Esbriet (pirfenidone) has potential interactions with other medications, such as ciprofloxacin and fluvoxamine. These interactions could affect how well the drug works or cause harmful effects.
Esbriet is used to treat idiopathic pulmonary fibrosis (IPF) in adults. IPF is a condition in which the lungs scar without a clear cause.
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions also can occur if you have certain health conditions.
Keep reading to learn about Esbriet’s possible interactions. For a detailed overview of this drug, check out this Esbriet overview article.
Before you start taking Esbriet, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions.
To learn whether Esbriet interacts with herbs, vitamins, or supplements, see the “Are there other interactions with Esbriet?” section.
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The following table lists drugs that may interact with Esbriet. Keep in mind that this table does not include all drugs that may interact with Esbriet. For more information about some of these interactions, see the “Drug interactions explained” section.
| Drug group or drug name | Drug examples | What can happen |
|---|---|---|
| certain antiarrhythmic drugs | • amiodarone (Pacerone) • mexiletine | can increase the risk of side effects from Esbriet |
| diuretics (water pills) | • hydrochlorothiazide (Microzide) • furosemide (Lasix) • others | can increase the risk of photosensitivity (very sensitive to UV light) and severe sunburn as side effects from Esbriet and certain diuretics |
| certain asthma medications | • zafirlukast (Accolate) • zileuton (Zyflo) | can increase the risk of side effects from Esbriet |
| certain oncology medications | • rucaparib (Rubraca) • vemurafenib (Zelboraf) | can increase the risk of side effects from Esbriet |
| oral contraceptives (birth control pills) | • ethinyl estradiol/desogestrel (Bekyree, others) • ethinyl estradiol/norethindrone (Nexesta Fe, others) | can increase the risk of side effects from Esbriet |
| retinoids | • retinol • tretinoin (Retin-A, others) | can increase the risk of photosensitivity (very sensitive to UV light) and severe sunburn as side effects from Esbriet and retinoids |
| carbamazepine (Equetro, others) | — | can make Esbriet less effective |
| cimetidine (Tagamet HB) | — | can increase the risk of side effects from Esbriet |
| ciprofloxacin (Cipro) | — | can increase the risk of side effects from Esbriet |
| fluvoxamine (Luvox) | — | can increase the risk of side effects from Esbriet |
Esbriet is not known to interact with alcohol. But Esbriet and alcohol can cause some similar side effects, such as headache and pain in the abdomen. So you may be more likely to experience these side effects if you drink alcohol during your treatment with Esbriet.
Also, Esbriet can cause liver damage as a side effect. Similarly, consuming alcohol can cause liver damage, especially if consumed in large amounts over time. Your doctor will likely order liver function tests throughout your treatment with Esbriet. If you consume alcohol regularly during treatment with Esbriet, your doctor may order these tests more often.
If you have questions about consuming alcohol during treatment with Esbriet, talk with your doctor or pharmacist.
Interaction with diuretics
Esbriet interacts with diuretics, which doctors prescribe to treat edema (fluid retention). Edema might be due to conditions such as heart failure and chronic kidney disease.
Both Esbriet and diuretics can cause photosensitivity, which means you’re very sensitive to UV light. If you take these medications together, it raises your risk of this side effect further. It also raises your risk of severe sunburn.
Some diuretics that may interact with Esbriet are:
- hydrochlorothiazide (Microzide)
- furosemide (Lasix)
- chlorthalidone (Thalitone)
- torsemide (Soaanz)
- triamterene (Dyrenium)
What you can do
Due to the risk of photosensitivity, your doctor may avoid prescribing Esbriet if you’re taking a diuretic.
But if you have a condition that causes edema, it may not be possible to avoid this interaction. So if you do take Esbriet with a diuretic, your doctor may prescribe a lower dosage of Esbriet or the diuretic than usual. You should not take a dose of either medication higher than your doctor prescribes.
While taking Esbriet, you can take some
- using sunscreen whenever you expose your skin to sunlight
- wearing protective clothing (such as a hat and long sleeves) any time you expose your skin to the sun
- avoiding tanning beds
- avoiding light from sunlamps
If you take Esbriet and a diuretic together, tell your doctor right away if you have symptoms of photosensitivity. These may include a skin rash and sunburn.
If you have questions about taking Esbriet with a diuretic, talk with your doctor or pharmacist.
Interaction with ciprofloxacin (Cipro)
Esbriet interacts with ciprofloxacin (Cipro), an antibiotic that treats certain bacterial infections.
Ciprofloxacin slows activity of a certain enzyme (a type of protein) in the body. This enzyme breaks down Esbriet so the drug can be removed from your body. But slowing the activity of this enzyme can raise the level of Esbriet in the body. This can raise your risk of Esbriet side effects.
What you can do
If you take Esbriet with ciprofloxacin, your doctor may prescribe a lower dosage of Esbriet or ciprofloxacin than usual. You should not take a dose of either medication higher than your doctor prescribes.
When you take these drugs together, your doctor will check your liver health. They’ll order liver function tests to check your liver before you start and during treatment.
If you take Esbriet and ciprofloxacin together, tell your doctor right away if you have symptoms such as:
- pain in the abdomen
- nausea
- headache
If you have questions about taking Esbriet with ciprofloxacin, talk with your doctor or pharmacist.
Interaction with fluvoxamine (Luvox)
Esbriet interacts with fluvoxamine (Luvox), which doctors prescribe to treat obsessive-compulsive disorder (OCD).
Your body relies on a specific enzyme (a type of protein) to break down Esbriet. This action makes it easier to remove the drug from your body. But fluvoxamine slows the activity of this enzyme, which increases the amount of Esbriet in your body. In turn, this raises your risk of Esbriet side effects.
What you can do
Due to the increased risk of side effects from Esbriet, your doctor likely won’t prescribe it with fluvoxamine. Instead, they can discuss alternatives to Esbriet or fluvoxamine for your condition.
Despite the increased risk of side effects, taking Esbriet and fluvoxamine together is sometimes the best treatment choice. In this case, your doctor may prescribe a lower dosage of Esbriet or fluvoxamine than usual. They’ll also monitor you closely for symptoms of Esbriet side effects. They also may order liver function tests more often to check your liver health.
If you have questions about taking Esbriet with fluvoxamine, talk with your doctor or pharmacist.
Esbriet may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests.
The discussion below does not include a full list of all other interactions possible with Esbriet.
Does Esbriet interact with supplements?
Currently, Esbriet has no reports of interacting with supplements, herbs, or vitamins. But this doesn’t mean that interactions with these products won’t be recognized in the future.
Before you start taking Esbriet, talk with your doctor and pharmacist about any supplements, herbs, or vitamins you take. Sharing this information with them may help you avoid possible interactions.
Does Esbriet interact with food?
Esbriet currently has no reports of interacting with food. If you have questions about eating certain foods during your treatment with Esbriet, talk with your doctor.
Does Esbriet interact with vaccines?
Currently, Esbriet has no reports of interacting with vaccines. If you have questions about getting certain vaccines during your Esbriet treatment, talk with your doctor.
Does Esbriet interact with lab tests?
Esbriet currently has no reports of interacting with lab tests. If you have questions about having certain lab tests during your treatment with Esbriet, talk with the healthcare professional ordering the test.
Esbriet can sometimes affect your liver, which blood tests may confirm. Some people may not notice symptoms of liver problems, but others might. Let your doctor know right away if you have the following symptoms that might indicate liver problems:
- feeling unusually tired
- loss of appetite
- pain on the right side of your stomach
Does Esbriet interact with cannabis or CBD?Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been reported to interact with Esbriet.
Cannabis can increase or decrease the effect of Esbriet. Increasing its effect can raise your risk of Esbriet side effects. Decreasing its effect could make Esbriet less effective at treating your condition.
Before you start treatment with Esbriet, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Esbriet. Before taking Esbriet, talk with your doctor about your health history. They’ll determine whether Esbriet is right for you.
Health conditions or other factors that might interact with Esbriet include:
Kidney condition: Your kidneys remove Esbriet from your body. But having chronic kidney disease or other kidney conditions can impact how well your body removes Esbriet. If it doesn’t remove enough Esbriet, your risk of Esbriet side effects increases. Depending on the severity of your kidney condition, your doctor may prescribe a lower Esbriet dosage. They also may monitor you closely for side effects. It’s possible, too, that they may not prescribe Esbriet for you. In this case, they can discuss other treatments for IPF with you.
Liver condition: If you have cirrhosis or another liver condition, your body may have problems breaking down Esbriet. This can increase the level of Esbriet in your system and raise your risk of side effects from Esbriet. In this case, your doctor may prescribe a lower Esbriet dosage and monitor you closely for side effects. Or they may explore other treatments for IPF with you instead of prescribing Esbriet.
Smoking tobacco: Your doctor likely will advise you to avoid smoking tobacco if they prescribe Esbriet for you. Smoking can cause your body to break down Esbriet more quickly, which can make Esbriet less effective. If you smoke, talk with your doctor about ways to quit before you begin taking Esbriet.
Pregnancy: It’s not known whether Esbriet is safe to take during pregnancy. If you’re pregnant or may become pregnant, talk with your doctor before beginning treatment with Esbriet.
Breastfeeding: It’s not known whether it’s safe to take Esbriet while breastfeeding. Researchers don’t know if the drug passes into breast milk or if it could cause side effects in a child who’s breastfed. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.
Allergic reaction: If you’ve ever had an allergic reaction to Esbriet or any of its ingredients, your doctor likely won’t prescribe Esbriet. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better for you.
Taking certain steps can help you avoid interactions with Esbriet. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- whether you drink alcohol or use cannabis
- the
list of medications you take, as well as any vitamins, supplements, and herbs - what to do if you start taking a new drug during your Esbriet treatment
It’s also important to understand Esbriet’s
If you did not get paperwork with Esbriet, ask your pharmacist to print a copy for you. If you have difficulty reading or understanding this information, your doctor or pharmacist can help.
Taking Esbriet exactly as prescribed also can help prevent interactions.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.