Nintedanib Eg (Nintedanib)

Nintedanib is used in fibrotic lung diseases and certain cancers, targeting pathways that drive fibroblast proliferation and tumor growth.

• Idiopathic pulmonary fibrosis: slows decline in lung function and reduces disease progression.
• Systemic sclerosis‑associated interstitial lung disease: improves lung capacity and delays worsening.
• Non‑small cell lung cancer: used in combination therapy to inhibit tumor angiogenesis and growth.

• 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 limiting fibrotic remodeling and tumor vascularization.

Nintedanib may cause a range of adverse reactions, from mild to serious. Patients should be monitored regularly for any new symptoms.

Common Side Effects

• Diarrhea: frequent loose stools, often mild to moderate.
• Nausea: feeling of sickness, may affect appetite.
• Vomiting: occasional episodes, usually self‑limiting.
• Abdominal pain: discomfort in the stomach area.
• Decreased appetite: reduced desire to eat, can lead to weight loss.
• Weight loss: unintended loss of body weight.

Serious or Rare Side Effects

• Elevated liver enzymes: may indicate hepatic injury.
• Bleeding events: increased risk of gastrointestinal or other bleeding.
• Cardiovascular events: such as hypertension or arterial thromboembolism.
• Severe infections: opportunistic infections in immunocompromised patients.
• Gastrointestinal perforation: rare but potentially life‑threatening.
• Allergic reactions: rash, pruritus, or anaphylaxis in extreme cases.

Before initiating therapy, clinicians should assess baseline organ function and consider potential risks.

• Liver function monitoring: check ALT, AST, and bilirubin before and during treatment.
• Bleeding risk assessment: evaluate concomitant anticoagulant or antiplatelet use.
• Cardiovascular evaluation: review history of hypertension, ischemic disease, or thromboembolism.
• Pregnancy and lactation: avoid use unless benefits outweigh unknown risks.
• Drug interaction review: assess all concomitant medicines for CYP3A4 or P‑gp relevance.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Nintedanib can interact with several drug classes; some combinations should be avoided while others require close monitoring.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase nintedanib exposure.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): heightened bleeding risk.
• Antiplatelet agents (e.g., aspirin, clopidogrel): additive hemorrhagic potential.
• P‑glycoprotein inhibitors (e.g., verapamil): may raise plasma levels.
• High‑dose aspirin (>325 mg): increased gastrointestinal toxicity.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce efficacy.
• Diuretics: monitor electrolytes and renal function.
• NSAIDs: watch for additive GI irritation.
• Statins metabolized by CYP3A4: consider dose adjustment.
• Herbal supplements (e.g., St John’s wort): potential induction of metabolism.