Nintedanib (Vargatef®)

You take nintedanib by mouth as capsules.

During treatment you usually see a cancer doctor, a cancer nurse or 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. They 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.

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.

Each cycle lasts 21 days (3 weeks). On day 1 of the cycle you have docetaxel as a drip (infusion) into a vein. A chemotherapy nurse will give it to you in the chemotherapy day unit.

On day 2, you start taking nintedanib. You do not have nintedanib and docetaxel on the same day.

You usually keep taking nintedanib for 20 days. This completes 1 cycle of treatment.

Your doctor will talk to you about how many cycles of treatment you can have. They 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.

You take nintedanib twice a day with food. Swallow the capsules whole with a glass of water. Do not chew, open or crush them. Take them about 12 hours apart and at the same times every day.

You may be given capsules of different strengths. Always take them exactly as your nurse or pharmacist explained. This is important to make sure the treatment 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. If you are sick just after taking the capsules, contact the hospital. Do not take another dose.

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 your treatment is stopped, return any unused capsules to the pharmacist.

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

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

• a temperature above 37.5°C 
• a temperature below 36°C
• you feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough
• breathlessness
• diarrhoea
• needing to pass urine (pee) often, or discomfort when you pass urine.

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 stop your treatment for a short time, until your cell count increases. Sometimes they will reduce the dose of your treatment.

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.

Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.

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.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

Contact the hospital straight away on the 24-hour number, if:

• your mouth or throat is sore, or affecting how much fluid you can drink or food you can eat 
• your mouth, tongue, throat or lips have any blisters, ulcers or white patches. 

They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

• drink plenty of fluids
• avoid alcohol and tobacco
• avoid food or drinks that irritate your mouth and throat.

This treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly tasks such as fastening buttons or tying shoelaces.

If you have these symptoms, always tell your doctor, nurse or pharmacist. They sometimes need to change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends. But for some people they continue and are a long-term side effect of treatment.

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
• dark, grainy vomit that looks like coffee grounds
• bleeding from the back passage
• black poo (stool).

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

If the number of platelets is low, you may bruise or bleed easily. You may have:

• nosebleeds
• bleeding gums
• heavy periods
• blood in your urine (pee) or stools (poo)
• tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin. 

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.

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.

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

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.

This treatment can affect how the kidneys work. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how well your kidneys are working. Contact the hospital on the 24-hour number if you:

• have blood in your urine (pee) 
• are passing less urine or peeing less often than usual.

Drinking fluids helps protect your kidneys. The advice is usually to try to drink at least 2 litres (3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how much is right for you.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

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

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

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. We do not know whether nintedanib makes the contraceptive pill less effective. People who take the contraceptive pill are advised to use another type of contraception as well. Your doctor, nurse or pharmacist can tell you more about this.

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

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.

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

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.