Nintedanib Eg (Nintedanib)

Nintedanib acts on pathways that drive fibrosis and tumor angiogenesis, making it useful in several serious respiratory and oncologic conditions.

• Idiopathic pulmonary fibrosis: slows decline in lung function and reduces disease progression.
• Systemic sclerosis‑associated interstitial lung disease: helps preserve lung capacity and delay worsening.
• Non‑small cell lung cancer (in combination therapy): contributes to tumor growth inhibition when used with other anticancer agents.

• Nintedanib inhibits multiple 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 attenuating fibrotic processes and tumor vascularization.

Nintedanib may cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Diarrhoea: frequent loose stools, often mild to moderate.
• Nausea: feeling of sickness, may be transient.
• Vomiting: occasional episodes, usually self‑limiting.
• Decreased appetite: reduced desire to eat.
• Liver enzyme elevation: mild increases in ALT/AST.
• Abdominal pain: discomfort in the stomach area.

Serious or Rare Side Effects

• Severe liver injury: marked elevation of liver enzymes or hepatitis.
• Gastrointestinal perforation: rare but potentially life‑threatening.
• Cardiovascular events: such as myocardial infarction or stroke.
• Severe bleeding: especially in patients on anticoagulants.
• Interstitial lung disease exacerbation: worsening of underlying lung disease.
• Allergic reactions: including rash, urticaria, or anaphylaxis.

Before initiating therapy, clinicians should assess baseline organ function and review concomitant medications.

• Liver function monitoring: obtain baseline ALT/AST and repeat periodically.
• Gastrointestinal assessment: monitor for persistent diarrhoea or abdominal pain.
• Bleeding risk: evaluate patients on anticoagulants or with a history of bleeding.
• Pregnancy and lactation: avoid use unless benefits outweigh potential risks.
• Storage: Store below 25°C: keep in the original pack, protect from moisture.

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

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase nintedanib exposure.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): heightened bleeding risk.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., fluconazole): may modestly raise plasma levels.
• P-glycoprotein inhibitors (e.g., verapamil): could increase systemic exposure.
• CYP3A4 inducers (e.g., rifampicin): may reduce efficacy by lowering drug concentrations.