Nintedanib (Vargatef®)

Nintedanib is a targeted therapy drug which is also known as Vargatef®. It is used to treat a type of non-small cell lung cancer called adenocarcinoma. It does this by stopping signals that tell cancer cells to grow. It is best to read this information with our general information about the type of cancer you have.

Nintedanib is given as capsules and you usually have it as an outpatient. It is given in combination with a chemotherapy drug called docetaxel. Your cancer doctor or nurse will tell you how often you will have it.

Like all targeted therapy drugs, Nintedanib can cause side effects. Some of the side effects can be serious, so it’s important to read the detailed information below. How targeted therapy affects people varies from person to person. Your healthcare team can talk to you more about this and give you advice on how to manage any side effects.

Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we don’t mention.

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

If you need to seek medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is nintedanib?

Nintedanib (Vargatef) is a targeted therapy drug used to treat a type of non-small cell lung cancer called adenocarcinoma. It may also be used to treat other cancers as part of a clinical trial.

It is best to read this information with our general information on non-small cell lung cancer.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


How nintedanib works

Nintedanib stops proteins sending signals to cancer cells to grow. Nintedanib can also stop the cancer cells from developing new blood vessels. This reduces their supply of oxygen and nutrients, so that the cancer shrinks or stops growing.


When nintedanib is given

Nintedanib is used to treat a type of non-small cell lung cancer called adenocarcinoma that has spread or come back after chemotherapy.

Nintedanib is given with a chemotherapy drug called docetaxel.


Taking nintedanib capsules

You take nintedanib twice a day with food. Try and keep the doses 12 hours apart. For example, you might take one capsule at 8am and another one at 8pm. Swallow the capsules whole with a glass of water. Don’t chew or open them up.

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

When you are having nintedanib capsules and docetaxel chemotherapy, you start taking the capsules the day after chemotherapy. Do not take nintedanib on the same day as the docetaxel. You usually take nintedanib for 20 days and then you have docetaxel again. This is called a cycle of treatment. 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.

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.

There are some other important things to remember when taking your capsules:

  • Don’t take nintedanib if you’re allergic to peanut or soya.
  • 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.
  • Keep the capsules in the original package at room temperature.
  • Keep them safe and out of the reach of children.
  • Return any remaining capsules to the pharmacist if your treatment is stopped.


Possible side effects of nintedanib

We explain the most common side effects of nintedanib here. We haven’t included all the less common and rarer side effects. You may get some of the side effects we mention, but you will not get them all.

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 prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This will help the drugs work as well as possible for you.

Your nurse will give you advice about managing side effects. After your treatment is over, side effects will start to improve. Always tell your doctor or nurse about the side effects you have.

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.

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.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Diarrhoea

Your doctor can prescribe anti-diarrhoea drugs to control any diarrhoea. You may be given these before you leave hospital. It’s important to take them exactly as your nurse or pharmacist explained. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.

If you have diarrhoea more than four to six times a day or at night, contact the hospital straight away on the numbers your nurse gave you. 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 lead to you becoming too dry (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's important that you drink around two litres (three and a half 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, or having a dry mouth and eyes.

Loss of appetite

This treatment can affect your appetite. Do not worry if you don’t 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

Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.

Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.

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 or delay treatment for a short time. 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 doesn’t 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, such bleeding from the back passage, black stools, or vomiting up blood (or vomit that looks like coffee grounds).

Bleeding

Nintedanib can cause bleeding problems, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. Tell your doctor if you are taking any medicines that may affect bleeding. This includes aspirin, blood-thinning tablets such as warfarin or injections such as heparin, or vitamin E.

Contact your doctor straight away if you have any heavy or unusual bleeding. This includes vomiting or coughing up blood, unexpected vaginal bleeding, or blood in your stools (bowel movements).

Skin changes

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

Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help.

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.


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.

High blood pressure

Nintedanib may cause this. Tell your doctor or nurse if you have ever had any problems with high blood pressure. Your nurse will check it regularly during your treatment. Let them know if you have any headaches.

Slow wound healing

Wounds may take longer to heal while you're 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 about nintedanib

Other medicines

Nintedanib may interact with other medicines, including some that are used to treat epilepsy and some anti-biotics. It may also interact with the herbal remedy St John’s wort. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.

Contraception

Your doctor will advise you not to become pregnant or to father a child during treatment. This is because nintedanib may harm a developing baby. It’s important to use effective contraception during and for a few months after treatment. You can talk to your doctor or nurse about this.

Breastfeeding

Women are advised not to breastfeed during treatment with nintedanib. This is in case there is nintedanib in the breast milk.

Fertility

Nintedanib may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.

Medical and dental treatment

If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having nintedanib. Explain you are taking tablets that no one should stop or restart without advice from your cancer doctor.

Give them contact details for your cancer doctor.

Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are taking nintedanib.