Nintedanib Teva (Nintedanib)

Nintedanib acts on fibrotic and oncogenic pathways, providing therapeutic benefit in specific pulmonary and oncologic conditions.

• Idiopathic pulmonary fibrosis: slows the decline in lung function and reduces disease progression.
• Non‑small cell lung cancer: used in combination regimens to inhibit tumor angiogenesis and growth.

• Nintedanib inhibits multiple receptor tyrosine kinases, including vascular endothelial growth factor receptors (VEGFR 1‑3), fibroblast growth factor receptors (FGFR 1‑3), and platelet‑derived growth factor receptors (PDGFR‑α/β). By blocking these pathways, the drug reduces fibroblast proliferation, angiogenesis, and extracellular matrix deposition, thereby attenuating fibrotic remodeling and tumor vascularization.

Adverse reactions may occur with Nintedanib treatment and are categorized by frequency and severity.

Common Side Effects

• Diarrhea: frequent, often mild to moderate.
• Nausea: occasional, may be transient.
• Vomiting: occasional, usually mild.
• Decreased appetite: reported in some patients.
• Abdominal pain: mild to moderate.
• Headache: occasional.

Serious or Rare Side Effects

• Elevated liver enzymes (ALT, AST): may indicate hepatic injury.
• Bleeding events: including gastrointestinal hemorrhage.
• Gastrointestinal perforation: rare but potentially life‑threatening.
• Arterial thromboembolic events: such as myocardial infarction or stroke.
• Severe infections: opportunistic infections have been reported.

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

• Liver function monitoring: check ALT, AST, and bilirubin before and during treatment.
• Cardiovascular assessment: evaluate history of ischemic heart disease or thromboembolic disorders.
• Bleeding risk: avoid concomitant use of strong anticoagulants unless necessary.
• Gastrointestinal health: use caution in patients with a history of ulcer disease or perforation.
• Pregnancy and lactation: avoid use unless benefits outweigh potential risks.
• Store at below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Nintedanib may interact with other medicines that affect its metabolism or increase bleeding risk.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): may raise nintedanib exposure.
• Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce therapeutic effect.
• Anticoagulants (e.g., warfarin) and antiplatelet agents (e.g., aspirin): increase bleeding potential.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., erythromycin, fluconazole): may modestly increase plasma levels.
• P‑gp/BCRP inhibitors (e.g., verapamil): may slightly elevate exposure.
• Diuretics: monitor electrolytes as nintedanib can affect renal handling.