What is nintedanib (Vargatef®)?

Nintedanib (Vargatef®) is used to treat a type of non-small cell lung cancer called adenocarcinoma that has spread, or come back, after chemotherapy. It is given with a chemotherapy drug called docetaxel.

Nintedanib may sometimes be used to treat other cancers. It is best to read this information with our general information about targeted therapies and the type of cancer you have.

Nintedanib belongs to a group of targeted therapy drugs known as cancer growth inhibitors. It is a multi-tyrosine kinase inhibitor (TKI). Kinases are proteins that control how cells grow and divide. Nintedanib blocks different proteins (kinases) from sending signals to the cancer cells to grow.  This causes the cancer cells to die. 

Nintedanib is also an angiogenesis inhibitor drug. It stops the cancer cells from developing new blood vessels.  

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

How nintedanib is given

Nintedanib is given as capsules you take at home. You start taking nintedanib the day after you have the chemotherapy drug  docetaxel. Docetaxel is given as a drip (infusion) into a vein. 

During treatment you usually see a cancer doctor, a cancer nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

You will have regular blood samples taken throughout your treatment. These allow your doctor to check: 

  • the levels of different blood cells (blood count) in your body
  • how your liver and kidneys are working.

The nurse or pharmacist will give you the nintedanib capsules to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you. You may be given capsules of different strengths.

Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they have been explained to you.

Your course of treatment

When you have nintedanib and docetaxel you usually have it as a course of several cycles of treatment over a few months. Your nurse or doctor will discuss your treatment plan with you.

You start taking nintedanib the day after you have had docetaxel. You do not have nintedanib and docetaxel on the same day.

You usually take nintedanib for 20 days and then have docetaxel again. This is called a cycle of treatment. Each cycle lasts 21 days (3 weeks). Your doctor will talk to you about how many cycles of treatment you can have.

Your doctor may talk to you about continuing nintedanib after finishing treatment with docetaxel. In this situation, you usually take nintedanib every day for as long as it keeps the cancer under control.

Taking nintedanib capsules

You take nintedanib twice a day with food. They must be swallowed whole with a glass of water. They should not be chewed, opened or crushed. Take them about 12 hours apart and at the same time every day. 

Always take nintedanib exactly as your nurse or pharmacist explained. This is important to make sure it works as well as possible for you.

If you forget a dose, just take the next dose at the usual time. Never take a double dose to make up for the one you missed. 

Your doctor may ask you to stop taking nintedanib, or take a lower dose, because of side effects. Always follow your doctor’s advice carefully.

Other things to remember about your capsules:

  • Do not take nintedanib if you are allergic to peanut or soya.
  • Keep them in the original package and at room temperature, away from heat and direct sunlight.
  • Keep them safe and out of sight and reach of children.
  • If you are sick just after taking the capsules, contact the hospital. Do not take another dose.
  • If your treatment is stopped, return any unused capsules to the pharmacist. 

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them. 

If you have chemotherapy along with nintedanib, some side effects may be worse. You may also have side effects not listed here. We have more information about chemotherapy.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve. 

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Common side effects of nintedanib

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

You will have regular blood tests during treatment. If your white blood cell count is low, your doctor may reduce or delay your treatment for a short time.

Diarrhoea

This treatment may cause diarrhoea. Diarrhoea usually means that you have to open your bowels more often than you normally do. The bowel movements are also looser than normal. If you have a stoma, it will be more active than usual.

Your hospital team may give you anti-diarrhoea drugs to take at home.

If you have diarrhoea or a mild increase in stoma activity:

  • follow any advice from your cancer team about taking anti-diarrhoea drugs
  • drink at least 2 litres (31/2 pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Contact the hospital straight away if:

  • you have diarrhoea at night
  • you have diarrhoea more than 4 times in a day
  • you have a moderate or severe increase in stoma activity
  • the anti-diarrhoea drugs do not work within 24 hours.

You may need to go to hospital to have fluids through a drip.

Your doctor may ask you to stop taking nintedanib. When the diarrhoea is better, they will tell you if you can start taking it again. Sometimes your doctor may reduce the dose.

Feeling sick

Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.

If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.

Dehydration

If you have diarrhoea or feel sick, it can be difficult to drink enough. This can make you dehydrated. It can also affect the levels of minerals and salts in your body, for example, sodium, potassium and calcium. Your doctor will take regular blood tests to check these.

It is important that you drink around 2 litres (3½ pints) of fluids every day while having treatment with nintedanib.

Let your doctor or nurse know if you have any signs of dehydration, such as:

  • feeling dizzy or tired
  • passing small amounts of urine (pee)
  • having a dry mouth and eyes.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.

Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Tummy pain

You may get pain or discomfort in your tummy (abdomen). Your doctor can prescribe drugs to help. Tell them if the pain does not improve or gets worse.

Rarely, nintedanib can cause a hole (perforation) in the small bowel. Tell your doctor immediately if you have sudden or severe pain in your tummy or signs of bleeding. Signs of bleeding from the bowel include:

  • vomiting up blood
  • vomit that looks like coffee grounds
  • bleeding from the back passage
  • black poo (stool).

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. 

Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.

Skin changes

This treatment may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. This treatment can cause a rash, which may be itchy.

Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

Hair thinning

Some people have hair thinning or hair loss. Hair changes are usually temporary and improve gradually once treatment is over.

Changes in the way the liver works

Nintedanib may affect how your liver works. This is usually mild and goes back to normal after treatment. The drug may cause the skin and whites of your eyes to become yellow (jaundiced). Tell your nurse or doctor if you notice this.

You will have blood tests to check how well your liver is working.

Effects on the kidneys

This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your kidneys are working.

It is important to drink at least 2 litres (3½ pints) of fluids each day to help protect your kidneys.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

Less common side effects of nintedanib

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain.

If you have any of these symptoms, contact a doctor straight away.

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Effects on the heart

In some people, nintedanib may cause heart problems.

Contact a doctor straight away if you:

  • have pain or tightness in your chest
  • feel breathless or dizzy
  • feel your heart is beating too fast or too slowly.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor.

High blood pressure

Tell your doctor or nurse if you have ever had any problems with your blood pressure. You will have regular blood pressure checks when taking this drug. Let your doctor or nurse know if you have any headaches.

Slow wound healing

Wounds may take longer to heal while you are being treated with nintedanib. If you have any wounds which are not healing or look infected, speak to your doctor straight away.

If you have any surgery planned, nintedanib will be stopped before the operation and not started again until the wound is fully healed.

Other information

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Vaccinations

Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.

Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.

If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for at least 3 months after treatment finishes. It is best to use a barrier form of contraception as a second form of contraception, as it is not known if nintedanib affects contraceptives. Your doctor, nurse or pharmacist can tell you more about this.

Breastfeeding

Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.