Background and Importance Nintedanib is a tyrosine kinase inhibitor drug indicated for idiopathic pulmonary fibrosis and other chronic progressive phenotype fibrosis. However, it is difficult to maintain the full dose due to its most frequent adverse effect: diarrhoea.

Because of the complexity of these patients, multidisciplinary care between nursing and pharmacy is performed. Before starting treatment, oral intake of carob flour is indicated to prevent and treat diarrhoea.

Carob is a plant with medicinal use in gastrointestinal disorders as it has anti-inflammatory, anti-diarrhoeal and anti-ulcer properties. We recommend, according to bibliography, the intake of 20 grams once or twice a day.

Aim and Objectives To evaluate the benefit of daily intake of carob flour on diarrhoea caused by the antifibrotic drug nintedanib in a tertiary level hospital.

Material and Methods All patients dispensed nintedanib from March 2022 to July 2023 were included. Information regarding nintedanib initiation date, duration of treatment, indication, dosing at cut-off and co-medications was collected from medical history. Carob flour intakes and incidence of diarrhoea were registered by nursing and pharmacy on follow-up.

Results Forty-seven patients were included, highlighting two groups:

Patients who took carob flour 48.9% (n=23), of whom 20 did not have diarrhoea. The other three patients had diarrhoea, suspecting that they took less than recommended, in two of them it was necessary to reduce the dose.

Patients who did not take flour: 51.1% (n=24), of whom 16 did not have diarrhoea. The remaining eight patients had diarrhoea, decreasing the dose in four of them.

Most of the patients who did not take flour started treatment more than 12 months ago (62.5%), when this dietary recommendation was not made.

Conclusion and Relevance Carob flour is useful in preventing diarrhoea caused by nintedanib due to its anti-diarrhoeal properties because it is rich in starch and fibre, which leads to a decrease in stool production and diarrhoea. In addition, the proteins present utilise separate glucose and amino acid cotransporters that promote glucose absorption. By improving stool consistency, it contributes to better tolerance of nintedanib.

More exhaustive studies should be performed to confirm these results, bearing in mind the carob flour intake varies from patient to patient, making results difficult to assess.

Conflict of Interest No conflict of interest.