Nintedanib

• Nintedanib acts on multiple receptor tyrosine kinases involved in fibrotic and oncogenic pathways.
• Idiopathic pulmonary fibrosis: slows disease progression and reduces decline in lung function.
• Systemic sclerosis‑associated interstitial lung disease: helps preserve lung capacity and delay worsening.
• Non‑small cell lung cancer: used in combination therapy to inhibit tumor growth.

• Nintedanib inhibits several receptor tyrosine kinases—including vascular endothelial growth factor receptors (VEGFR 1‑3), platelet‑derived growth factor receptors (PDGFR‑α/β) and fibroblast growth factor receptors (FGFR‑1‑3). By blocking these pathways, it reduces fibroblast proliferation, angiogenesis, and extracellular matrix deposition, thereby limiting fibrotic remodeling and tumor angiogenesis.

Nintedanib may cause a range of adverse reactions, from mild to serious.

Common Side Effects

• Diarrhea: frequent loose stools, often mild to moderate.
• Nausea: sensation of unease and urge to vomit.
• Vomiting: expulsion of stomach contents.
• Abdominal pain: discomfort in the stomach area.
• Decreased appetite: reduced desire to eat.
• Weight loss: unintended reduction in body weight.

Serious or Rare Side Effects

• Elevated liver enzymes: indicates possible liver injury.
• Bleeding events: includes gastrointestinal or pulmonary hemorrhage.
• Cardiovascular events: such as myocardial infarction or stroke.
• Severe infections: opportunistic or bacterial infections.
• Gastrointestinal perforation: rare but potentially life‑threatening.

• Before initiating therapy, clinicians should assess patient‑specific risk factors and monitor for adverse events.
• Monitor liver function: perform baseline and periodic liver enzyme tests.
• Assess bleeding risk: evaluate concomitant anticoagulant use and history of hemorrhage.
• Evaluate cardiovascular status: watch for signs of ischemic events.
• Avoid use in pregnancy: teratogenic potential is unknown; contraindicated.
• Adjust for hepatic impairment: dose may need modification in moderate to severe liver disease.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Nintedanib can interact with several drug classes, requiring careful management.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): may increase nintedanib exposure.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): heightened bleeding risk.
• P‑glycoprotein inhibitors (e.g., verapamil): can raise plasma concentrations.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., erythromycin): may modestly raise levels.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce efficacy.
• NSAIDs or antiplatelet agents: monitor for additive bleeding.
• St. John’s wort: potential reduction in drug exposure.
• Proton pump inhibitors: may affect absorption, observe clinical response.