Nitrofurantoin is contraindicated in patients with severe renal impairment (CrCl <30 mL/min) due to the risk of drug accumulation and serious toxicity.
Contraindicated in severe renal impairment (CrCl <30 mL/min) per FDA guidelines.
Risk of irreversible peripheral neuropathy from accumulation.
Short-term use (<7 days) may be considered in CrCl 30-60 mL/min but with caution.
Always verify renal function before prescribing.
Nitrofurantoin is primarily eliminated unchanged via glomerular filtration and tubular secretion in the kidneys. In severe renal impairment, reduced renal clearance leads to systemic accumulation of the drug, prolonging its half-life and increasing exposure to potentially toxic levels.
Accumulation can cause severe adverse effects including peripheral neuropathy, pulmonary toxicity (e.g., interstitial pneumonitis, fibrosis), hemolytic anemia (especially in G6PD deficiency), and hepatotoxicity.
Avoid nitrofurantoin in patients with CrCl <30 mL/min. Assess renal function (e.g., via creatinine clearance) prior to initiation. Use alternative antibiotics such as trimethoprim-sulfamethoxazole or fluoroquinolones for urinary tract infections in this population. If used short-term in mild-moderate impairment, monitor closely for toxicity.
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