In which conditions should the nurse use caution when administering nitrofurantoin?

Nitrofurantoin is an antibiotic commonly used to treat urinary tract infections, but its use does require caution in specific patient populations. In particular, renal impairment poses a significant risk when administering this medication. Nitrofurantoin is primarily excreted through the kidneys, and in patients with reduced renal function, the drug may accumulate to toxic levels.

When renal function is compromised, the ability of the body to eliminate nitrofurantoin effectively diminishes, increasing the risk for adverse effects such as peripheral neuropathy and pulmonary toxicity. Therefore, renal function must be assessed through glomerular filtration rate (GFR) before starting treatment with nitrofurantoin, and it is generally contraindicated in patients with a GFR of less than 60 mL/min.

While liver disease, heart failure, and diabetes mellitus also require consideration in the medication administration process, the major concern with nitrofurantoin specifically centers on its clearance through the kidneys, making renal impairment the most crucial condition warranting caution.