Nintedanib Eugia (Nintedanib)

Nintedanib is used in fibrotic lung disorders and selected oncologic indications, targeting pathways that drive fibroblast activity and tumor growth.

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

• Nintedanib blocks 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 inhibiting these pathways, the drug reduces endothelial cell proliferation, fibroblast activation, and extracellular matrix deposition, thereby attenuating angiogenesis and fibrotic tissue formation in the lungs and other affected organs.

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 accompany meals.
• Decreased appetite: reduced desire to eat, sometimes leading to weight loss.

Serious or Rare Side Effects

• Elevated liver enzymes: may indicate hepatic injury, requires monitoring.
• Bleeding events: increased risk of gastrointestinal or other hemorrhage.
• Cardiovascular complications: such as hypertension or arterial thrombotic events.

When prescribing Nintedanib, clinicians should observe several safety considerations to minimize risk.

• Monitor liver function: perform baseline and periodic ALT/AST tests.
• Assess bleeding risk: avoid in patients with active ulcers or on anticoagulants.
• Evaluate cardiovascular status: watch for hypertension or thrombotic events.
• Avoid use in severe hepatic impairment: contraindicated in patients with Child‑Pugh C.
• Adjust for drug interactions: review concomitant CYP3A4 modulators.
• Store at room temperature: keep in original packaging, protect from moisture and light.

Nintedanib interacts with several medicines that can alter its exposure or increase adverse effects.

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.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., erythromycin, clarithromycin): may modestly increase exposure.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce efficacy by lowering drug levels.
• P‑glycoprotein inhibitors (e.g., verapamil): can affect absorption.
• Antacids containing aluminum or magnesium: may decrease oral bioavailability if taken simultaneously.