleuritic chest pain

L.d

A restrictive lung function defect

LV - Imaging

LV.b

Imaging: Ground-glass opacities (GGO) / shadowing

LV.f

Imaging: Bibasilar opacities/shadowing

LV.l

Imaging: Peribronchovascular areas of consolidation

LV.be

Imaging: Intrathoracic lymph node enlargement

LV.bs

Imaging: Reverse ventilation-perfusion mismatch

LVIII - Pathology

LVIII.a

Path: NSIP-cellular pattern (see also Ia, Ib)

LVIII.b

Path: Eosinophilic pneumonia (subacute or acute) (see also Ic)

LVIII.d

Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

LVIII.f

Path: ILD with a granulomatous component (see also Im)

LVIII.k

Path: Desquamative interstitial pneumonia (DIP-pattern)

LVIII.l

Path: Giant-cell interstitial pneumonia (GIP)-pattern

LVIII.o

Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

LVIII.p

Path: Resolving alveolar damage

LVIII.v

Path: NSIP-fibrotic pattern

LVIII.w

Path: Pulmonary fibrosis (UIP-pattern)

LVIII.al

Path: Acute/subacute bronchiolitis (see also IVc, IVi)

LVIII.ay

Path: Pulmonary vasculitis other than capillaritis

LVIII.az

Path: Granulomatous pulmonary vasculitis