Anti-fibrotic treatments for IPF

Your pulmonary fibrosis treatment will depend on your condition. Although there is no cure for idiopathic pulmonary fibrosis (IPF) at present, recent studies suggest that people taking anti-fibrotic treatments can live longer.

What are anti-fibrotics?

Anti-fibrotic medications like nintedanib and pirfenidone can slow down the build-up of scar tissue or fibrosis in the lungs and are usually used to treat idiopathic pulmonary fibrosis (IPF). These IPF treatments may reduce the rate that your lung fibrosis progresses. But they don’t stop the lung scarring completely or get rid of any scar tissue that has already formed.

If you don’t have idiopathic pulmonary fibrosis, find out about treatments for hypersensitivity pneumonitis or autoimmune diseases, such as rheumatoid arthritis and systemic sclerosis.  

Nintedanib (Ofev®)

Nintedanib is an anti-fibrotic medication used to treat idiopathic pulmonary fibrosis.  Your medical team will prescribe you nintedanib for as long as it’s helping you, unless you have significant side effects.

  • Take nintedanib twice a day, ideally 12 hours apart, with or straight after food. Don’t chew or crush the capsule, but swallow it whole.
  • Most people take 150mg of nintedanib twice a day. If your body can’t tolerate this dose, your medical team may put you on 100 mg twice a day if they think a reduced dose will help you.
  • If you’re on nintedanib, your medical team will monitor you regularly to check it’s working and help you manage any side effects. You will also have regular blood tests to make sure your liver is healthy.

Need to know about nintedanib

  • You cannot take nintedanib if you are allergic to soya or peanuts.
  • The most common side effect is loose bowel motions or diarrhoea. You might also have nausea, vomiting, loss of appetite or abdominal pain.
  • Occasionally, you may experience liver inflammation or bleeding such as nose bleeds.
  • Sometimes there can be problems with nintedanib if you’re taking other medications. Make sure you discuss your medical history with your medical team -especially if you’re on blood thinning medications, you’ve had problems with your heart, you have allergies or you have any recent or planned surgeries.
  • Some medicines can increase the risk of side effects. These include ibuprofen and other non-steroidal anti-inflammatory drugs, certain antibiotics and some immunosuppressant drugs.
  • You can drink a small amount of alcohol with nintedanib (no more than the recommended number of units a week).
I struggled on one anti-fibrotic so was started on the other – and now I can say I don’t know I’m taking it

Pirfenidone (Esbriet®)

Pirfenidone is an anti-fibrotic idiopathic pulmonary fibrosis treatment. Your medical team will prescribe you pirfenidone for as long as it’s helping you, unless you have significant side effects.

  • Take pirfenidone three times a day, with or straight after food.  Swallow the tablet whole and don’t chew or crush it.
  • The full dose of pirfenidone is 801mg three times a day.  You will start on a lower dose and over a few weeks, you’ll work up to the full dose.  If you experience side effects, your medical team may reduce the dose.
  • Your medical team will monitor you regularly and help you manage any side effects. You will also have blood tests to make sure your liver is healthy.

Need to know about pirfenidone

  • The most common side effect is photosensitivity (a skin reaction to daylight).  You should avoid the sun and cover up with long sleeves, gloves and a hat. You should also wear factor 50 sunscreen all year round for additional protection.
  • You might have nausea, vomiting, loss of appetite or indigestion. Taking pirfenidone with food can help to reduce these side effects.
  • You may also experience liver inflammation or fatigue.
  • Sometimes there can be problems with pirfenidone if you’re taking other medications.  Make sure you discuss your medical history with your medical team -especially if you’re taking antibiotics, indigestion medication, CYP1A2 inhibitors or medicines for heart disease.
  • Smoking reduces the effectiveness of pirfenidone.  You are advised not to smoke whilst taking pirfenidone.
  • You are advised to avoid grapefruits and grapefruit juice.
  • You can drink a small amount of alcohol with pirfenidone (no more than the recommended number of units a week).

Other IPF medications

You may also be offered other treatment – such as medications to help manage a cough or breathlessness, and over-the-counter medicines and advice to manage acid reflux.

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