Pirfenidone
ESBRIET
Pronunciation: pir-FEN-i-doen (es-BREE-et)
“Perfed’n’done Is brittle”
What it isTGF-beta-modulating antifibrotic; idiopathic pulmonary fibrosis.
Why this oneUnlike nintedanib, its tolerability profile centers on photosensitivity and appetite or weight loss rather than diarrhea.
What limits itGI upset, weight loss and photosensitivity limit use; monitor liver tests. CYP1A2 interactions matter, and smoking lowers exposure.
FDA-approved for
- idiopathic pulmonary fibrosis (2014)
Principal riskPhotosensitivity and weight loss
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityDrug-induced liver injury (ALT, AST and bilirubin before and during treatment), photosensitivity and rash including SJS/TEN/DRESS, and GI intolerance; lower the dose with strong CYP1A2 inhibitors such as fluvoxamine.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Idiopathic pulmonary fibrosis | Adult | 267 mg TID | 801 mg TID (2,403 mg/day) | 2,403 mg/day |
Titration Days 1-7: 267 mg TID; days 8-14: 534 mg TID; day 15 onward: 801 mg TID
Renal Use with caution in mild/moderate/severe impairment; not recommended in ESRD on dialysis
Hepatic Use with caution in mild/moderate (Child-Pugh A/B); not recommended in severe (Child-Pugh C)
Instructions
- Take with food at the same time daily
- Conduct liver function tests before and during treatment
- Avoid sunlight/sunlamps; use sunscreen (SPF 50+) and protective clothing
- Stop smoking before and during treatment
- If ≥14 days missed, re-initiate with 2-week titration
Available strengths
- cap 267 mg
- tab 267, 534, 801 mg
Cautions
- Elevated liver enzymes and drug-induced liver injury (including fatal)
- Photosensitivity reaction or rash
- Severe cutaneous adverse reactions (SJS, TEN, DRESS)
- Gastrointestinal disorders (nausea, vomiting, diarrhea, dyspepsia, GERD, abdominal pain)
Adverse reactions
- Nausea
- Rash
- Abdominal pain
- Upper respiratory tract infection
- Diarrhea
- Fatigue
- Headache
- Decreased appetite
- Dyspepsia
- Dizziness
- Vomiting
- GERD
Pregnancy Insufficient human data; not teratogenic in animals.
Lactation No information on presence in human milk.
Cost
Generic entry2022
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Memory aids: interaction avatars
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Self-check
- Pirfenidone: Which skin effect distinguishes tolerability from nintedanib?
Photosensitivity. - Pirfenidone: How does smoking affect exposure?
It lowers exposure.