Drug Interaction Report

Depending on the amount of fat, food may help the absorption of regorafenib. You should take it with a low-fat breakfast at the same time everyday to maintain consistent blood levels and effects. Examples of a low-fat breakfast include: 2 slices of white toast with 1 tablespoon of low-fat margarine and 1 tablespoon of jelly, plus 8 ounces of skim milk (319 calories; 8.2 g fat); or 1 cup of cereal, 8 ounces of skim milk, 1 slice of toast with jam, apple juice, and 1 cup of coffee or tea (520 calories; 2 g fat). Avoid consuming grapefruit or grapefruit juice during treatment, as it may alter the blood levels and effects of the medication. Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Grapefruit juice and Seville orange juice can increase the blood levels of nintedanib. This may increase the risk and/or severity of side effects such as liver problems, diarrhea, nausea, vomiting, stomach or intestinal wall perforation, bleeding, and cardiovascular problems such as heart attack, chest pain, or stroke. It is best to avoid or minimize the consumption of Seville oranges, Seville orange juice, grapefruit, and grapefruit juice during treatment. You should take nintedanib with food and swallow it whole with water. Taking nintedanib with food may help with absorption of the medication and reduce gastrointestinal side effects. Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

The recommended maximum number of medicines in the 'multikinase inhibitors' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'multikinase inhibitors' category:

• Ofev (nintedanib)
• Stivarga (regorafenib)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.