Nintedanib Eugia (Uk) (Nintedanib)

Nintedanib is indicated for fibrotic lung disorders and certain cancers, acting on pathways that drive fibroblast proliferation and tumor angiogenesis.

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

• 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 signaling pathways, it reduces endothelial cell proliferation, fibroblast activation, and angiogenesis, thereby limiting fibrotic remodeling and tumor vascularization. The inhibition is competitive and reversible, leading to decreased downstream MAPK and PI3K‑AKT signaling, which further curtails cellular proliferation and extracellular matrix deposition.

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

Common Side Effects

• Diarrhea: frequent loose stools that may be mild to moderate.
• Nausea: feeling of sickness often accompanied by loss of appetite.
• Vomiting: occasional episodes of expelling stomach contents.
• Elevated liver enzymes: increase in ALT/AST indicating hepatic stress.

Serious or Rare Side Effects

• Hepatic failure: severe liver injury requiring medical intervention.
• Severe bleeding: gastrointestinal or intracranial hemorrhage.
• Arterial thromboembolic events: heart attack or stroke.

When prescribing Nintedanib, clinicians should observe several precautionary measures to minimize risk.

• Liver function monitoring: assess ALT, AST and bilirubin before and during therapy.
• Cardiovascular assessment: evaluate history of ischemic heart disease or stroke.
• Bleeding risk evaluation: avoid use in patients with active ulcers or on anticoagulants without supervision.
• Pregnancy and lactation: contraindicated unless benefits outweigh unknown risks.
• Renal impairment: adjust dosing or monitor renal function in severe cases.
• Store at below 25°C: keep in the original packaging, protect from moisture and heat.

Nintedanib interacts with several medicines; awareness of these interactions helps prevent adverse events.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase nintedanib exposure.
• Anticoagulants (warfarin, direct oral anticoagulants): heightened risk of bleeding.
• High‑dose aspirin or NSAIDs: additive bleeding risk.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce efficacy.
• P‑glycoprotein inhibitors (e.g., verapamil): modest increase in plasma levels.
• Diuretics: monitor for dehydration and renal function.