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Nintedanib Adverse Effects — RACP Adult Medicine MCQ

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EasyRespiratoryNintedanib Adverse EffectsRACP Adult Medicine

A 60-year-old woman with interstitial lung disease has progressive breathlessness. PFTs show FVC 60% predicted and DLCO 40% predicted. HRCT shows a definite usual interstitial pneumonia (UIP) pattern. ANA and ENA are negative. She is commenced on nintedanib. What adverse effect is most commonly dose-limiting?

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Correct answer: E — Diarrhoea

Diarrhoea is the most common adverse effect of nintedanib, occurring in up to 62% of patients (INPULSIS trials). It is the most common reason for dose reduction or discontinuation. Management includes dietary modification, loperamide, and dose reduction (from 150 mg BD to 100 mg BD). Hepatotoxicity (elevated transaminases) occurs but is less common. LFTs should be monitored monthly for the first 3 months then periodically.

Reference: eTG – 2025 – Respiratory; AMH – 2025 – Nintedanib