Drug-induced haemolysis: another reason to be cautious with nitrofurantoin

Abstract

We report the case of a previously healthy woman in her 60s who presented to the emergency department with acute confusion, vomiting and fever. She was recently diagnosed with a urinary tract infection as an outpatient and had completed the fifth day of a 7-day course of treatment with nitrofurantoin. We maintained a wide differential diagnosis including infectious, metabolic, autoimmune and medication-related causes. She developed an acute normocytic anaemia in hospital with a haemoglobin drop from 121 g/L to 89 g/L. Further investigation revealed evidence of haemolysis with an elevated bilirubin, lactate dehydrogenase, reticulocyte count and decreased haptoglobin. She was worked up for both inherited and acquired causes of haemolysis and found to have glucose-6-phosphate dehydrogenase deficiency. Her presentation was thought to be secondary to nitrofurantoin-induced haemolysis and she recovered completely with conservative management through intravenous fluids and discontinuation of nitrofurantoin.

The Conjugates of Indolo[2,3-b]quinoline as Anti-Pancreatic Cancer Agents: Design, Synthesis, Molecular Docking and Biological Evaluations

“…The calculated SI values of 2 w approximately two and three times higher than the SI of DiMIQ (6) (Table 1 and Figure The second conjugate, 1, showed cytotoxicity and selectivity similar to that of the referen compound 6 over normal cells (Table 1 and Figure 8). Drug-induced hemolysis has been identified as a serious side effect of some an cancer therapies and has been proven for some drugs, such as tamoxifen [60], artemisin derivatives [61], and other bioactive compounds [62]. An additional evaluation was p formed using another mammalian cell model, namely freshly isolated human eryth cytes, to gain more information on the possible toxicity of conjugates 1 and 2.…”

“…One of the expectations for the new conjugates was to increase their cytotoxicity vitro, compared to the independent effects caused by DiMIQ and hydroxycinnamic a Drug-induced hemolysis has been identified as a serious side effect of some anticancer therapies and has been proven for some drugs, such as tamoxifen [60], artemisinin derivatives [61], and other bioactive compounds [62]. An additional evaluation was performed using another mammalian cell model, namely freshly isolated human erythrocytes, to gain more information on the possible toxicity of conjugates 1 and 2.…”