Therapeutic field trial of a macro- and microfilaricidal agent in canine in a single well-tolerated dose to dogs that were naturally infected with Dirofilaria immitis. J Clin Endocrinol Metab. Nov;82(11) Long-term and low-dose treatment with cabergoline induces macroprolactinoma shrinkage. Colao A(1), Di . Urinary Tract Infection. Susceptible strains of Escherichia coli, Enterobacter spp, Klebsiella spp, Staphylococcus aureus, and S saprophyticus. Macrocrystals.
Therapeutic) Dose (Or Macro
Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: There is no known specific antidote. However, Nitrofurantoin can be haemodialysed in cases of recent ingestion. Standard treatment is by induction of emesis or by gastric lavage. Monitoring of full blood count, liver function, and pulmonary function tests are recommended.
A high fluid intake should be maintained to promote urinary excretion of the drug. Nitrofurantoin is a broad spectrum antibacterial agent, active against the majority of urinary pathogens. The wide range of organisms sensitive to the bactericidal activity include:. The nitrofurantoin macrocrystals are specially formulated. The controlled crystal size is designed to control the speed of absorption and thus reduce the incidence of nausea.
Clinical and animal studies indicate that Nitrofurantoin therapy decreases the likelihood of nausea in patients who might experience these symptoms on Nitrofurantoin therapy. This special formulation of Nitrofurantoin had not caused any decrease in antibacterial efficacy. Orally administered Nitrofurantoin is readily absorbed in the upper gastrointestinal tract at a slower rate and to reduced extent when compared to microcrystalline Nitrofurantoin.
Blood concentrations at therapeutic dosage are usually low. Maximum urinary excretion usually occurs hours after administration of macrocrystalline Nitrofurantoin. It has an elimination half-life of about 30 minutes or less. Carcinogenic effect of nitrofurantoin in animal studies was observed. However, human data and extensive use of nitrofurantoin over 50 years do not support such observations.
The capsule fill contains lactose monohydrate, maize starch and purified talc. The capsule shell contains quinoline yellow E , titanium dioxide E , gelatin, sodium lauryl sulphate. The printing ink contains shellac and black iron oxide E Each pack comprises 3 blister cards containing 10 capsules on each card.
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This information is intended for use by health professionals. Macrodantin mg Capsules Nitrofurantoin mg Capsules, Hard. Each capsule contains mg Nitrofurantoin Ph. Excipients with known effect Lactosemg per capsule For the full list of excipients, see section 6.
Severe chronic recurrence UTIs: Elderly Provided there is no significant renal impairment, in which Nitrofurantoin is contraindicated, the dosage should be that for any normal adult. Method of administration For oral use.
Capsule contain lactose Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Increased absorption with food or agents delaying gastric emptying. Decreased absorption with magnesium trisilicate. Decreased renal excretion of Nitrofurantoin by probenecid and sulfinpyrazone. Decreased anti-bacterial activity by carbonic anhydrase inhibitors and urine alkalisation.
Anti-bacterial antagonism by quinolone anti-infectives. Interference with some tests for glucose in urine. As Nitrofurantoin belongs to the group of Antibacterials, it will have the following interactions: Antibacterials inactivate oral typhoid vaccine. Pregnancy Animal studies with Nitrofurantoin have shown no teratogenic effects. Breast-feeding Breast feeding an infant known or suspected to have an erythrocyte enzyme deficiency including G6PD deficiency , must be temporarily avoided, since Nitrofurantoin is detected in trace amounts in breast milk.
A tabulated list of undesirable effects is outlined below: The undesirable effects are listed according to organ systems and following frequencies: Hepatobiliary disorders Not known Cholestatic jaundice, Chronic active hepatitis fatalities have been reported , Hepatic necrosis, autoimmune hepatitis Skin and subcutaneous tissue disorders Not known Transient alopecia Exfoliative dermatitis and erythema multiforme including Stevens-Johnson Syndrome , maculopapular, erythematous or eczematous eruptions,urticaria, rash, and pruritus.
Symptoms Symptoms and signs of overdose include gastric irritation, nausea and vomiting. Management There is no known specific antidote. Antibacterials for systemic use, nitrofuran derivatives ATC code: J01XE01 Mechanism of action Nitrofurantoin is a broad spectrum antibacterial agent, active against the majority of urinary pathogens. According to the Beers Criteria, nitrofurantoin is considered a potentially inappropriate medication PIM for use in geriatric patients due to the possibility of pulmonary toxicity, hepatotoxicity, and peripheral neuropathy, especially with long-term use, lack of efficacy in patients with renal impairment, and the availability of safer alternatives.
The drug may cause pulmonary fibrosis and peripheral neuropathy. Almost all antibacterial agents have been associated with pseudomembranous colitis antibiotic-associated colitis which may range in severity from mild to life-threatening.
In the colon, overgrowth of Clostridia may exist when normal flora is altered subsequent to antibacterial administration. The toxin produced by Clostridium difficile is a primary cause of pseudomembranous colitis. It is known that systemic use of antibiotics predisposes patients to development of pseudomembranous colitis. Consideration should be given to the diagnosis of pseudomembranous colitis in patients presenting with diarrhea following nitrofurantoin administration.
Systemic antibiotics should be prescribed with caution to patients with inflammatory bowel disease such as ulcerative colitis or other GI disease. If diarrhea develops during therapy, the drug should be discontinued.
Following diagnosis of pseudomembranous colitis, therapeutic measures should be instituted. In milder cases, the colitis may respond to discontinuation of the offending agent. In moderate to severe cases, fluids and electrolytes, protein supplementation, and treatment with an antibacterial effective against Clostridium difficile may be warranted.
Products inhibiting peristalsis are contraindicated in this clinical situation. Practitioners should be aware that antibiotic-associated colitis has been observed to occur over two months or more following discontinuation of systemic antibiotic therapy; a careful medical history should be taken.
Major Antacids can delay both the rate and the extent of GI absorption of nitrofurantoin. This interaction may be due to surface absorption of the antibacterial onto the antacid. Separate administration by at least 1 hour. Moderate Antimuscarinics can delay gastric emptying, possibly increasing the bioavailability of nitrofurantoin. Moderate Coadministration of articaine with oxidizing agents, such as nitrofurantoin, may increase the risk of developing methemoglobinemia. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary.
If methemoglobinemia occurs or is suspected, discontinue articaine and any other oxidizing agents. Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen.
Atropine; Hyoscyamine; Phenobarbital; Scopolamine: Belladonna Alkaloids; Ergotamine; Phenobarbital: Minor Monitor patients for the development of peripheral neuropathy when receiving bortezomib in combination with other drugs that can cause peripheral neuropathy like nitrofurantoin; the risk of peripheral neuropathy may be additive.
Moderate Coadministration of bupivacaine with oxidizing agents, such as nitrofurantoin, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue bupivacaine and any other oxidizing agents. Moderate Coadministration of lidocaine with oxidizing agents, such as nitrofurantoin, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue lidocaine and any other oxidizing agents.
Calcium Carbonate; Magnesium Hydroxide: Moderate Coadministration of chloroprocaine with oxidizing agents, such as nitrofurantoin, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue chloroprocaine and any other oxidizing agents.
Moderate Anti-infectives that disrupt the normal GI flora may potentially decrease the effectiveness of estrogen-containing oral contraceptives. Moderate It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives OCs and antibiotics was reported.
It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use.
Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines and penicillin derivatives.
These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified.
During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries e. Drospirenone; Ethinyl Estradiol; Levomefolate: Moderate L-methylfolate and nitrofurantoin should be used together cautiously. Nitrofurantoin is a folate antagonist. Plasma concentrations of both medications may be reduced when used concomitantly.
Ethinyl Estradiol; Ethynodiol Diacetate: Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate: Moderate Nitrofurantoin is a folate antagonist. Patients taking nitrofurantoin may develop folate deficiency. Further study is needed to confirm these interactions. Ethinyl Estradiol; Norethindrone Acetate: Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate: Ethinyl Estradiol; Norethindrone; Ferrous fumarate: Folic Acid, Vitamin B9: Moderate Nitrofurantoin may increase the clearance of indocyanine green.
The half-life of indocyanine green was lower in patients taking the drugs concomitantly compared to patients with normal and abnormal liver function taking no concomitant medications.
The mechanism of interaction is unclear; those proposed in the medical literature include increased indocyanine green uptake by the liver cell, enhanced binding by specific hepatic carrier proteins, or more rapid excretion into bile. Major Oral compounds known to interact with antacids, like nitrofurantoin, should not be taken within 2 hours of dosing with lanthanum carbonate. If these agents are used concomitantly, space the dosing intervals appropriately. Monitor serum concentrations and clinical condition.
Moderate Coadministration of mepivacaine with oxidizing agents, such as nitrofurantoin, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue mepivacaine and any other oxidizing agents. Moderate Coadministration of prilocaine with oxidizing agents, such as nitrofurantoin, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue prilocaine and any other oxidizing agents. Moderate High doses of probenecid can inhibit the renal tubular secretion of nitrofurantoin, leading to a decrease in renal clearance.
Nitrofurantoin serum concentrations can increase, elevating the risk of toxicity. Lower doses of nitrofurantoin should be used when probenecid is used. Moderate Monitor for signs and symptoms of hepatic injury during coadministration of riluzole and nitrofurantoin. Concomitant use may increase the risk for hepatotoxicity. Discontinue riluzole if clinical signs of liver dysfunction are present.
Moderate Coadministration of ropivacaine with oxidizing agents, such as nitrofurantoin, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue ropivacaine and any other oxidizing agents.
Moderate High doses of sulfinpyrazone can inhibit the renal tubular secretion of nitrofurantoin, leading to a decrease in renal clearance. Lower doses of nitrofurantoin should be used when sulfinpyrazone is used.
Moderate Coadministration of tetracaine with oxidizing agents, such as nitrofurantoin, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue tetracaine and any other oxidizing agents.
Learn about Nitrofurantoin Mono/Macro (Generic Macrobid), dosing, proper use and what to know before beginning treatment. Oral dosage (oral suspension containing 25 mg/5mL of nitrofurantoin) For long -term suppressive therapy for urinary tract infection (UTI) prophylaxis in patients. Context: Cabergoline fails to normalize hyperprolactinemia in a considerable proportion of prolactinomas, especially macroadenomas.