Nintedanib Sandoz (Nintedanib)

Nintedanib is used in fibrotic lung disease pathways to manage progressive interstitial lung conditions.

• Idiopathic pulmonary fibrosis: slows decline in lung function and reduces disease progression.
• Systemic sclerosis‑associated interstitial lung disease: helps preserve pulmonary capacity and delays worsening.
• Progressive fibrosing interstitial lung disease: reduces rate of decline in forced vital capacity.

• 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, it reduces fibroblast proliferation, migration and transformation, limits pathological angiogenesis, and decreases extracellular matrix deposition, thereby attenuating lung fibrosis.

Nintedanib may cause a range of adverse reactions, varying from mild to serious.

Common Side Effects

• Diarrhea: frequent loose stools, often early in therapy.
• Nausea: feeling of sickness that may reduce appetite.
• Elevated liver enzymes: mild increase in ALT/AST observed in laboratory tests.
• Decreased appetite: reduced desire to eat.

Serious or Rare Side Effects

• Hepatic failure: severe liver injury requiring immediate medical attention.
• Gastrointestinal perforation: rare tearing of the stomach or intestinal wall.
• Severe bleeding: including pulmonary or gastrointestinal hemorrhage.

When using Nintedanib, several precautions should be observed to ensure patient safety.

• Liver monitoring: perform baseline and periodic liver function tests.
• Bleeding risk: assess for history of bleeding and avoid concomitant anticoagulants when possible.
• Cardiovascular assessment: monitor blood pressure and manage hypertension.
• Pregnancy and lactation: avoid use unless benefits outweigh risks; consult a healthcare provider.
• Drug interactions: review concomitant medications for CYP3A4 inhibitors or inducers.
• Store at below 25°C: keep in the original packaging, protect from moisture.

Nintedanib can interact with several medicines; awareness of major and moderate interactions helps prevent adverse outcomes.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): may increase nintedanib exposure.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): heightened bleeding risk.
• P‑glycoprotein inhibitors (e.g., verapamil): can raise plasma levels.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampin, carbamazepine): may reduce efficacy.
• Antacids containing aluminum or magnesium: may affect absorption if taken simultaneously.
• Diuretics: increased risk of dehydration and renal effects.