Abdominal Discomfort and Dyspnoea

🗒️ Question

A 62 year old woman with idiopathic pulmonary fibrosis (IPF) is reviewed in the respiratory clinic. She was started on antifibrotic therapy with nintedanib three months ago. She reports ongoing mild shortness of breath, however she has also noticed an increase in bowel frequency and loose stools since starting the medication. Her past medical history includes type 2 diabetes for which she takes metformin.

On examination, her blood pressure is 128/76 mmHg, heart rate is 82 bpm and regular and oxygen saturation is 92% on room air. She appears mildly dehydrated and there is no evidence of peripheral oedema.

Investigations

• Blood tests

• Urea 7.2: mmol/L (2.5–7.8)

• Creatinine: 110 µmol/L (60–120)

• CRP: 8 mg/L (<5)

Which adverse effect of nintedanib is she most likely experiencing?

(A) Anaemia

(B) Diarrhoea

(C) Hepatotoxicity

(D) Hypertension

(E) Nausea