NIFIBRO SOFT CAPSULES 100 MG [SIN17606P]

Product Info

NIFIBRO SOFT CAPSULES 100 MG

[SIN17606P]

Indication

4.1 THERAPEUTIC INDICATIONS

Nifibro is indicated in combination with docetaxel for the treatment of adult patients with locally advanced, metastatic or locally recurrent non-small cell lung cancer (NSCLC) of adenocarcinoma tumour histology after first line chemotherapy.

Nifibro is indicated for the treatment of Idiopathic Pulmonary Fibrosis (IPF).

Nifibro is indicated for the treatment of chronic fibrosing Interstitial Lung Diseases (ILDs) with a progressive phenotype [see section Clinical Efficacy and Safety – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information]

Nifibro is indicated to slow the rate of decline in pulmonary function in patients with systemic sclerosis associated interstitial lung disease (SSc-ILD).

Dosing

4.2 POSOLOGY AND METHOD OF ADMINISTRATION

Posology

Adults

Dosing in NSCLC

Treatment with nintedanib should be initiated and supervised by a physician experienced in the use of anticancer therapies.

For posology, method of administration, and dose modifications of docetaxel, please refer to the corresponding product information for docetaxel.

The recommended dose of nintedanib is 200 mg twice daily administered approximately 12 hours apart, on days 2 to 21 of a standard 21-day docetaxel treatment cycle.

Nintedanib must not be taken on the same day of docetaxel chemotherapy administration (= day 1). The recommended maximum daily dose of 400 mg should not be exceeded.

Patients may continue therapy with nintedanib after discontinuation of docetaxel for as long as clinical benefit is observed or until unacceptable toxicity occurs.

Dosing in IPF / chronic fibrosing ILDs with a progressive phenotype / SSc-ILD

Treatment with nintedanib should be initiated by physicians experienced in the diagnosis and treatment of conditions for which nintedanib is indicated.

The recommended dose of nintedanib is 150 mg twice daily administered approximately 12 hours apart. The recommended maximum daily dose of 300 mg should not be exceeded.

Dose adjustments
NSCLC

As initial measure for the management of adverse reactions (see Tables 1a and 1b), treatment with nintedanib should be temporarily interrupted until the specific adverse reaction has resolved to levels that allow continuation of therapy (to grade 1 or baseline). Nintedanib treatment may be resumed at a reduced dose. Dose adjustments in 100 mg steps per day (i.e. a 50 mg reduction per dosing) based on individual safety and tolerability are recommended as described in Table 1a and Table 1b.

In case of further persistence of the adverse reaction(s), i.e. if a patient does not tolerate 100 mg twice daily, treatment with nintedanib should be permanently discontinued. In case of specific elevations of aspartate aminotransferase (AST)/ alanine aminotransferase (ALT) values to > 3 x upper limit normal (ULN) in conjunction with an increase of total bilirubin to ≥ 2 x ULN and alkaline phosphatase (ALKP) < 2 x ULN; (see Table 1b) treatment with nintedanib should be interrupted. Unless there is an alternative cause established, nintedanib should be permanently discontinued (see section Special Warnings and Precautions for Use – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

IPF / chronic fibrosing ILDs with a progressive phenotype / SSc-ILD

In addition to symptomatic treatment if applicable, the management of adverse reactions (see section Special Warnings and Precautions for Use, Undesirable Effects – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information) of nintedanib may require dose reduction or temporary interruption until the specific adverse reaction resolves to levels that allow continuation of therapy. Nintedanib treatment may be resumed at the full dosage (150 mg twice daily) or at the reduced dosage (100 mg twice daily), which subsequently may be increased to the full dosage. If a patient does not tolerate 100 mg twice daily, treatment with nintedanib should be discontinued.

Dose modifications or interruptions may be necessary for liver enzyme elevations. For aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 3 times to < 5 times the upper limit of normal (ULN) without signs of severe liver damage, interrupt treatment or reduce nintedanib to 100mg twice daily. Once liver enzymes have returned to baseline values, treatment with nintedanib may be reintroduced at a reduced dosage (100mg twice daily), which subsequently may be increased to the full dosage (150mg twice daily) [see section Special Warnings and Precautions for Use, Undesirable Effects – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information].

Special populations

Paediatric population

The safety and efficacy of nintedanib in children aged 0–18 years have not been established.

Elderly patients (≥ 65 years)

No overall differences in safety and efficacy were observed for elderly patients. No adjustment of the initial dosing is required on the basis of a patient’s age (see section Pharmacokinetic Properties – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information). Patients ≥ 75 years may be more likely to require dose reduction to manage adverse effects.

Race

Based on population pharmacokinetic (-PK) analyses, no a priori dose adjustments of nintedanib are necessary (see section Special Populations, Special Warnings and Precautions for Use, Pharmacokinetic Properties – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information). Safety data for Black patients are limited.

Body weight

Based on population PK analyses, no a priori dose adjustments of nintedanib are necessary (see section Pharmacokinetic Properties – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

Renal impairment

Less than 1% of a single dose of nintedanib is excreted via the kidney (see section Pharmacokinetic Properties – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information). Adjustment of the starting dose in patients with mild to moderate renal impairment is not required. The safety, efficacy, and pharmacokinetics of nintedanib have not been studied in patients with severe renal impairment (< 30 ml/min CrCL).

Hepatic Impairment

IPF / chronic fibrosing ILDs with a progressive phenotype / SSc-ILD

Nintedanib is predominantly eliminated via biliary/faecal excretion (> 90 %). Exposure increased in patients with hepatic impairment (Child Pugh A, Child Pugh B; see section Pharmacokinetic Properties – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

In patients with mild hepatic impairment (Child Pugh A), the recommended dose of nintedanib is 100mg twice daily approximately 12 hours apart.

In patients with mild hepatic impairment (Child Pugh A), treatment interruption or discontinuation for management of adverse reactions should be considered.

The safety and efficacy of nintedanib have not been investigated in patients with hepatic impairment classified as Child Pugh B and C. Treatment of patients with moderate (Child Pugh B) and severe (Child Pugh C) hepatic impairment with nintedanib is not recommended (see section Pharmacokinetic Properties – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

NSCLC

Nintedanib is predominantly eliminated via biliary/faecal excretion (> 90 %). Exposure increased in patients with hepatic impairment (Child Pugh A, Child Pugh B; see section Pharmacokinetic Properties – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

No adjustment of the starting dose is needed for patients with mild hepatic impairment (Child Pugh A) based on clinical data.

Limited safety data available from 9 patients with moderate hepatic impairment (Child Pugh B) are insufficient to characterize this population.

The safety, efficacy and pharmacokinetics of nintedanib have not been investigated in patients with severe hepatic impairment (Child Pugh C). Treatment of patients with moderate (Child Pugh B) and severe (Child Pugh C) hepatic impairment with nintedanib is not recommended (see sections Special Warnings and Precautions for Use and Pharmacokinetic Properties – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

Method of Administration

Nintedanib capsules should be taken orally, preferably with food, swallowed whole with water, and should not be chewed. If a dose is missed, administration should resume at the next scheduled time at the recommended dose. If a dose is missed, the patient should not be given an additional dose.

Nintedanib capsules may be taken with a small amount (teaspoonful) of cold or room temperature soft food, such as apple sauce or chocolate pudding, and must be swallowed unchewed immediately, to ensure the capsule stays intact.

The capsule should not be opened or crushed. If contact with the content of the capsule occurs, hands should be washed immediately and thoroughly.

Contraindications

4.3 CONTRAINDICATIONS

Nintedanib is contraindicated in patients with known hypersensitivity to nintedanib or to any of the excipients (see section Qualitative and Quantitative Composition – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

Nintedanib is contraindicated during pregnancy (see sections Fertility, Pregnancy and Lactation and Preclinical Safety Data – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

NSCLC

For contraindications of docetaxel please refer to the corresponding product information for docetaxel.