Nintedanib Zidrium Teva (Nintedanib)

Nintedanib targets fibrotic lung diseases and certain cancers by inhibiting key growth factor receptors.

• Idiopathic pulmonary fibrosis: slows disease progression and reduces decline in lung function.
• Systemic sclerosis‑associated interstitial lung disease: improves pulmonary function and delays worsening.
• Non‑small cell lung cancer (in combination therapy): enhances treatment efficacy when combined with chemotherapy.

• Nintedanib blocks the intracellular kinase activity of multiple receptor tyrosine kinases, including VEGFR 1‑3, PDGFR‑α/β, and FGFR 1‑3. Inhibition of these pathways reduces fibroblast proliferation, migration, and angiogenesis, thereby limiting extracellular matrix deposition and tumor angiogenesis.

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

Common Side Effects

• Diarrhea: frequent loose stools, often mild to moderate.
• Nausea: feeling of sickness, may be transient.
• Vomiting: occasional episodes.
• Abdominal pain: discomfort in the stomach area.
• Decreased appetite: reduced desire to eat.
• Liver enzyme elevation: mild increase in ALT/AST.

Serious or Rare Side Effects

• Hepatotoxicity: significant liver injury requiring monitoring.
• Bleeding events: increased risk of gastrointestinal or other bleeding.
• Cardiovascular events: such as myocardial infarction or stroke.
• Severe infections: opportunistic infections in immunocompromised patients.

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

• Liver function monitoring: assess ALT, AST, bilirubin before and during therapy.
• Gastrointestinal management: advise patients on hydration and antidiarrheal measures.
• Cardiovascular assessment: evaluate history of ischemic heart disease before initiation.
• Bleeding risk evaluation: avoid in patients with active ulcers or on anticoagulants without supervision.
• Pregnancy and lactation: contraindicated or used only if benefits outweigh risks; discuss with obstetrician.
• Store at ambient temperature: keep below 25°C in original packaging, protect from moisture and light.

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

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase nintedanib exposure.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): heightened bleeding risk.
• High‑dose aspirin or NSAIDs: additive bleeding potential.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., fluconazole): may modestly raise plasma levels.
• P-glycoprotein inhibitors (e.g., verapamil): could affect drug transport.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce effectiveness.
• Antacids containing aluminum or magnesium: may decrease absorption if taken simultaneously.