The Drug-Induced Respiratory Disease 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 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 (ILD), acute and/or severe (may produce the ARDS pattern)

I.b

Pneumonitis (interstitial lung disease/ILD)

I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.d

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

I.e

Acute eosinophilic pneumonia (AEP)

I.g

Pulmonary fibrosis

I.l

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

I.r

An imaging pattern consistent with DIP

I.v

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

I.ax

Chronic pneumonitis

II - Pulmonary edema - Acute lung injury - ARDS

II.a

Pulmonary edema, noncardiogenic (NCPE)

II.b

ARDS - Acute lung injury

II.j

Transient pulmonary opacities/infiltrates (see also under Iav)

III - Pulmonary/alveolar/airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

IV - Airway involvement

IV.a

Bronchospasm - Wheezing - Asthma

IV.ae

Tracheobronchitis-like clinical pattern

V - Pleural and/or pericardial involvement

V.a

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

V.b

Eosinophilic pleural effusion

V.d

Pleural/pericardial effusion, ANA positive (DI lupus)

V.i

Pleuritis (can cause chest pain)

VI - Pulmonary vasculopathy

VI.d

Pulmonary vasculitis or capillaritis

VII - Mediastinal involvement

VII.a

Lymphadenopathy (intrathoracic)

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

VIII.b

Hematoma of/around central airway wall potentially causing UAO

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

IX.i

Respiratory arrest - Apnea

X - Systemic/Distant conditions, syndromes and reactions

X.a

DRES syndrome - DRESS-like reaction

X.d

Lupus - Lupus syndrome (see also Vd)

X.e

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

X.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)

X.s

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

XI - Miscellaneous

XI.b

Chest pain (acute or subacute), lone or prominent

XI.c

Pleuritic chest pain

XI.bn

A restrictive lung function defect

XV - Pathology

XV.a

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

XV.b

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

XV.c

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

XV.e

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

XV.f

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

XV.h

Path: NSIP-fibrotic pattern

XV.j

Path: Pulmonary fibrosis (UIP-pattern)

XV.k

Path: Desquamative interstitial pneumonia (DIP-pattern)

XV.x

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

XV.ac

Path: Pulmonary vasculitis other than capillaritis

XV.af

Path: Granulomatous pulmonary vasculitis

XV.bi

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

XV.bl

Path: Resolving alveolar damage

XVI - Imaging

XVI.b

Imaging: Ground-glass opacities (GGO) / shadowing

XVI.f

Imaging: Bibasilar opacities/shadowing

XVI.l

Imaging: Peribronchovascular areas of consolidation

XVI.bc

Imaging: Intrathoracic lymph node enlargement

XVI.bp

Imaging: Reverse ventilation-perfusion mismatch