Nintedanib (Vargatef®)

You take nintedanib by mouth as capsules. Nintedanib capsules contain soya. It is important that you tell your doctor if you have an allergy to soya or peanuts. 

During your course of treatment, you will meet someone from your cancer team, such as a: 

• cancer doctor 
• specialist nurse 
• specialist pharmacist.  

This is who we mean when we mention doctor, nurse or pharmacist in this information. 

During your course of treatment, you will have regular blood tests. This is to check that it is safe for you to have treatment.

You will meet with a doctor, nurse or pharmacist regularly during treatment. They will talk to you about your blood results and ask how you have been feeling.

When you are having nintedanib and docetaxel, you usually have a course of several cycles of treatment over a few months. Your cancer team will discuss your treatment plan with you. 

Each cycle usually 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 capsules. 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 and any side effects can be managed. 

Sometimes the doctor may stop the nintedanib, or lower the dose for a while, to help manage side effects. Do not stop taking nintedanib unless your doctor tells you to.

Your doctor, nurse or pharmacist will give you the capsules to take home. They may give you capsules of different strengths. Always take them exactly as they tell you to. This is important to make sure they work as well as possible for you. 

Your cancer team may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they tell you to. 

You usually take nintedanib twice a day. Try to take the doses 12 hours apart.  

Make sure you: 

• take them with food 
• swallow them whole with a glass of water  
• do not chew, open or crush them 
• take them at the same times every day.  

If you forget to take the capsules, take the next dose at the scheduled time. Do not take a double dose to make up for the missed one. You can contact the hospital on the 24-hour number you have been given for advice.  

Other things to remember about your capsules: 

• Keep them in the original package and at room temperature, away from moisture, heat and direct sunlight. 
• Do not use the capsules if you can see the blister pack is open or a capsule is broken. 
• If your skin comes into contact with the contents of the capsule, wash your hands straight away. 
• Keep them safe, where children cannot see or reach them. 
• If you are sick (vomit) just after taking them, do not take an extra dose. Take your next dose at the usual time. 
• Do not throw away unused capsules. Return them to your cancer team at the hospital. 

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 severe diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. If you have a stoma, it will be more active than usual. 

Your doctor, nurse or pharmacist may give you anti-diarrhoea drugs to take at home. 

If you have diarrhoea or a mild increase in stoma activity, follow their advice about: 

• taking anti-diarrhoea drugs 
• how much and what type of fluids to drink 
• any changes to your diet that might help. 

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

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

You may need to give a stool sample, or go to hospital to have fluids through a drip or antibiotics.

Your doctor, nurse or pharmacist may 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 feel sick, do not drive or use machinery.

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:

• a sore mouth or throat affects how much you can drink or 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 in your tummy (abdomen), or have indigestion. Your doctor, nurse or pharmacist can give you advice or treatment to help.

Rarely, this treatment can cause inflammation of the pancreas (pancreatitis). Contact the hospital straight away on the 24-hour number if your symptoms do not go away, or if they get worse.

Rarely, nintedanib can cause a hole in the small bowel – this is called a perforation. 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 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 can affect your skin. It might feel dry. You may develop a rash, which may be itchy. Always tell your doctor, nurse or pharmacist about any skin changes. They can give you advice or prescribe creams or medicines to help.

If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day.

You might notice that your hair slowly gets thinner. But you are very unlikely to lose all the hair from your head. Your hair can also become more brittle. Your nurse can give you information about coping with hair loss. Your hair will usually go back to normal after treatment ends.

This treatment can affect how the liver works. You will have regular blood tests to check this. Sometimes liver changes can be serious. Contact the hospital straight away on the 24-hour number if you have any of these symptoms: 

• yellow skin or eyes 
• feeling very sleepy 
• dark urine (pee) or pale stools (poo) 
• unexplained bleeding or bruising 
• pain in the right side of your tummy (abdomen).

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 and may have a urine sample test to check how well your kidneys are working

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.

Contact the hospital on the 24-hour number if you: 

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

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, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use 
• how long after treatment you should continue to use contraception. 

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.