Nintedanib Eignapharma (Nintedanib)

Nintedanib is used to target fibrotic lung diseases and certain cancers by inhibiting key growth factor receptors.

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

• Nintedanib blocks the intracellular tyrosine kinase activity of multiple receptors 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 preventing ligand‑induced activation, it reduces endothelial cell proliferation, fibroblast activation, and angiogenesis, thereby limiting fibrotic tissue formation and tumor vascularisation.

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

Common Side Effects

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

Serious or Rare Side Effects

• Severe liver injury: marked elevation of transaminases or hepatitis.
• Bleeding events: gastrointestinal or other hemorrhage.
• Cardiovascular events: arterial thromboembolism or myocardial infarction.
• Severe infections: opportunistic infections in immunocompromised patients.

Before initiating Nintedanib, several safety considerations should be reviewed.

• Liver function: assess baseline hepatic enzymes and monitor regularly.
• Bleeding risk: avoid in patients with active bleeding or uncontrolled hypertension.
• Gastrointestinal health: monitor for severe diarrhea or dehydration.
• Pregnancy and lactation: contraindicated or use only if benefits outweigh risks (category unknown).
• Drug interactions: review concomitant medications that affect CYP3A4.
• Store at ambient temperature: keep below 25 °C, in original packaging, protect from moisture and light.

Nintedanib can interact with other medicines, requiring attention to avoid reduced efficacy or increased toxicity.

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 levels.
• P‑glycoprotein substrates (e.g., digoxin): possible altered concentrations.
• Antihypertensives: monitor blood pressure as nintedanib may affect vascular tone.
• Herbal supplements (e.g., St John’s wort): may reduce drug levels.