Nintedanib Stada (Nintedanib)

Nintedanib is used in fibrotic lung diseases and selected oncology indications, targeting multiple receptor tyrosine kinases that drive fibroblast proliferation, angiogenesis, and tumor growth.

• 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 angiogenesis and growth.

• Nintedanib blocks the intracellular kinase activity of several receptor tyrosine kinases, notably vascular endothelial growth factor receptors (VEGFR 1‑3), fibroblast growth factor receptors (FGFR 1‑3) and platelet‑derived growth factor receptors (PDGFR‑α/β). Inhibition of these pathways reduces endothelial cell proliferation, fibroblast activation and angiogenic signaling, thereby limiting fibrotic remodeling 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.
• Nausea: feeling of sickness.
• Decreased appetite: reduced desire to eat.
• Abdominal pain: stomach discomfort.

Serious or Rare Side Effects

• Elevated liver enzymes: indicating possible liver injury.
• Bleeding events: increased risk of hemorrhage.
• Gastrointestinal perforation: rare but serious condition.

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

• Liver function monitoring: assess transaminases before treatment and periodically during therapy.
• Bleeding risk assessment: evaluate concomitant anticoagulant or antiplatelet use.
• Cardiovascular evaluation: review history of ischemic heart disease or thromboembolic events.
• Pregnancy and lactation: avoid use unless benefits clearly outweigh potential risks, as safety data are limited.
• Drug interactions: review concomitant medications that affect CYP3A4 or P‑gp pathways.
• Store at below 25°C: keep in the original packaging, protect from moisture and light.

Nintedanib interacts with several medicines; some combinations should be avoided while others require close monitoring.

Major Interactions (Avoid)

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

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce efficacy.
• NSAIDs: may add to gastrointestinal bleeding potential.
• Diuretics: monitor for dehydration and renal function changes.