Nintedanib Eg (Nintedanib)

Nintedanib acts on fibrotic and oncogenic pathways, making it useful in several pulmonary and cancer indications.

• Idiopathic pulmonary fibrosis: reduces the rate of forced vital capacity decline.
• Systemic sclerosis‑associated interstitial lung disease: helps preserve lung function.
• Non‑small cell lung cancer (in combination with chemotherapy): improves progression‑free survival.

• 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, the drug decreases fibroblast proliferation, angiogenesis, and extracellular matrix deposition, thereby attenuating fibrotic remodeling and tumor‑driven vascular growth.

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

Common Side Effects

• Diarrhea: frequent loose stools, often mild to moderate.
• Nausea and vomiting: gastrointestinal upset that may affect appetite.
• Decreased appetite: reduced food intake leading to weight loss.
• Elevated liver enzymes: mild transaminase increases detected on routine labs.

Serious or Rare Side Effects

• Severe liver injury: jaundice, hepatic failure requiring monitoring.
• Major bleeding events: gastrointestinal or intracranial hemorrhage, especially with anticoagulants.
• Cardiovascular complications: hypertension, arterial thrombotic events, or heart failure.
• Gastrointestinal perforation: rare but potentially life‑threatening.
• Severe infections: opportunistic infections in immunocompromised patients.

Before initiating therapy, clinicians should assess baseline organ function and counsel patients on potential risks.

• Liver monitoring: perform baseline and periodic liver function tests.
• Cardiovascular assessment: evaluate blood pressure and cardiac history.
• Bleeding risk: review concomitant anticoagulant or antiplatelet use.
• Gastrointestinal symptoms: advise patients to report persistent diarrhea or abdominal pain.
• Pregnancy and lactation: avoid use unless benefits outweigh potential fetal risks.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Nintedanib can interact with several drug classes, influencing its exposure or safety profile.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): increase nintedanib plasma levels.
• Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine): markedly reduce nintedanib exposure.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): may heighten bleeding risk.

Moderate Interactions (Monitor Closely)

• P‑gp inhibitors (e.g., verapamil, amiodarone): modestly raise nintedanib concentrations.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs): increase gastrointestinal bleeding potential.
• Diuretics and antihypertensives: may exacerbate hypotension or electrolyte disturbances.