Nintedanib is a targeted cancer drug (biological therapy) and is also known 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 1 type of chemotherapy and whose cancer has grown back or has spread. You have it with a type of chemotherapy called docetaxel.
You may also have nintedanib as part of a clinical trial for other types of cancer.
How it works
Nintedanib is a cancer growth blocker. It blocks particular proteins called protein kinases on the 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.
How you have it
Nintedanib is a capsule that you swallow whole with a glass of water. Do not crush or chew the capsules. You should take nintedanib with food.
If you miss a dose, don't take an extra dose. Take the next prescribed dose at the usual time.
If you accidentally take too much, see a doctor or go to a hospital straight away.
Taking your capsules
You should take the right dose, not more or less.
Talk to your specialist or advice line before you stop taking a cancer drug.
When you have it
You take nintedanib two times 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 chemotherapy.
You usually keep taking it for as long as it is working, unless the side effects get too bad.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
Common side effects
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.
Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.
Increased risk of getting an infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
Loss of appetite
You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
Change of levels of minerals in the blood
You will have regular blood tests to check for this.
Numbness or tingling in fingers or toes
Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons.
Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.
Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids, avoid acidic foods such as oranges, lemons and grapefruits and chew gum to keep the mouth moist. Tell your doctor or nurse if you have ulcers.
Tummy (abdominal) pain
Tell your treatment team if you have this. They can check the cause and give you medicine to help.
Bruising, bleeding gums or nosebleeds
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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).
Hair thinning and hair loss
You may have some hair loss or hair thinning. This can be upsetting. Your hair might grow back once treatment has finished.
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
- blood clots
- high blood pressure
- collection of pus (abscess)
- weight loss
- serious infections
- yellowing of your skin (jaundice) due to high bilirubin levels in the blood
Rare side effects
This side effects happens in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:
- hole in the stomach or bowel
- heart attack
- serious liver problems
- inflammation of your pancreas (pancreatitis)
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Pregnancy and contraception
It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.
Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.
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 might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Don’t breastfeed during this treatment because the drug may come through into your breast milk.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Slow wound healing
This drug can slow wound healing. If you need to have an operation you may need to stop taking it for a while beforehand. Your doctor will let you know when you can start taking it again.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.