Nintedanib Teva (Nintedanib)

Nintedanib acts on pathways involved in fibroblast activity and is used for progressive fibrotic lung conditions.

• Idiopathic pulmonary fibrosis: slows decline in lung function and reduces disease progression.
• Systemic sclerosis‑associated interstitial lung disease: improves forced vital capacity and delays respiratory deterioration.
• Progressive fibrosing interstitial lung disease: provides antifibrotic benefit across multiple underlying etiologies.

• Nintedanib inhibits multiple receptor tyrosine kinases—including VEGFR, FGFR and PDGFR—thereby blocking downstream signaling that drives fibroblast proliferation, migration, and transformation. This results in reduced extracellular matrix deposition, attenuated angiogenesis, and overall antifibrotic activity within the lung tissue.

Nintedanib may cause a range of adverse reactions.

Common Side Effects

• Diarrhea: frequent loose stools, often mild to moderate.
• Nausea: sensation of unease or urge to vomit.
• Vomiting: expulsion of stomach contents.
• Abdominal pain: discomfort or cramping in the stomach area.
• Decreased appetite: reduced desire to eat.
• Weight loss: unintended reduction in body weight.

Serious or Rare Side Effects

• Elevated liver enzymes: potential indication of hepatic injury.
• Bleeding events: increased risk of gastrointestinal or other hemorrhage.
• Cardiovascular events: such as myocardial infarction or stroke.
• Severe infections: opportunistic or serious bacterial infections.
• Gastrointestinal perforation: rare but life‑threatening breach of the GI tract.

Before initiating therapy, clinicians should evaluate patient‑specific risk factors and monitor for adverse events.

• Liver monitoring: check hepatic enzymes regularly.
• Bleeding risk: assess concomitant anticoagulant or antiplatelet use.
• Cardiovascular assessment: review history of heart disease or stroke.
• Gastrointestinal health: be cautious in patients with ulcerative conditions.
• Drug interactions: review all concomitant medications for CYP3A4 substrates or inhibitors.
• Store at ambient temperature: keep in original packaging, protect from moisture and heat.

Nintedanib can interact with several drug classes, requiring careful management.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase exposure.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): heightened bleeding risk.
• Antiplatelet agents (e.g., aspirin, clopidogrel): additive hemorrhagic potential.
• Potent P‑gp inhibitors (e.g., verapamil): may raise plasma levels.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., fluconazole): may modestly raise concentrations.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce efficacy.
• Diuretics and NSAIDs: monitor renal function and fluid balance.