What medication is used for fibrotic opacities? An overview of antifibrotic treatments

October 12, 2025 •

4 min read

According to the American Lung Association, over 80,000 Americans are affected by Idiopathic Pulmonary Fibrosis (IPF), a disease that causes scarring in the lungs. To manage the resulting fibrotic opacities, specific antifibrotic medications are often prescribed to slow the progression of the disease.

Quick Summary

The primary medications for fibrotic opacities are antifibrotic drugs, notably nintedanib and pirfenidone, which work by inhibiting lung scarring. While they do not cure the underlying condition, these treatments can significantly slow disease progression and are often used alongside other supportive therapies.

Key Points

Antifibrotic Drugs are Primary Treatment: The main medications for fibrotic opacities caused by pulmonary fibrosis are antifibrotic drugs, including nintedanib (Ofev®) and pirfenidone (Esbriet®).
Medications Slow, Not Cure: These antifibrotic drugs work by slowing down the rate of lung scarring and the decline in lung function; they cannot reverse existing scar tissue.
Nintedanib vs. Pirfenidone: Nintedanib is a tyrosine kinase inhibitor, while pirfenidone has anti-inflammatory and antioxidant effects. The choice depends on individual patient factors.
Comprehensive Treatment Is Needed: A holistic approach includes managing associated symptoms like cough and acid reflux, treating any underlying autoimmune conditions, and incorporating supportive care like oxygen and pulmonary rehabilitation.
Lifestyle Management Is Crucial: Lifestyle adjustments such as quitting smoking, eating a healthy diet, and regular physical activity can significantly support medical treatment.
Clinical Trials Offer New Hope: Ongoing research and clinical trials are investigating new therapies that may lead to breakthroughs in reversing fibrosis or offering more effective treatment options.

What Are Fibrotic Opacities?

Fibrotic opacities refer to areas of scar tissue that develop in the lungs, a condition known as pulmonary fibrosis. These scarred areas appear as dense, white patches on a chest imaging scan, such as a high-resolution computed tomography (HRCT) scan. This scarring causes the lung tissue to become stiff and thick, which hinders its ability to expand and efficiently transfer oxygen into the bloodstream. Over time, this leads to increasing shortness of breath, fatigue, and other respiratory symptoms.

Causes of Fibrotic Opacities

The causes of pulmonary fibrosis are varied and sometimes unknown. The term "idiopathic pulmonary fibrosis" (IPF) is used when a specific cause cannot be identified. For other forms, known causes include:

Autoimmune Diseases: Connective tissue diseases such as rheumatoid arthritis, lupus, and scleroderma can cause fibrotic lung changes.
Environmental Exposures: Long-term inhalation of toxins like asbestos, silica dust, and coal dust can lead to lung scarring. In some cases, exposure to molds or bird droppings can also trigger a fibrotic response.
Certain Medications: Some pharmaceutical drugs, including amiodarone, bleomycin, and methotrexate, are known to have pulmonary fibrosis as a potential side effect.
Other Conditions: Chronic acid reflux (GERD), radiation therapy to the chest, and certain infections can also contribute to lung fibrosis.

Antifibrotic Medications: Nintedanib and Pirfenidone

For many fibrotic lung conditions, particularly IPF, the cornerstone of treatment involves antifibrotic agents. Two such drugs, nintedanib and pirfenidone, are approved to slow the progressive scarring of the lungs. It is important to note that these medications do not reverse existing scarring but rather decelerate the rate of lung function decline, helping to manage symptoms and improve quality of life.

Nintedanib (Ofev®)

Nintedanib is a tyrosine kinase inhibitor that blocks various growth factor receptors involved in the scarring process. By interrupting these signaling pathways, it helps to slow the rate of fibrosis. It is prescribed for several fibrosing interstitial lung diseases, including IPF, systemic sclerosis-associated interstitial lung disease (SSc-ILD), and other chronic fibrosing ILDs with a progressive phenotype. Nintedanib is typically taken orally with food. The dose may be adjusted by a doctor based on a patient's tolerability.

Pirfenidone (Esbriet®)

Pirfenidone is a pyridine derivative with anti-inflammatory, antioxidant, and antifibrotic properties. It is thought to work by interfering with the production of a natural substance in the body that promotes fibrosis. Pirfenidone is approved for the treatment of IPF. Patients usually take this medication with food, with a gradual dose increase over time as prescribed by a healthcare provider.

Comparison of Antifibrotic Medications

While both nintedanib and pirfenidone aim to slow disease progression, they have different mechanisms of action and side effect profiles. The choice between them is often individualized based on a patient's comorbidities, side effect tolerance, and preference.


Feature	Nintedanib (Ofev®)	Pirfenidone (Esbriet®)
Mechanism of Action	Tyrosine kinase inhibitor, blocks growth factor receptors involved in fibrosis.	Interferes with a substance that promotes fibrosis; has anti-inflammatory and antioxidant effects.
Indicated Conditions	IPF, SSc-ILD, and other progressive fibrosing ILDs.	Idiopathic Pulmonary Fibrosis (IPF).
Common Side Effects	Diarrhea, nausea, vomiting, abdominal pain, weight loss.	Nausea, rash (photosensitivity), fatigue, diarrhea, headache.
Monitoring	Regular liver function tests (LFTs) at baseline and periodically.	Regular LFTs at baseline, and periodically.
Dosing Schedule	Taken orally with food, typically twice a day.	Taken orally with food, typically multiple times a day with a gradual dose increase over time as prescribed.

Management of Associated Symptoms and Underlying Conditions

Beyond the primary antifibrotic treatment, a comprehensive management plan addresses secondary issues and underlying causes:

Symptom Management: To alleviate symptoms such as a chronic dry cough, a doctor might recommend over-the-counter cough suppressants or, in severe cases, prescription medications. For gastroesophageal reflux disease (GERD), which is common in IPF patients, antacid medications like proton pump inhibitors can be used to prevent stomach acid from affecting the lungs.
Treating Autoimmune Causes: If an autoimmune disease is the root cause of the lung fibrosis, immunosuppressants such as azathioprine or mycophenolate mofetil might be prescribed. These medications suppress the immune system to reduce inflammation. However, this approach is not recommended for IPF, where it has shown little to no benefit.
Oxygen Therapy: As the fibrosis progresses and oxygen levels in the blood decline, supplemental oxygen therapy can be prescribed. This helps to reduce shortness of breath and other complications from low blood oxygen.

Lifestyle and Supportive Care

Medical treatments are most effective when combined with lifestyle modifications and supportive care. Pulmonary rehabilitation is a key component, offering structured exercise training, breathing techniques, and nutritional guidance to improve physical and emotional well-being. Quitting smoking is paramount, as smoking can worsen lung damage. Patients are also encouraged to get vaccinated against respiratory infections like the flu and pneumonia. Emotional support from family, friends, and support groups can also help manage the fear and anxiety associated with a chronic illness.

The Role of Clinical Trials and Future Directions

For some patients, clinical trials exploring new drug interventions may be an option. Research continues to investigate novel therapies that can not only slow progression but potentially reverse fibrosis. Promising areas include drugs that target key fibrotic pathways or improve lung repair. Biomarkers and advanced imaging are also being developed to personalize treatment strategies. Information on active clinical trials can be found at ClinicalTrials.gov.

Conclusion

Fibrotic opacities, a hallmark of pulmonary fibrosis, are primarily treated with antifibrotic drugs like nintedanib and pirfenidone to slow the inexorable progression of lung scarring. While these medications do not offer a cure, they are vital for managing the disease and improving a patient's quality of life. The choice of medication is a personal one, made in consultation with a medical professional, and side effect management is a key part of long-term adherence. A holistic treatment plan that includes addressing underlying causes, managing symptoms, supportive therapies like pulmonary rehabilitation, and lifestyle adjustments is essential for optimal outcomes. Continuous research and clinical trials offer hope for even more effective treatments in the future.

Frequently Asked Questions

No, antifibrotic medications like nintedanib and pirfenidone are not a cure for fibrotic opacities or pulmonary fibrosis. Their purpose is to slow down the progression of scarring and lung function decline, not to reverse existing scar tissue.

Nintedanib is a tyrosine kinase inhibitor that blocks specific cellular pathways causing fibrosis. Pirfenidone is a pyridine derivative with anti-inflammatory properties that inhibits the substance promoting scarring. The choice is based on a doctor's assessment of individual patient needs, comorbidities, and tolerance.

Common side effects for nintedanib include diarrhea, nausea, vomiting, and abdominal pain. For pirfenidone, common side effects include nausea, fatigue, a photosensitivity rash, and gastrointestinal issues.

Yes, regular monitoring is necessary. Both nintedanib and pirfenidone require periodic liver function tests (LFTs) to monitor for potential side effects, particularly during the initial months of treatment.

It is crucial to tell your doctor and pharmacist about all other prescription and over-the-counter medicines, vitamins, and herbal supplements you take. Some medications may interact with antifibrotic drugs or affect their efficacy, requiring dosage adjustments or closer monitoring.

Yes, pulmonary rehabilitation is highly recommended as a supportive therapy. It includes exercise training, breathing techniques, and counseling to help manage symptoms, improve physical function, and enhance quality of life.

If an autoimmune disease like rheumatoid arthritis is the cause, immunosuppressants such as mycophenolate mofetil might be part of the treatment plan, in addition to or instead of antifibrotics, to manage the underlying condition.