How do you manage diarrhea in a patient with CTD-ILD on MMF who was recently started on full dose nintedanib?  

It is important to keep in mind that immunomodulator therapy is also frequently associated with gi toxicity (MMF, methotrexate, leflunomide, azathioprine, etc.). Given this, it is important to begin one therapy at a time in order to mitigate side effects and do understand which agent is responsible....

In general, making certain the patient is taking adequate oral fluids is important. OTC antidiarrheals can also be helpful. Reduction of the nintedanib dose is very helpful in managing the diarrhea. If the diarrhea is severe, I recommend holding the nintedanib until it is resolved, then restarting w...

These are great responses and excellent references. It is reasonable to remember that mycophenolate itself is associated with a colitis response and has been reported to cause infectious diarrheal states as well, such as C diff. Or even CMV-associated colitis. Cultures and additional testing may be ...

This can certainly be challenging since both medications can independently cause diarrhea. Imodium can be helpful as well as stepping down on the dose of nintedanib. But some of my patients have found that they have specific dietary triggers that may not have been an issue in the past but now make d...

Hopes and prayers. Seriously though, in my experience, this is really hard. There are several options: Reduce nintedanib dosing. The usual starting dose is 150 mg BID, but you can drop it to 100mg BID. This often does the trick. Reduce MMF dosing. This often works, too. Switch to mycophenolic a...