Nitrofurantoin can cause serious lung injury. The reaction can occur within hours of the start of treatment if the patient has previously received nitrofurantoin or within a few days of starting nitrofurantoin for the first time. Symptoms include difficulty breathing, chills, fever, chest pain, and cough. In other persons, lung injury may occur after approximately a month of treatment. Symptoms include difficulty breathing, rapid breathing, and cough. Fortunately, the symptoms usually resolve within a week if the medication is stopped. In still other persons, lung injury may not develop until after several months or years of therapy. Unless it is recognized and treated, this delayed lung injury can result in permanent lung damage that remains even after the drug is stopped.

A condition known as peripheral neuropathy (damage to the sensory nerves of the arms and legs), may occur with nitrofurantoin therapy, most commonly causing tingling in the extremities. The condition can become severe and is more likely to occur in patients with diabetes mellitus, vitamin B deficiency, or general debilitation.

A type of anemia (reduced red blood cell count) called hemolytic anemia can occur during therapy with nitrofurantoin. This reaction occurs most frequently in persons with a deficiency of an enzyme called glucose-6-phosphate dehydrogenase which is very important to the survival of red blood cells.

Nitrofurantoin also can cause liver damage leading to jaundice or a form of hepatitis which can be fatal. Elevated liver enzymes indicate liver damage and are a reason to stop the drug.

Treatment with nitrofurantoin can cause urine to change color to a dark yellow or brown.

Reference: FDA Prescribing Information

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