Macrobid Side Effects - Adults and Elderly (Guide)

Mahshid Moghei, PhD Medically reviewed by Mahshid M. on

Older Man Experiencing Side Effects from Macrobid (Nitrofurantoin)

Macrobid (nitrofurantoin) has a longer list of side effects than other antibacterial agents. In addition, it has been known to have adverse reactions on older adults (65 years and older) than on adults under the age of 65. However, the good news is that many studies have been performed to better understand these adverse reactions.

In this study, published in 2017 cited “3400 patients at least 65-years old were prescribed nitrofurantoin during the study period. Of these, 641 were identified as possibly having one of five targeted symptoms/disease complications (pulmonary and hepatic) associated with nitrofurantoin. After a detailed chart audit, 89% were deemed to have no adverse reaction; 7% had a minor side effect or allergy; and 3.9% met criteria for suspicion of a nitrofurantoin-induced adverse events. Of the latter, five patients were rated as being highly suspicious for nitrofurantoin toxicity; four of the five were identified with pulmonary toxicity; and one with hepatotoxicity. Four out of five of these patients used nitrofurantoin chronically.”

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Key Takeaways

  • More common side effects of Macrobid (nitrofurantoin) include nausea, diarrhea, loss of appetite, headache, dizziness, and in some cases allergic skin reactions.

  • Less common side effects include dark urine, pulmonary reactions, hepatotoxicity (liver damage) reactions, and peripheral neuropathy. However, these more severe reactions are less common in patients taking Macrobid (nitrofurantoin).

  • Elderly patients (65 years and older) may have more risk of pulmonary and hepatic issues than patients that are under the age of 65.

Common Side Effects of Macrobid (nitrofurantoin)

Here are the more common side effects of Macrobid (nitrofurantoin):

Side Effect

Category

Approximate Frequency

Nausea

Common

~10–15%

Diarrhea

Common

~5–10%

Loss of appetite

Common

~3–5%

Headache

Common

~5–10%

Drowsiness/Dizziness

Common

~1–5%

Allergic skin reactions (rash)

Common

~1–5%

Dark urine

Common (non-harmful)

Variable

Pulmonary reactions (acute)

Severe

<1%

Pulmonary reactions (chronic)

Severe

Rare (~0.01%)

Hepatotoxicity (liver damage)

Severe

Rare (~0.01–0.03%)

Peripheral neuropathy

Severe

Rare (~0.03–0.05%)

Hemolytic anemia (G6PD deficient patients)

Severe

Rare (~0.1%)

Severe Allergic Reactions

Macrobid (nitrofurantoin) has been known to have more severe allergic reactions in patients. Which is why it’s always important to bring a complete list of all medications to each primary care provider before seeking or taking any additional medications. In addition, listing your allergies for the primary care doctor if they don’t have your complete paperwork on file.

Severe Allergic Reaction

Description

Approximate Frequency

Anaphylaxis

A severe, life-threatening allergic reaction causing difficulty breathing, swelling, and low blood pressure.

Rare (~0.01–0.03%)

Angioedema

Swelling of deeper layers of the skin, often around the eyes, lips, or throat.

Rare (~0.01%)

Erythema multiforme

Red or purple skin lesions, sometimes involving mucous membranes.

Rare (~0.01%)

Stevens-Johnson Syndrome (SJS)

A severe skin and mucous membrane disorder with widespread rashes and blisters.

Very Rare (<0.01%)

Toxic Epidermal Necrolysis (TEN)

A more severe form of SJS, causing large-scale skin peeling and systemic involvement.

Extremely Rare (<0.001%)

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

A severe reaction involving rash, fever, and organ involvement.

Rare (~0.01%)

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Hepatotoxicity

Hepatotoxicity has been known to be experienced by patients (in rare cases) on Macrobid (nitrofurantoin). However rare, it should be a concern that you should know about. Here are the common hepatotoxicity types and the estimated cases per year (number of patients impacted):

Hepatotoxicity Type

Description

Approximate Frequency

Estimated Cases (per 100,000 users)

Acute Hepatitis

Inflammation of the liver, often reversible upon drug discontinuation.

~0.03–0.08%

~30–80

Chronic Active Hepatitis

Progressive liver damage that may lead to cirrhosis.

Rare (~0.01–0.02%)

~10–20

Cholestatic Jaundice

Bile flow obstruction causing yellowing of the skin and eyes.

Rare (~0.01–0.03%)

~10–30

Fulminant Hepatic Failure

Sudden and severe liver failure, potentially fatal.

Extremely Rare (<0.001%)

<1

Nerve Problems (Neuropathy)

Nerve problems (neuropathy) has been known to impact some patients on Macrobid (nitrofurantoin), however peripheral neuropathy is only more common in patients with diabetes, kidney impairment, or prolonged nitrofurantoin use.

Condition

Description

Approximate Frequency

Peripheral Neuropathy

Damage to peripheral nerves, causing numbness, tingling, or weakness, especially in the hands and feet.

Rare (~0.03–0.05%)

Optic Neuritis

Inflammation of the optic nerve, potentially causing vision problems.

Extremely Rare (<0.01%)

Cranial Neuropathy

Dysfunction of cranial nerves, though rarely associated with nitrofurantoin.

Extremely Rare (<0.01%)

Antibiotic-Associated Diarrhea (AAD)

Antibiotic-associated diarrhea (AAD) is one of the more common side effects of Macrobid (nitrofurantoin), however, Clostridioides difficile Infection (CDI or C. diff) is less common and more rare in patients (usually consisting of more severe diarrhea cases):

Condition

Description

Approximate Frequency

Mild Diarrhea

Loose stools without significant complications, resolving after completing the antibiotic course.

~5–10%

Clostridioides difficile Infection (CDI or C. diff)

Severe diarrhea caused by overgrowth of C. difficile (C. diff), potentially leading to colitis.

Rare (~0.01–0.03%)

Adverse Reactions for 65 Years and Older (Elderly)

The two more common concerns with Macrobid (nitrofurantoin) for the elderly (or those 65 years and older) include pulmonary issues and hepatic issues.

Pulmonary issues involve the lungs and respiratory system. Nitrofurantoin can occasionally cause lung-related side effects, which might include:

  1. Acute Pulmonary Reactions:

    • Cough, shortness of breath, fever, and chest pain.

    • These are typically allergic reactions and usually resolve after stopping the medication.

  2. Chronic Pulmonary Toxicity:

    • Progressive difficulty breathing, fatigue, and in some cases, lung scarring (pulmonary fibrosis).

    • This can develop with long-term use of nitrofurantoin and may not always resolve completely after stopping the drug.

Hepatic issues relate to problems with the liver. Nitrofurantoin can, in rare cases, cause liver damage, including:

  1. Hepatitis:

    • Jaundice (yellowing of the skin or eyes), fatigue, nausea, and abdominal pain.

    • An inflammatory response in the liver, often due to hypersensitivity.

  2. Liver Toxicity (Hepatotoxicity):

    • Similar to hepatitis but may include more severe signs of liver dysfunction.

    • Long-term use of nitrofurantoin can lead to liver damage, which may be reversible or, in rare cases, permanent.

For more information, visit the study performed on older adults right here.

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Common Questions

Common questions about Macrobid (nitrofurantoin):

What are the common side effects of Macrobid?

Common side effects include:

  • Nausea

  • Vomiting

  • Loss of appetite

  • Diarrhea

  • Headache

Are there any serious side effects that a patient should look for?

If any of these begin to occur, you should contact your primary care physician as soon as possible. Look for:

  • Difficulty breathing, chest pain, or cough (possible pulmonary reactions)

  • Yellowing of the skin/eyes or dark urine (signs of liver issues)

  • Severe fatigue, rash, or fever (potential allergic reaction)

Can Macrobid cause long-term issues in a patient?

In more rare cases, long-term use can lead to pulmonary toxicity (lung damage) or hepatic toxicity (liver damage). These risks are higher with chronic use.

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Sources

  1. U.S. Food and Drug Administration. (2009). Nitrofurantoin monohydrate/macrocrystals [Label Information]. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020064s019lbl.pdf

  2. Kunin, C. M. (1980). Antibacterial activity of nitrofurantoin: Mechanism of action and implications for treatment of urinary tract infections. PubMed. Retrieved from https://pubmed.ncbi.nlm.nih.gov/7435512/

  3. Gupta, K., & Hooton, T. M. (2017). Nitrofurantoin and recurrent urinary tract infections: Evidence and challenges. National Center for Biotechnology Information (NCBI). Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC5478436/


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