Nintedanib Teva (Nintedanib)

Nintedanib is employed to treat fibrotic lung conditions and as part of combination regimens for certain cancers, acting on pathways that drive fibroblast activity and tumor angiogenesis.

• Idiopathic pulmonary fibrosis: slows disease progression and reduces decline in lung function.
• Systemic sclerosis‑associated interstitial lung disease: helps preserve pulmonary capacity and delays worsening.
• Non‑small cell lung cancer (in combination therapy): contributes to tumor growth inhibition when used with standard chemotherapy.

• Nintedanib blocks several receptor tyrosine kinases, notably VEGFR 1‑3, PDGFR‑α/β and FGFR 1‑3. Inhibition of these pathways reduces fibroblast proliferation, extracellular matrix deposition and angiogenesis, thereby attenuating fibrotic remodeling in the lung and limiting tumor vascular support.

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

Common Side Effects

• Diarrhea: frequent loose stools, often manageable with dietary measures.
• Nausea: mild to moderate feeling of queasiness.
• Vomiting: occasional episodes of stomach emptying.
• Elevated liver enzymes: increase in ALT/AST observed in laboratory tests.

Serious or Rare Side Effects

• Hepatotoxicity: severe liver injury requiring monitoring and possible discontinuation.
• Bleeding events: increased risk of gastrointestinal or other bleeding.
• Cardiovascular events: rare cases of arterial thromboembolism.

When prescribing Nintedanib, clinicians should observe several precautionary measures to ensure patient safety.

• Liver function monitoring: assess ALT, AST, and bilirubin before treatment and periodically thereafter.
• Gastrointestinal management: advise patients to stay hydrated and report severe diarrhea promptly.
• Drug interactions: review concomitant medications that affect CYP3A4 metabolism.
• Pregnancy and lactation: avoid use due to unknown fetal risk; discontinue if pregnancy occurs.
• Contraindications: do not use in patients with severe hepatic impairment.
• Store at ambient temperature: keep in original container, protect from moisture and direct sunlight.

Nintedanib can interact with other medicines, influencing its efficacy or safety profile.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase nintedanib exposure and toxicity.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): heightened bleeding risk.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., fluconazole): may modestly raise plasma levels.
• P-glycoprotein substrates (e.g., digoxin): potential for altered concentrations.
• Acid‑reducing agents (e.g., proton pump inhibitors): may reduce absorption, monitor efficacy.