Drug & supplement interaction

Ketogenic Diet + Nintedanib Esylate

Nintedanib Esylate brand name: Ofev.

Minor Interaction
Medically reviewed by · Updated September 2026
The bottom line Minor

Ketogenic Diet has a minor interaction with Nintedanib Esylate. Although there is some concern that the ketogenic diet might have additive effects when used with anticoagulant and antiplatelet drugs, most clinical research does not show this effect.

Read the full interaction report
SeverityMinor
LikelihoodUnlikely
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Ketogenic Diet and Nintedanib Esylate

Here is the interaction we found between these two, with the evidence behind it.

Minor

ANTICOAGULANT/ANTIPLATELET DRUGS

Why this applies to Nintedanib Esylate

Nintedanib Esylate falls under ANTICOAGULANT/ANTIPLATELET DRUGS — the group Ketogenic Diet interacts with.

Although there is some concern that the ketogenic diet might have additive effects when used with anticoagulant and antiplatelet drugs, most clinical research does not show this effect.
One small observational study found that the ketogenic diet was associated with prolonged bleeding times in 16 of 51 (31%) children with epilepsy who were also on chronic anticonvulsant therapy. However, a larger observational study of 162 children with epilepsy taking chronic anticonvulsants has found that following the ketogenic diet does not increase the risk of bleeding, even in the 25 children undergoing surgery. Research in adults also has not reported changes in bleeding time.
Severity Minor Likelihood Unlikely Evidence B

Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Good question to ask. The note on file groups Ofev (nintedanib) with blood thinners because it can carry a small bleeding risk on its own. The concern is that a ketogenic diet might add to that bleeding tendency, but most of the research does not actually show this happening. One small study in children hinted at longer bleeding times, while a larger study and adult data found no real change.

For you, that means the keto diet is unlikely to meaningfully increase nintedanib's effects. Still, since nintedanib can sometimes cause bruising, nosebleeds, or bleeding gums, mention any unusual bleeding to your doctor. If you're considering keto while on Ofev, it's worth a quick chat with your pharmacist or physician first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Melchior RW, Dreher M, Ramsey E, Savoca M, Rosenthal T. Cardiopulmonary bypass considerations for pediatric patients on the ketogenic diet. Perfusion. 2015;30(5):423-6. PubMed
  2. Dressler A, Chiara H, Benninger F, et al. Effects of the ketogenic diet on platelet counts and global coagulation tests in childhood epilepsy. Seizure. 2020;80:31-37. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Ketogenic Diet Also Interacts With Other Medications

Ketogenic Diet has 137 moderate, 121 minor known drug interactions in our database — the Nintedanib Esylate one above is one of them. If you take anything else, check it against the full list below.

Moderate 137 Minor 121 No known interaction 2,572 (incl. Nintedanib Esylate)
Taking anything else?

Check Another of Your Medications Against Ketogenic Diet

Covers the 2,830 medications we’ve checked against Ketogenic Diet. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Nintedanib Esylate

This page covers Ketogenic Diet only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Nintedanib Esylate page lists 285 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Danshen (major), Grapefruit (major), Piracetam (major) and St. John's Wort (major).

By severity: 5 major · 240 moderate · 40 minor.

From our pharmacist’s overview on the Nintedanib Esylate page

“You take Ofev (nintedanib) to slow lung scarring, and this page deserves a careful read before any supplement joins it. Of the 285 ingredients here, the biggest cluster, over 200, can add to bleeding risk, a real concern since nintedanib itself can make you bleed more easily.”

Reviewed by 2 · Jul 18, 2026

Open the Nintedanib Esylate interaction page

How much people look this up

Where Ketogenic Diet and Nintedanib Esylate Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Ketogenic Diet
Steady interest

#1,210 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Nintedanib Esylate
Steady interest

#1,957 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Eating pattern

About Ketogenic Diet

What is Ketogenic Diet?

  • Weight loss
  • Type 2 diabetes and blood sugar control
  • Drug-resistant epilepsy (especially in children)
  • Reducing appetite
  • Athletic and metabolic interest

The ketogenic diet is a very low-carbohydrate, high-fat eating plan that shifts the body to burn fat for fuel. It has the strongest evidence as a medical therapy for hard-to-treat epilepsy and may help short-term weight loss and blood sugar, but it can be hard to sustain and is not right for everyone. Talk with a doctor or pharmacist before starting, especially if you have a medical condition or take medication.

Read the full Ketogenic Diet monograph & all interactions
Medication

About Nintedanib

What Is Nintedanib Used For?

Brand name: Ofev

Nintedanib capsules are approved for adults with idiopathic pulmonary fibrosis (IPF) — a chronic, progressive scarring of the lungs — and for adults with chronic fibrosing interstitial lung diseases (ILDs) with a progressive phenotype, meaning fibrosing lung diseases that continue to worsen over time despite treatment.

Nintedanib capsules (including Ofev) are also indicated to slow the rate of decline in lung function in adults with systemic sclerosis-associated interstitial lung disease (SSc-ILD), a lung complication of the autoimmune condition systemic sclerosis (scleroderma). Note that the Nintedanib esylate capsule product is approved for IPF and chronic fibrosing ILDs with a progressive phenotype, but SSc-ILD approval is carried by Ofev and other nintedanib capsule products — always confirm with your prescriber which product you have been prescribed.

See full Nintedanib drug information
Keep checking

Other Drugs & Ketogenic Diet

Browse every other medication we’ve checked against Ketogenic Diet — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
137Moderate
121Minor
2,571No known interaction
137 Moderate 121 Minor 2,571 No interaction
Moderate

137 interactions

Showing 60 of 137 moderate interactions — see all 137 on the Ketogenic Diet page.

Minor

121 interactions

Showing 60 of 121 minor interactions — see all 121 on the Ketogenic Diet page.

No interaction 2,571 drugs checked — show the list

We also checked Ketogenic Diet against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,571 medications checked with no known interaction — see the full Ketogenic Diet list.

See the full Ketogenic Diet interactions page
See every supplement checked against Nintedanib Esylate, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Ketogenic Diet monograph › Uses, safety, and every drug interaction in one place Nintedanib Esylate supplement interactions › Every supplement checked against Nintedanib Esylate, ranked by severity Nintedanib drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Following Ketogenic Diet While Taking Nintedanib Esylate: Common Questions

Can you follow Ketogenic Diet while taking Nintedanib Esylate?
There is only a minor interaction, which is usually not serious. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Ketogenic Diet and Nintedanib Esylate interaction?
We rate it Minor. This interaction is generally not clinically significant, but it remains worth noting and discussing with your pharmacist.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Nintedanib Esylate and Ketogenic Diet?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.