Table 3.

Adverse Effects Associated With Medications and Response

Drug	Adverse Effect	Dose Modification	Additional Measures/Therapy
Nintedanib	Diarrhea	Reduce dose	Imodium
	Nausea, vomiting, abdominal pain	Reduce dose, take with food	PPI, histamine2-blocker
	Elevated liver enzyme levels	Reduce or interrupt dose	Monitor liver function monthly for 3 mo, then every 3 mo
Pirfenidone	Nausea, vomiting, anorexia	Reduce dose, take with food	PPI, histamine2-blocker, metoclopramide
	Photosensitivity reaction, rash	Reduce or interrupt dose	Sunscreen, avoid sunlight
	Elevated liver enzyme levels	Reduce or interrupt dose	Monitor liver function monthly for 6 mo, then every 3 mo
Prednisone	Glucose intolerance	Reduce to lowest effective dosea	Glycemic monitoring
	Osteoporosis, myopathy, weight gain	Reduce to lowest effective dosea	Bisphosphonates, teriparatide, bone mineral density monitoring
	Immunosuppression, Infection	Reduce to lowest effective dosea	PJP prophylaxis, monitor for infection
Azathioprine	Cytopenias	Split or interrupt dose	Thiopurine S-methyltransferase level
	Infection	Reduce to lowest effective dose	PJP prophylaxis, monitor for infection
	Nausea, vomiting	Reduce dose, take with food	PPI, histamine2-blocker
Cyclophosphamide	Hemorrhagic cystitis	Stop medication Adequate hydration	Prophylactic mesna
Mycophenolate mofetil	Diarrhea	Stop dosing, change to mycophenolic acid	Adequate hydration
	Leukopenia	Dose reduction
Rituximab	Infusion reactions	Interrupt or reduce rate	Acetaminophen, antihistamine, corticosteroid pretreatment
	Cytopenias		Avoid myelosuppressive agents
	Infection		PJP prophylaxis, monitor for infection
Tacrolimus	Hypertension, nephrotoxicity	Adjust dose to keep trough level < 10 μg/L	Control blood pressure, monitor renal function and electrolytes

PJP = Pneumocystis jirovecii pneumonia; PPI = proton pump inhibitor.

^aConsider glucocorticoid-sparing agents.