Nitrofurantoin was found to interact with HbO2 to cause the concomitant formation of methemoglobin and superoxide. The rate of formation of methemoglobin and superoxide was linearly dependent upon the concentration of nitrofurantoin and could be inhibited by superoxide dismutase, catalase, or the prior conversion of HbO2 to ethylioscyanoferrohemoglobin. The ability of nitrofurantoin to interact with HbO2 and cause superoxide formation may represent one mechanism by which it produces red cell toxicity and suggests that generation of superoxide in erythrocytes may occur via a different mechanism than that which occurs in microsomes.
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