How Compound Nifedipine May Help Slow Destructive Interstitial Lung Disease
Few things are scarier than not being able to breathe. Dorothy A., a 73-year-old retired elementary principal who struggled with shortness of breath while using stairs or exercising for the past ten years, now found that even the act of speaking or eating caused her to wheeze and panic. Her chronic interstitial lung disease was robbing the very air from the lungs, literally stiffening and scarring her lung tissues, and making terrifying shortness of breath her daily reality.
Interstitial lung disease, which encompasses pulmonary fibrosis or fibrotic lung diseases, can be a very difficult condition for patients to weather, as the disease systematically destroys structures in the lungs. When presented with patients who suffer from interstitial lung diseases like pulmonary fibrosis, compound pharmacists may have an opportunity to positively impact patient quality of life by trying a regimen of the compound nifedipine.1
How Does Compound Nifedipine Help Combat Interstitial Lung Disease?
The ideal patient for potential nifedipine therapy is someone like Dorothy. Often the first and only visible symptom of interstitial lung disease, shortness of breath worsens over time, and at the time of her diagnosis, Dorothy found it consistently hard to breathe all the time. With otherwise healthy respiratory system tissues, Dorothy could see a significant slowing in the buildup of fibrotic structures in the interstitium.
Normally used sublingually for angina or for hypertension, calcium blocker compound nifedipine has been shown to potentially reduce or inhibit the bleomycin-induced fibrotic shifts that can occur during pulmonary fibrosis. This effectively can prevent the aggressive progression of fibrosis in vivo. Although it does not treat or reverse the progression of pulmonary fibrosis, the halting of the lung destruction and remodeling through the calcium blocking channel can slow disease progression.2
Clinical tests show that nifedipine is not without its potential side effects, including potential exacerbation of gastroesophageal reflux in recipients during clinical trials. One side effect is nifedipine’s unintended reduction of tone in patients’ esophageal sphincters, leading to increased reflux. A preexisting GERD condition should preclude pharmacists from working nifedipine into a patient’s treatment regime, which is why patients like Dorothy should be carefully screened.
Nifedipine also appears to have no effect whatsoever on lung inflammation, so if patients’ ILD or specifically pulmonary fibrosis presents primarily with inflammatory symptoms, nifedipine may not be the treatment of choice for that patient. Pharmacists should always consult with a patient’s primary care physician and pulmonary specialist, especially since pulmonary fibrosis is no longer thought to be a predominantly proinflammatory disorder.3
Nifedipine does, however, show marked improvement in slowing lung stiffness and overexpression of smooth actin. It also causes increased soluble collagen and hydroxyproline production, slowing fibrotic growth. Although lung tissue damaged by pulmonary fibrosis cannot regain normal function, slowing the development of these structures can aid in improving quality of life.4
Compound Pharmacists and Off-Label Treatments for Interstitial Lung Disease
The first thing a compound pharmacist must remember is that pulmonary fibrosis is chronic, aggressive, progressive and no curative treatment currently exists. When a patient is in a position to consider nifedipine treatment, pharmacists should always ask about quality of life indicators and formulate a plan based on patient comfort rather than disease eradication.
Pharmacists should also be fully aware of a host of comorbidities that often accompanies interstitial lung disease at all stages of progression, but particularly later-stage pulmonary fibrosis. These can include heart failure, respiratory failure, pulmonary hypertension and more, and comorbidities can determine what potential therapies a pharmacist can try.
Nifedipine has been primarily tested on and shown to slow the progression of pulmonary fibrosis, specifically, but there are a variety of interstitial lung diseases. Some patients with other variations on ILD may also benefit from nifedipine, and a compound pharmacist can work closely with a patient’s health care team to determine if nifedipine’s calcium blocking effects can help.5
Patients may ask about existing FDA-approved medications nintedanib (Ofev) and pirfenidone (Esbriet), and how they relate to potential off-label treatments. A compounding pharmacist can explain that nifedipine works differently than nintedanib and pirfenidone, a kinase inhibitor and pyridone treatment, respectively. Both are known to have side effects that cause elevated liver enzymes, making them potentially a poor choice for patients with existing liver complications.6
The flexibility of compounding makes it possible to work with medications like nifedipine, intended for hypertension, and try to improve patient well-being as much as possible by applying the drugs in creative but effective ways. Not all patients will be candidates for nifedipine treatments, but a compounding pharmacist who is educated about dual or alternate uses for common medications can arm themselves with the knowledge to provide better patient care.
Pharmaceutica North America is a premier provider of high-quality active pharmaceutical ingredients and compounding kits. Contact us to learn more about nifedipine and how our products can help you provide the best possible patient services.
- “Interstitial lung disease,” Feb. 8, 2014, https://www.nlm.nih.gov/medlineplus/ency/article/000128.htm ↩
- “Disruption of Calcium Signaling in Fibroblasts and Attenuation of Bleomycin-Induced Fibrosis by Nifedipine,” Oct. 2015, http://www.ncbi.nlm.nih.gov/pubmed/25664495 ↩
- “Calcium Channel Blockers and Esophageal Sclerosis: Should We Expect Exacerbation of Interstitial Lung Disease?” Jan. 31, 2012, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304075/ ↩
- “A Review of Pulmonary Fibrosis,” July 20, 2015, http://www.uspharmacist.com/content/d/feature/c/55786/ ↩
- “Idiopathic Pulmonary Fibrosis: The Role of Pharmacy Benefit Manager in Providing Access to Effective, High-Value Care,” Oct. 30, 2015, http://www.ajmc.com/journals/supplement/2015/ace0039_oct15_idiopathicpulmonaryfibrosis/ace0039_oct15_idiopathicpulmonaryfibrosis_pharmabenefit/P-2 ↩
- “First two drugs approved for idiopathic pulmonary fibrosis,” Jan. 1, 2015, https://www.pharmacist.com/first-two-drugs-approved-idiopathic-pulmonary-fibrosis ↩