Pirfenidone (Esbriet) is a medication used for the treatment of idiopathic pulmonary fibrosis (IPF). It slows down disease progression by regulating the fibrotic process. Its use may be accompanied by a range of side effects, which need to be alleviated through proper medication use and daily management.
What Are the Side Effects of Pirfenidone (Esbriet)?
Gastrointestinal Reactions
Main Manifestations: Nausea (36%), vomiting (13%), diarrhea (26%), dyspepsia (19%), and abdominal pain (24%).
Characteristics: Most occur in the early stage of treatment (within the first 3 months) and gradually diminish as the duration of medication use increases.
Photosensitivity Reactions and Skin Rashes
Approximately 30% of patients develop skin rashes, and 9% experience photosensitivity reactions (such as skin burns or erythema after sun exposure).
In severe cases, it can lead to skin desquamation or blistering, which requires immediate medical attention.
Abnormal Liver Function
3.7% of patients experience an increase in ALT/AST to ≥ 3 times the upper limit of normal values, and an increase in bilirubin is occasionally seen.
Severe liver injury (e.g., cholestatic hepatitis) is rare.
Other Reactions
Fatigue (26%), dizziness (18%), decreased appetite (13%), and weight loss (10%).
Methods to Alleviate the Side Effects of Pirfenidone (Esbriet)
Dosage Adjustment and Medication Timing
Initial Titration: Take 1 capsule each time (3 times a day) for the first 7 days; take 2 capsules each time from Day 8 to Day 14; increase to 3 capsules each time from Day 15 onwards. This helps reduce gastrointestinal irritation.
Administration with Meals: It can reduce the incidence of nausea and dizziness (food slows down the rate of drug absorption).
Symptomatic Treatment
Photosensitivity Reactions: Use sunscreen with SPF 50+, wear long-sleeved clothing, and avoid direct sunlight at noon.
Gastrointestinal Discomfort: Eat small, frequent meals. If necessary, use antiemetics (e.g., ondansetron) or proton pump inhibitors (e.g., omeprazole) in combination.
Monitoring and Intervention
Liver Function: Conduct monthly tests for ALT/AST before medication use and within 6 months after starting medication, then recheck every 3 months thereafter.
Severe Reactions: If ALT/AST exceeds 5 times the normal value or is accompanied by jaundice, permanent discontinuation of the medication is required.
Daily Precautions for Pirfenidone (Esbriet)
Contraindications and Cautions for Medication Use
Contraindicated Combinations: Strong CYP1A2 inhibitors (e.g., fluvoxamine) can increase the blood concentration of pirfenidone, so such inhibitors need to be discontinued or the dosage of pirfenidone reduced to 1 capsule each time.
Special Populations: Patients with severe liver/renal insufficiency or end-stage renal disease should avoid using this medication; smokers need to quit smoking (smoking reduces the efficacy of the medication).
Lifestyle Management
Avoid Alcohol Consumption: Alcohol may increase the risk of liver injury.
Activity Safety: Avoid driving or operating machinery when experiencing dizziness or fatigue.
Long-Term Follow-Up
Regularly recheck lung function (FVC) to evaluate the therapeutic effect, and record new symptoms (e.g., worsening dyspnea).
