The concentration of the drug in the urine is inadequate for therapeutic effectiveness in patients with renal impairment (i.e., CrCl less than 60 mL/minute) and the risk for adverse reactions is greater in those with substantial renal impairment. Anuria, oliguria, or significant impairment of renal function, defined as a creatinine clearance (CrCl) less than 60 mL/minute or clinically significant elevated serum creatinine, are contraindications to nitrofurantoin use per the package labels. Nitrofurantoin is known to be substantially excreted by the kidney. In general, the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy in elderly patients should be considered when prescribing nitrofurantoin. Spontaneous reports also suggest an increased proportion of severe hepatic reactions, including fatalities, in geriatric patients. As in younger patients, chronic pulmonary reactions generally are observed in patients receiving therapy for 6 months or longer. Spontaneous reports suggest a higher proportion of pulmonary reactions, including fatalities, in geriatric patients these differences appear to be related to the higher proportion of older patients receiving long-term nitrofurantoin therapy. Use nitrofurantoin with caution in geriatric patients.
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