Has your doctor told you or someone in your family has a lung disease that causes scarring? It could be something like `Idiopathic Pulmonary Fibrosis (IPF)`, a condition for which no definitive cause can be found. You may have heard of the drug `Nintedanib` (often known by the brand name `Ofev`), which is used in such cases. Since this is a drug that needs to be used with some caution, we are going to talk about it simply and in a friendly way.
What is this medicine called Nintedanib?
Simply put, Nintedanib is a drug that prevents and slows down the scarring of your lung tissue. It is mainly used to treat several conditions.
- Idiopathic Pulmonary Fibrosis (IPF): This is a disease in which the lungs gradually become stiff and scarred for no known reason.
- Chronic progressive fibrosing interstitial lung diseases: This refers to a group of diseases that are long-term and cause progressive scarring of the lungs.
- Systemic sclerosis-associated interstitial lung disease: This medicine is also used for lung problems associated with the disease `systemic sclerosis`.
This medicine does not cure the disease completely, but rather controls and slows down the damage caused to the lungs by the disease.
Things you need to tell your doctor before taking this medicine
It is very important to tell your doctor about your complete health history before starting Nintedanib. Be sure to tell your doctor if you have any of the conditions below.
| Health condition or habit | Why is that important? |
|---|---|
| Bleeding disorders or a family history of such | This medicine may increase the risk of bleeding. |
| A history of heart disease or blood clots | You should be aware of the risk of heart attacks and blood clots. |
| Liver disease | Liver function may be affected, so it should be checked frequently. |
| Presence of protein in the urine | You should be aware of the possible effects on the kidneys. |
| Having had recent surgery | The wound healing process may be affected. |
| Smoking tobacco or cigarettes | Smoking may reduce the effectiveness of the medicine. |
| Stomach or intestinal problems | There is a small risk of intestinal tears. |
| Being pregnant or trying to get pregnant | Very important: This medicine can cause serious harm to an unborn baby. |
| Breastfeeding the baby | It is not recommended because the medicine can pass to the baby through breast milk. |
| Allergies to other medications, foods, and dyes | This is important to determine if you will also be allergic to this medicine. |
How should I use the medicine?
- This medicine should be taken orally with a glass of water .
- It is best to take the medicine with a meal . This can help reduce stomach upset.
- Swallow the capsule whole. Do not break, crush, or chew it.
- Continue to use it as directed until your doctor tells you to stop.
- If you accidentally get the medicine powder inside the capsule on your hands, immediately wash your hands thoroughly with soap and water.
- If you suspect you have taken an overdose, do not delay. Immediately call the National Poisons Information Centre at the Colombo National Hospital . Or go to the Emergency Department (ETU) of the nearest hospital.
What to do if you miss a dose of medicine?
If you forget to take a dose, skip it. Do not take two pills at the next scheduled time to make up for the missed dose. Just take your next dose at your regular time.
Can there be problems with other medications? (Drug Interactions)
Yes, some medications can interact with Nintedanib. So tell your doctor about all the medications you take, including vitamins, herbal remedies, and supplements.
- Aspirin and similar medications
- Medicines that prevent blood clotting (e.g. Warfarin, Apixaban, Rivaroxaban )
- Some antibiotics (e.g. Erythromycin, Clarithromycin )
- Some medications used for seizures (e.g. Carbamazepine, Phenytoin )
- Ketoconazole (an antifungal)
- Rifampin (a medicine for tuberculosis)
- St. John's Wort (a herb used for mental health)
This list is not complete, so it's safest to tell your doctor about everything you take.
Things to consider when taking Nintedanib
Special attention to pregnancy: This is the most important thing. Do not become pregnant while taking Nintedanib. You must use reliable birth control for 3 months after stopping the medicine. This medicine can seriously harm an unborn baby. If you think you may be pregnant, tell your doctor immediately. Also, do not breastfeed while taking this medicine.
- Regular medical checkups: Your doctor will need to see you regularly to check how you are doing. He or she will also order blood work to check your liver function.
- Vomiting and diarrhea: This medicine may cause stomach upset, vomiting, and diarrhea. If this happens , drink plenty of fluids, such as water and juice. Excessive fluid loss can be dangerous. If you can't control this condition, tell your doctor.
- Bleeding risk: This medicine may cause bruising and increase the risk of bleeding. Tell your doctor if you have unusual bleeding (e.g., from your gums, nose) or bruising.
- Smoking: If you smoke, tell your doctor if you feel like the medicine is not working properly. Even if you decide to quit smoking, let your doctor know.
What are the possible serious side effects?
If you experience any of the following symptoms, inform your doctor immediately. In some cases, you may need to go to the Emergency Department (ETU) of the nearest hospital.
| Side effect | Main symptoms |
|---|---|
| Allergic reactions | Skin rash, itching, swelling of the face, lips, tongue or throat. |
| Bleeding | Black or bloody stools, vomit that looks like coffee grounds, red or dark brown urine, small red/purple spots on the skin, unusual bruising. |
| Blood clot | Leg pain, swelling or warmth, difficulty breathing, chest pain. |
| Heart attack | Tightness/pain in the chest, shoulders, arms, or jaw, nausea, difficulty breathing, feeling cold, fainting. |
| Liver injury | Pain in the upper right side of the stomach, loss of appetite, nausea, light-colored stools, dark yellow/brown urine, yellowing of the skin or eyes, unusual tiredness. |
| Stroke | Sudden numbness/weakness of the face, arm, or leg, difficulty speaking, confusion, difficulty walking, severe headache. |
| Stomach/intestinal tears | Fever, stomach pain, sudden change in bowel movements. |
| Excessive diarrhea or vomiting | Uncontrollable diarrhea or vomiting. |
Common, less serious side effects that may occur
These usually subside over time, but if they persist or are bothersome, tell your doctor.
- Headache
- Loss of appetite and weight loss
- Nausea (feeling sick to your stomach)
How do you store and dispose of the medicine?
- Keep out of reach of children and pets.
- Store at room temperature (between 20-25 degrees Celsius). Protect from excessive heat and moisture.
- Get rid of expired medications. The best way to do this is to ask a hospital or pharmacy to take them to a medication take-back program. If this is not possible, consult your doctor.
Take-Home Message
- Nintedanib is a special drug that controls the scarring of the lungs. Rather than curing the disease, it slows down the progression of the disease.
- Before you start taking this medicine, tell your doctor about all your health conditions and all other medications you are taking.
- Very important: Avoid getting pregnant while taking the medicine and for 3 months after stopping. It is very harmful to the baby in the womb.
- Be aware of the signs of serious side effects such as liver damage, bleeding, and heart failure. If in doubt, seek medical advice immediately.
- Maintain regular contact with your doctor. Don't be afraid to talk to them about any questions or concerns.
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