[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Antifibrotics](https://durgical.com/en/pharmacology/classes/antifibrotics/) › Nintedanib # Nintedanib ## Antifibrotics? Antifibrotics ## Pregnancy: contraindicated? Can harm the fetus. Pregnancy is excluded before treatment and highly effective contraception continues for at least three months after the last dose; breastfeeding is not… An oral kinase inhibitor that slows lung scarring in idiopathic pulmonary fibrosis and other progressive fibrosing lung diseases; diarrhoea is common. Updated Nov 1, 2026 Also called: Nintedanib esylate ## Quick facts **Group** [Antifibrotics](https://durgical.com/en/pharmacology/classes/antifibrotics/) **Target** Growth-factor receptor tyrosine kinases (VEGFR, FGFR and PDGFR) **Used for** Idiopathic pulmonary fibrosis **Key effects** Diarrhoea · Nausea · Raised liver enzymes **Monitor** Liver tests · Pregnancy test before starting **ATC** L01EX09 No doses: the clinician sets them by the current guideline. On this page - The basics Mechanism of action - Indications - Adverse effects - Pharmacokinetics - Memory aid - Clinical What the labels mean - Safety Contraindications - Key interactions - What is monitored - Administration and safety - Pregnancy and breastfeeding - Nursing care - Study Test yourself - Connections Connections ## Mechanism of action ✂**Growth-factor receptor tyrosine kinases (VEGFR, FGFR and PDGFR)**Nintedanib ⓘ The figure shows nintedanib in the ATP pocket of the human VEGFR2 kinase domain (crystal structure). It blocks the FGF and PDGF receptor kinases in the same way. **Target in 3D:** Growth-factor receptor tyrosine kinases (VEGFR, FGFR and PDGFR). PDB structure 3C7Q (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/3C7Q) · Drag to rotate · pinch to zoom Nintedanib is a small-molecule inhibitor of several receptor tyrosine kinases: the PDGF receptors alpha and beta, FGF receptors 1 to 3 and VEGF receptors 1 to 3, plus some non-receptor kinases. It competes with ATP in the kinase pocket, so the growth-factor signal does not pass into the cell. Lung fibroblasts then proliferate, migrate and turn into collagen-making myofibroblasts less, and the yearly loss of lung function slows. - Growth factors (PDGF, FGF, VEGF) activate fibroblast receptor kinases - Nintedanib occupies the ATP pocket of these kinases - Fibroblasts multiply, migrate and make collagen less - Loss of lung function (FVC) slows; scar is not reversed ## Indications - Idiopathic pulmonary fibrosis [Interstitial lung disease →](https://durgical.com/en/conditions/interstitial-lung-disease/) - Chronic fibrosing interstitial lung diseases with a progressive phenotype [Interstitial lung disease →](https://durgical.com/en/conditions/interstitial-lung-disease/) - Interstitial lung disease associated with systemic sclerosis, to slow the decline in lung function [Systemic sclerosis (scleroderma, including CREST) →](https://durgical.com/en/conditions/systemic-sclerosis/) ## Adverse effects ### Common - Diarrhoea (very common) - Nausea, vomiting, abdominal pain and decreased appetite - Raised liver enzymes - Weight loss and headache - Hypertension ### Serious (rare, important) - Drug-induced liver injury, including fatal cases, mostly in the first months - Bleeding, some of it fatal - Arterial thromboembolic events such as myocardial infarction - Gastrointestinal perforation - Embryo-fetal harm - Proteinuria, sometimes in the nephrotic range ## Contraindications - Pregnancy (fetal harm) - Not recommended in moderate or severe hepatic impairment - Caution with high cardiovascular risk, bleeding risk, recent abdominal surgery or diverticular disease ## Key interactions **P-gp and CYP3A4 inhibitors (ketoconazole, erythromycin)** Higher nintedanib exposure; patients are watched closely for adverse effects **P-gp and CYP3A4 inducers (rifampicin, carbamazepine, phenytoin, St John's wort)** Lower nintedanib exposure; combination avoided **Anticoagulants** Higher bleeding risk; anticoagulation is monitored closely **Oral hormonal contraceptives** May fail when vomiting or diarrhoea reduce absorption; a barrier method is added ## What is monitored - Liver tests (ALT, AST, bilirubin) before starting, regularly in the first months and then periodically - Pregnancy test before starting in women who can become pregnant - Diarrhoea, hydration and weight - Urine protein; signs of bleeding in patients on anticoagulants ## Administration and safety - Oral capsules taken with food, swallowed whole with liquid - Capsules are not chewed, crushed or opened; skin that touches the contents is washed at once - A missed dose is skipped, not made up ## Pregnancy and breastfeeding Can harm the fetus. Pregnancy is excluded before treatment and highly effective contraception continues for at least three months after the last dose; breastfeeding is not recommended. ## Nursing care - Ask about pregnancy plans, bleeding disorders, anticoagulants, heart disease and recent abdominal surgery before starting - Teach early treatment of diarrhoea with fluids and an antidiarrhoeal, and to report persistent diarrhoea - Check liver tests and teach the signs of liver injury: jaundice, dark urine, right upper abdominal pain - Teach the warning signs of bleeding, chest pain and stroke - Advise stopping smoking ## Pharmacokinetics **Absorption** Oral capsule taken with food; low absolute bioavailability (about 5%) because of transporters and first-pass metabolism **Distribution** Highly bound to plasma proteins (about 98%), mainly albumin **Metabolism** Mainly hydrolysed by esterases to a free acid, then glucuronidated; CYP3A4 plays a minor role. It is a P-glycoprotein substrate **Elimination** Mainly in faeces via the bile; very little in urine **Half-life** About 9.5 hours (effective half-life in IPF) ## Memory aid NINTEDANIB runs the GUT: Gut (diarrhoea), Uterus (no pregnancy), Thrombosis and bleeding (VEGF block). ## Test yourself Think of the answer, then tap the question to see it. ## Which receptor families does nintedanib inhibit? The tyrosine kinases of the PDGF, FGF and VEGF receptors. ## What is the most common adverse effect of nintedanib? Diarrhoea. ## Why is extra care needed when a patient on nintedanib takes an anticoagulant? Nintedanib raises bleeding risk (it blocks VEGF signalling), so bleeding risk adds up. ## Which contraception advice goes with nintedanib? Highly effective contraception during treatment and for at least three months afterwards, with a barrier method added because diarrhoea or vomiting can make the pill fail. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/nintedanib/) [More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology) ## What the labels mean **Pregnancy: contraindicated** Can harm the fetus. Pregnancy is excluded before treatment and highly effective contraception continues for at least three months after the last dose; breastfeeding is not… ## Connections ## Related drugs 1 - [Pirfenidone](https://durgical.com/en/pharmacology/pirfenidone/) ## Related conditions 2 - [Interstitial lung disease](https://durgical.com/en/conditions/interstitial-lung-disease/) - [Systemic sclerosis (scleroderma, including CREST)](https://durgical.com/en/conditions/systemic-sclerosis/) [← Back to the class: Antifibrotics](https://durgical.com/en/pharmacology/classes/antifibrotics/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - NINTEDANIB capsule](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b72b26c3-7731-80c0-734b-a5f53a1d89ae) (DailyMed (U.S. National Library of Medicine), 2026); [Nintedanib: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a615009.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [RCSB PDB - 3C7Q: Structure of VEGFR2 kinase domain in complex with BIBF1120](https://www.rcsb.org/structure/3C7Q) (RCSB Protein Data Bank, 2008); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01EX09) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/nintedanib/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/nintedanib/