Nintedanib Eg (Nintedanib)

Nintedanib acts on multiple receptor tyrosine kinases involved in fibrotic and oncologic pathways, providing disease‑modifying benefits in several serious lung conditions.

• Idiopathic pulmonary fibrosis: slows decline in lung function and reduces disease progression.
• Systemic sclerosis‑associated interstitial lung disease: improves forced vital capacity and stabilises respiratory status.
• Non‑small cell lung cancer: used in combination regimens to inhibit tumor angiogenesis and growth.

• Nintedanib inhibits the intracellular kinase activity of 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 fibrosis and tumor vascularisation.

Nintedanib is associated with a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Diarrhoea: frequent, may be mild to moderate.
• Nausea: often transient.
• Vomiting: occasional.
• Decreased appetite: may affect nutritional intake.
• Abdominal pain: mild to moderate.
• Elevated liver enzymes (ALT/AST): usually reversible.

Serious or Rare Side Effects

• Hepatic failure: requires immediate medical attention.
• Arterial thromboembolism: risk of stroke or myocardial infarction.
• Severe bleeding: especially when combined with anticoagulants.
• Gastrointestinal perforation: rare but life‑threatening.
• Severe hypertension: may need antihypertensive therapy.
• Serious infections: monitor for signs of pneumonia or sepsis.

Before initiating therapy, clinicians should assess baseline organ function and consider patient‑specific risk factors.

• Liver function monitoring: check ALT/AST before start and periodically during treatment.
• Cardiovascular risk: evaluate for history of arterial thromboembolism or uncontrolled hypertension.
• Bleeding risk: avoid concomitant use with strong anticoagulants unless benefits outweigh risks.
• Pregnancy and lactation: safety unknown; avoid use in pregnant or breastfeeding women.
• Store at below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Nintedanib may interact with several drug classes, altering its exposure or increasing toxicity.

Major Interactions (Avoid)

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

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., erythromycin): may modestly increase exposure.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce efficacy.
• Diuretics: monitor electrolytes and renal function when combined.