Pirfenidone, sold under the brand name Esbriet, is a prescription medication used for the treatment of idiopathic pulmonary fibrosis (IPF). This condition involves the scarring of lung tissue, which makes breathing progressively more difficult. The medication is an oral treatment taken daily to help slow the progression of this scarring.
Standard Dosing and Titration
Initiating treatment with pirfenidone involves a gradual increase in the dose over a two-week period. This process, known as titration, allows the body to adjust to the medication and can help manage potential side effects. The process begins with blood tests to check liver function before starting. Taking the medication with food is recommended to help reduce side effects such as nausea and dizziness.
The titration schedule is structured over 14 days. For the first week, from days one through seven, the dose is one 267 mg capsule or tablet taken three times per day, for a total daily intake of 801 mg. During the second week, from days eight through fourteen, the dosage increases to two 267 mg units three times daily, totaling 1602 mg per day.
From day 15 onward, the patient reaches the full maintenance dose. This consists of three 267 mg capsules or tablets taken three times a day, for a total daily dose of 2403 mg. It is advised that doses are taken at the same time each day with food. Some patients may transition to a single 801 mg tablet taken three times daily, which is equivalent to the nine-pill regimen.
Managing Missed Doses or Treatment Interruptions
If a person misses a single dose, they should take their next dose at the regularly scheduled time. It is important not to take two doses at once to make up for the one that was missed. Taking more than the prescribed three daily doses is not recommended.
A significant interruption in treatment requires a different approach. If a patient stops taking pirfenidone for 14 consecutive days or more, they should not resume their previous maintenance dose. Instead, treatment must be re-initiated through the original two-week titration schedule under a doctor’s guidance. For interruptions lasting less than 14 days, a patient can resume the dosage they were on before the interruption.
Dose Adjustments for Side Effects
A healthcare provider may alter the dose of pirfenidone if a patient experiences significant adverse reactions. Side effects such as gastrointestinal problems, dizziness, or a photosensitivity rash might prompt a physician to recommend a temporary dose reduction or interruption of the medication.
When a dose reduction is necessary, a doctor might instruct the patient to step back to a previously tolerated dose level from the initial titration period. For instance, a patient on the full maintenance dose might be advised to return to the day 8-14 dose of 1602 mg/day temporarily. Once the side effect has subsided, the healthcare provider may guide the patient in re-escalating the dose back to the full maintenance level.
Any modification to the prescribed dosage of pirfenidone must be supervised by a healthcare professional. In some cases, such as the development of a severe skin reaction or certain levels of liver enzyme elevations, the medication may need to be discontinued permanently.