Nintedanib Adalvo (Nintedanib)

Nintedanib is used in the management of fibrotic lung diseases, primarily targeting progressive interstitial lung conditions.

• Idiopathic pulmonary fibrosis: slows decline in lung function and reduces disease progression.
• Systemic sclerosis‑associated interstitial lung disease: decreases rate of forced vital capacity loss.

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

Nintedanib may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: frequent loose stools, often manageable with diet.
• Vomiting: occasional episodes, usually early in therapy.
• Abdominal pain: cramping or discomfort in the stomach area.
• Decreased appetite: reduced desire to eat, may affect weight.
• Weight loss: modest loss observed in some patients.

Serious or Rare Side Effects

• Liver enzyme elevation: significant increase in ALT/AST requiring monitoring.
• Bleeding events: heightened risk of gastrointestinal or other bleeding.
• Cardiovascular complications: including myocardial infarction or stroke.
• Severe infections: opportunistic infections in immunocompromised individuals.
• Gastrointestinal perforation: rare but potentially life‑threatening.

When prescribing Nintedanib, clinicians should observe several precautionary measures to ensure patient safety.

• Liver function monitoring: assess ALT/AST before and during treatment.
• Bleeding risk assessment: evaluate concomitant anticoagulant use and history of ulcers.
• Cardiovascular evaluation: review history of ischemic heart disease or stroke.
• Pregnancy avoidance: drug is not recommended for pregnant or nursing women.
• Hepatic impairment dose adjustment: consider reduced exposure in moderate liver dysfunction.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Nintedanib can interact with other medicines, influencing its plasma levels or increasing the risk of adverse events.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): may increase nintedanib exposure.
• Potent P‑gp inhibitors (e.g., verapamil): can raise systemic concentrations.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., erythromycin): may modestly raise levels.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce efficacy.
• Antacids or proton‑pump inhibitors: may affect absorption if taken simultaneously.