Nintedanib Teva (Nintedanib)

Nintedanib is an antifibrotic agent that targets progressive fibrosing lung disorders.

• Idiopathic pulmonary fibrosis: slows the decline in forced vital capacity and reduces disease progression.
• Systemic sclerosis‑associated interstitial lung disease: limits worsening of lung fibrosis and improves functional outcomes.
• Progressive fibrosing interstitial lung disease (PF‑ILD): may delay overall disease progression in eligible patients.

• 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, it reduces fibroblast proliferation, migration, and transformation, thereby attenuating the fibrotic remodeling processes that characterize interstitial lung diseases.

Nintedanib may cause a range of adverse reactions, from mild to serious. Patients should be monitored regularly for any new symptoms.

Common Side Effects

• Diarrhea: frequent loose stools, often mild to moderate.
• Nausea: feeling of sickness, may occur with or without vomiting.
• Abdominal pain: discomfort or cramps in the stomach area.
• Decreased appetite: reduced desire to eat, potentially leading to weight loss.
• Vomiting: expulsion of stomach contents, usually intermittent.

Serious or Rare Side Effects

• Elevated liver enzymes: indicates possible liver injury, requires laboratory monitoring.
• Bleeding events: increased risk of gastrointestinal or other bleeding, especially with anticoagulants.
• Cardiovascular complications: such as hypertension or arterial thrombotic events.
• Severe infections: opportunistic infections may arise in immunocompromised patients.
• Gastrointestinal perforation: rare but serious condition requiring immediate medical attention.

Before initiating therapy, clinicians should assess individual risk factors and monitor patients throughout treatment.

• Liver function monitoring: obtain baseline and periodic liver enzyme tests.
• Bleeding risk assessment: evaluate concomitant anticoagulant or antiplatelet use.
• Cardiovascular evaluation: screen for hypertension or history of thrombotic events.
• Renal function review: adjust use in patients with significant renal impairment.
• Drug interaction review: check for concomitant medications that may affect metabolism.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Nintedanib can interact with several drug classes; careful review is essential.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase nintedanib exposure.
• Anticoagulants (e.g., warfarin): heightened risk of bleeding.
• Antiplatelet agents (e.g., aspirin, clopidogrel): additive bleeding potential.

Moderate Interactions (Monitor Closely):\n- CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce efficacy.

• Non‑steroidal anti‑inflammatory drugs (NSAIDs): monitor for gastrointestinal bleeding.
• Diuretics: watch for changes in fluid balance and blood pressure.