Nintedanib Teva (Nintedanib)

• Nintedanib is used to treat fibrotic lung disorders and certain cancers by targeting multiple growth factor pathways.
• Idiopathic pulmonary fibrosis: slows disease progression and reduces decline in lung function.
• Systemic sclerosis‑associated interstitial lung disease: improves lung capacity and delays functional deterioration.
• Non‑small cell lung cancer: used in combination regimens to inhibit tumor angiogenesis and growth.

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

Adverse reactions may vary in frequency and severity.

Common Side Effects

• Diarrhea: mild to moderate, often manageable with supportive care.
• Nausea: occasional, may improve over time.
• Elevated liver enzymes: transient increases in ALT/AST.
• Decreased appetite: reduced food intake.
• Vomiting: occasional episodes.
• Abdominal pain: mild discomfort.

Serious or Rare Side Effects

• Hepatotoxicity: significant liver injury requiring monitoring.
• Cardiovascular events: rare cases of arterial thromboembolism.
• Severe bleeding: especially in patients on anticoagulants.
• Interstitial lung disease exacerbation: rare worsening of underlying disease.
• Severe hypersensitivity: rash, angioedema, or anaphylaxis.
• Gastrointestinal perforation: extremely rare but serious.

• Patients should be monitored for organ function and potential adverse events.
• Liver function monitoring: check ALT/AST before starting and periodically during therapy.
• Cardiovascular assessment: evaluate risk factors for arterial events.
• Bleeding risk: avoid concomitant anticoagulants unless necessary.
• Pregnancy and lactation: discuss risks with a healthcare professional.
• Drug interactions: review all concomitant medications for potential interactions.
• Store at ambient temperature: keep below 25°C, retain in original packaging, protect from moisture and light.

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

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may raise nintedanib exposure.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): increase bleeding risk.
• Antiplatelet agents (e.g., aspirin, clopidogrel): additive hemorrhagic potential.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., fluconazole): may modestly increase levels.
• P‑glycoprotein inhibitors (e.g., verapamil): could affect absorption.
• CYP3A4 inducers (e.g., rifampicin): may reduce efficacy.
• NSAIDs: monitor for gastrointestinal bleeding.
• Herbal supplements affecting liver enzymes: assess on a case‑by‑case basis.