31 August 2008

Adverse reactions to nitrofurantoin

Dr Grumble has seen some very nasty adverse reactions to nitrofurantion. So nasty that he has never forgotten them. It's a drug that he has always tended to avoid if possible. There are scientific papers on the topic. They are not particularly new. All this has been known for a long time. Here's an abstract from an article on the topic in a learned journal:

Reports on adverse reactions to nitrofurantoin today are common in Sweden and constitute 10 to 12 percent of all incoming reports. We present an analysis of 921 reports of adverse reactions received by the Swedish Adverse Drug Reaction Committee during the period 1966--1976. The two largest groups consist of reports of acute pulmonary reactions (43 percent) and allergic reactions (42 percent). The remaining reports fall into any of four smaller groups, chronic pulmonary reactions, liver damage, blood dyscrasias or neuropathy. Acute pulmonary and acute allergic reactions in all aspects are very similar and carry the characteristics of an acute hypersensitivity reaction. The increasing number of reports--even in relation to sales figures--would be best explained by a continuous sensitization. Chronic pulmonary reactions (interstitial pneumonitis) afflict older patients, often after prolonged treatment with relatively small doses. We suggest that these reactions are elicited by a toxic mechanism. Seventy-one percent of all reactions were severe enough to cause the patient's hospitalization; only 1 percent was fatal. The risk of an adverse reaction varies with sex and age, increases with age and is higher in women than in men. The time has come for a re-evaluation of nitrofurantoin and its role in the treatment of urinary tract infections.

The good news is that only just over 70% of victims had to be admitted to hospital and only 1% of the victims died. So nothing much to worry about then.

The culprit

Imagine Dr Grumble's surprise when he learned from Jobbing Doctor that this stuff is going to be made available over the counter to the public. If the mechanism of the toxicity proposed in the above abstract is correct is this a sensible thing to do? Are these things decided on the evidence and the opinion of professionals? Or is there some political driver? Why when we have such excellent primary care in the UK do they want to bypass the GP? Do you know why? Dr Grumble thinks he does.


Anonymous said...

How can they do this? It's crazy!

madsadgirl said...

And Dr Grumble is probably right!

No One said...

re "when we have such excellent primary care in the UK"

oh how we laughed

laughed so loudly


Anonymous said...

I can't find any evidence on the MHRA website that this is the case. It was an idea in the past I think but don't think anyone would pick nitrofurantoin.

I'm guessing this is just a a scare. Anyway there is a good case for people to be able to get some medicines from their community pharmacies. Do you mean to tell me that GP's test urine every time some one has a UTI, I'm guessing that for repeat cases they often just go with what usually works, easier for everyone if patient tries this directly.

Dr Grumble said...

This could just be a scare story but this government often makes policy by starting with deliberate leaks and then seeing what the reaction is. That's not at all a sensible way of proceeding but then they are not sensible.

Anonymous said...


I had eye surgery and in the post-op pack was MAXIDEX(dexamethasone) drops by ALCON LABS.

Two days later I was BLIND

Use Google and enter EPOCRATES MAXIDEX REACTION to verify