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This document outlines critical safety information and warnings related to the use of nitrofurantoin (Macrobid). Please review the following points carefully and consult your healthcare provider if you have any questions or concerns.

• Lung Damage: Prolonged use of nitrofurantoin (Macrobid) for more than six months may lead to lung damage. If you experience persistent coughing or difficulty breathing, contact your healthcare provider immediately.

• Liver Damage: There is a rare risk of severe liver damage with the use of this medication, especially for individuals with a history of liver issues. Symptoms such as unexplained stomach pain, nausea, vomiting, dark urine, pale stools, or yellowing of the skin or eyes require urgent medical attention.

• Nerve Damage (Neuropathy): This medication can sometimes cause nerve damage in the limbs or eyes, particularly in individuals with kidney issues or other risk factors. If you notice numbness, tingling, or a prickling sensation, inform your healthcare provider.

• Hemolytic Anemia: Nitrofurantoin may cause the breakdown of red blood cells, especially in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Those at higher risk include Black individuals and those of Mediterranean or Middle Eastern descent. Report any unexplained weakness, dizziness, or fatigue to your healthcare provider.

• Severe Diarrhea: Antibiotic use can disrupt gut bacteria, potentially leading to severe diarrhea caused by Clostridioides difficile. If you experience watery or bloody stools, stomach cramps, or fever, seek medical advice promptly. Practice good hygiene, especially if diagnosed with C. diff, to prevent spreading the infection.

Contraindications: Do not use this medication if you have a history of liver damage or jaundice linked to nitrofurantoin, severe kidney issues, significantly reduced urine output, are a female in late pregnancy (38 to 42 weeks) or during labor and delivery, or if the patient is a child under one month of age. Always consult your healthcare provider if any of these conditions apply to you before starting treatment.

Common side effects:

• Nausea
• Headache
• Gas
• Diarrhea
• Vomiting
• Upset stomach
• Stomach pain
• Dizziness
• Drowsiness
• Itchiness
• Fever
• Chills
• "Pins and needles" sensation in the arms and legs

Less common but important to monitor:

• Oral thrush
• Vaginal yeast infection
• White patches in the mouth
• Changes in vaginal discharge

Serious side effects:

• Severe allergic reactions
• Hives
• Rash
• Muscle aches
• Swelling of the lips or tongue
• Difficulty breathing
• Severe diarrhea
• Respiratory issues
• Trouble breathing
• New or worsening cough
• Liver problems
• Stomach bloating
• Severe stomach pain with vomiting
• Yellowing of the skin or eyes
• Dark urine
• Numbness or tingling in the hands and feet
• Unusual muscle weakness
• Symptoms of lung problems
• Persistent cough
• Chest pain
• Shortness of breath
• Severe intestinal condition due to C. difficile bacteria
• Persistent diarrhea
• Abdominal pain
• Blood or mucus in stools
• Very serious allergic reaction
• Severe dizziness

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Cholera Vaccine, Live
• Fluconazole