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Diffuse Alveolar Hemorrhage Following Pirfenidone Initiation.
Stacey K Dull1, Nikhil Jagan2, Douglas R Moore2
1Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA.
Journal of Pharmacy Practice
|April 17, 2019
Summary
Pirfenidone, used for idiopathic pulmonary fibrosis (IPF), may cause diffuse alveolar hemorrhage (DAH). Three IPF patients on pirfenidone developed DAH, with two improving after treatment discontinuation and corticosteroids.
Area of Science:
- Pulmonology
- Pharmacology
Background:
- Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease with limited treatment options.
- Pirfenidone is an antifibrotic medication approved for IPF treatment.
- Common pirfenidone side effects include gastrointestinal and skin reactions.
Observation:
- Three patients with IPF receiving pirfenidone presented with hemoptysis and diffuse alveolar hemorrhage (DAH).
- Symptoms developed within two months of initiating pirfenidone therapy.
- Bronchoscopy confirmed DAH in two patients.
Findings:
- Discontinuation of pirfenidone and initiation of corticosteroids led to improvement in two patients.
- One patient's condition worsened despite treatment.
- Nintedanib was initiated in two patients with no further complications.
Implications:
- This study reports the first potential cases of pirfenidone-induced DAH.
- Healthcare providers should be aware of this potential adverse effect when prescribing pirfenidone for IPF.
- Further research is needed to understand the mechanism of pirfenidone-associated DAH.
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