This page tells you about the biological therapy nintedanib (pronounced nin-ted-a-nib). There are sections on
Nintedanib is also called by its brand name Vargatef. It is a treatment for a type of non small cell lung cancer called adenocarcinoma.
Nintedanib is for people who have already had one type of chemotherapy and whose cancer has grown back or has spread. You have it with a type of chemotherapy called docetaxel.
You usually keep taking it for as long as it is working unless side effects get too bad.
You may have nintedanib as part of clinical trials for other types of cancer.
Nintedanib is a cancer growth blocker. It works by blocking particular proteins called protein kinases in cancer cells. The protein kinases encourage the cancer to grow. Nintedanib blocks a number of these proteins and is called a multi kinase inhibitor. It also stops the cancer cells growing their own blood vessels, which the cells need to be able to grow.
Nintedanib may shrink the cancer or stop it growing for a time.
Nintedanib is a capsule. You take the capsules twice a day, 12 hours apart. How many you take depends on your needs. Your doctor may change the dose during the treatment.
You take the capsules every day, except for 1 day every 3 weeks when you have docetaxel.
You should take the capsules at the same time each day. Swallow them whole and don’t open them. You should take them with food. If you forget to take them don’t take double the dose. Take your next dose as normal.
It is very important that you take your capsules according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. So check the pack leaflet and follow the instructions it gives. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We've listed the side effects associated with nintedanib. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.
You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects may be different if you are having nintedanib with other drugs.
Tell your doctor or nurse straight away if any of the side effects get severe.
More than 10 in every 100 people have one or more of these side effects.
- Diarrhoea affects around 5 out of 10 people (50%) and sometimes it can be severe. Drink plenty of fluids and contact your treatment centre straight away if you have signs of diarrhoea. Your doctor or nurse will give you anti diarrhoea medicines to take
- Loss of appetite affects around 5 out of 10 people (50%)
- Liver changes happen in around 4 out of 10 people (40%). For most people they are very mild and unlikely to cause symptoms
- Feeling or being sick occurs in just over 2 out of every 10 people (20%). This is usually well controlled with anti sickness medicines
- Numbness or tingling in fingers and toes happens in 2 out of every 10 people (20%). It can cause difficulty with fiddly things such as doing up buttons. It starts within a few days or weeks and usually goes within a few months of finishing treatment
- Stomach pains
- A sore mouth and throat occurs in 2 out of 10 people (20%)
- Skin changes – you may have a rash or red, dry, itchy skin
- Bruising more easily due to a drop in platelets – you may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- Low levels of potassium in your blood (hypokalaemia) – let your doctor or nurse know if you have cramping or tingling in your arm or leg muscles
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Tiredness and weakness (fatigue)
- Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
Between 1 and 10 in every 100 people have one or more of these side effects.
- Blood clots – let your doctor or nurse know straight away if you suddenly become breathless or have leg pain and redness or swelling of the legs
- Dehydration – drink plenty of fluids (around 2 litres a day)
- A collection of pus with swelling and inflammation (abscesses). These could develop in any part of the body including the mouth and tummy (abdomen)
- Yellowing of the skin and eyes (jaundice). See your doctor or nurse straight away if you have this
Fewer than 1 in 100 people have a hole in the wall of the stomach or bowel. Let your doctor or nurse know straight away if you have sudden, severe pain or blood in your vomit or poo (stool).
Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Don’t breastfeed during this treatment because the drug may come through in the breast milk.
Slow wound healing
Nintedanib can make wounds heal more slowly. If you need to have an operation you may need to stop taking nintedanib for a while beforehand. Your treatment team will let you know when you can start taking it again.
Possible long term effects
Nintedanib is a fairly new drug in cancer treatment. There is limited information available at the moment about possible longer term effects that it may cause. Tell your doctor or nurse if you notice anything that is not normal for you.
You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
We don’t list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk/emc.
If you have a side effect we don’t list here and you think it may be due to this treatment, you can report it to the Medicines Health and Regulatory Authority (MHRA). Go to yellowcard.mhra.gov.uk
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