Inappropriate Medication Use in Older Adults: Does Nitrofurantoin Belong on the List for the Reasons Stated?

Abstract

Fick et al¹ provide some useful recommendations to avoid medications that produce unwarranted toxic effects or drug-related problems in older adults. It is surprising to find that nitrofurantoin was given a high-severity rating because of purported "potential for renal impairment." This assessment was based on group consensus using a modified Delphi method. Group opinions can be misinformed. There is no evidence-based support for this notion. Nitrofurantoin has many potential adverse effects, but I am unaware of reports that it causes renal failure.^2,3 Perhaps the intent of the expert panelists was to indicate that nitrofurantoin is contraindicated in patients with renal failure (creatinine clearance 4 Nitrofurantoin may be ineffective for treatment of urinary tract infections in elderly patients with reduced renal function, but it is not contraindicated because of nephrotoxicity.