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Rivaroxaban decompensated cirrhosis — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentRivaroxaban decompensated cirrhosisGPhC CRA

An older adult has taken nitrofurantoin nightly for recurrent-UTI prophylaxis for five months. At a structured monitoring review, which paired finding most specifically suggests the two serious toxicities highlighted by the MHRA?

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Correct answer: B — New dry cough with exertional dyspnoea, together with rising ALT and bilirubin

Nitrofurantoin can cause acute, subacute or chronic pulmonary injury and several forms of hepatic injury. New cough and dyspnoea are pulmonary warning symptoms; a rising ALT and bilirubin suggest hepatic dysfunction. The MHRA advises vigilance for respiratory symptoms during treatment of any duration and periodic review for clinical or biochemical liver injury, particularly during long-term prophylaxis. The alternatives describe different organ-toxicities rather than the nationally highlighted lung–liver pair.

Reference: MHRA: Nitrofurantoin pulmonary and hepatic adverse reactions: https://www.gov.uk/drug-safety-update/nitrofurantoin-reminder-of-the-risks-of-pulmonary-and-hepatic-adverse-drug-reactions