Alert at Creatinine Clearance < 30mL/min. Side effects of Fluoroquinolones are more due to declining renal function rather than being solely age-related. The adverse effects of the CNS are more of a concern for the elderly. A patient that already has pre-existing CNS impairments should be monitored very closely. Dose reduction is recommended if the creatinine clearance is lower than the limit.
Chronic renal impairment is a risk factor for increased frequency of tendon rupture if fluoroquinolones are used.
- FDA Monograph: Ciprofloxin
- Stahlmann R, et.al. Fluoroquinolones in the Elderly. Safety considerations. Review Article. Drugs Aging 2003: 20(4): 289- 302
Nitrofurantoin can cause a pulmonary reaction, peripheral neuropathy, and hepatotoxicity. Other notes in older adults: avoid use in individuals with creatinine clearance under 30ml per minute. These patients are at an increased risk because renal clearance of the drug is impaired.