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Sorafenib is commonly used to treat certain cancers. Common side effects include diarrhea, tiredness, and hair loss. Call your health care provider right away if you have fever, bleeding, chest pain, or shortness of breath. Sorafenib is a tablet that you will swallow. 

Uses

What is sorafenib used for?

Sorafenib is commonly used to treat the following types of cancers. 

Sorafenib may also be used for other conditions as determined by your health care provider.

How does sorafenib work (mechanism of action)?

Sorafenib works by blocking certain proteins that help cancer cells grow and spread. It can also prevent the growth of new blood vessels that tumors need to grow.

How is sorafenib supplied (dosage forms)?

Brands and other names

  • Nexavar

Dosage forms and strengths

  • 200 mg oral tablets

How should I store sorafenib?

Sorafenib should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.

Side Effects

What are the most common side effects of sorafenib?

The most common side effects of sorafenib are listed below. Tell your health care provider if you have any of these side effects that bother you. Side effects may be different depending on the condition you are using the medicine for.

  • Diarrhea
  • Tiredness
  • Infection
  • Hair loss or hair thinning
  • Rash
  • Weight loss
  • Loss of appetite
  • Nausea
  • Stomach pain
  • Low levels of calcium
  • Increased blood pressure (see below)
  • Bleeding (see below)

There may be other side effects of sorafenib that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of sorafenib?

While less common, the most serious side effects of sorafenib are described below, along with what to do if they happen.

Severe Allergic Reactions. Sorafenib may cause allergic reactions, which can be serious. Stop taking sorafenib and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Heart Attack and Stroke. Sorafenib can increase your risk of a heart attack or stroke that can lead to death. This risk is higher in people who already have heart disease. Do not take sorafenib if you have had recent heart problems without talking to your health care provider. This could increase your risk of having a heart attack. Get emergency help if you have any of the following symptoms of a heart attack or stroke.

  • Chest pain or pressure
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, jaw, throat, or arm
  • Sweating, upset stomach, vomiting, or dizziness
  • Sudden weakness on one side of your body
  • Sudden and severe headache
  • Slurred speech or trouble understanding speech

Severe Bleeding. Sorafenib can increase your risk of severe bleeding that can lead to death. Some people with serious bleeding may need a blood transfusion or surgery. Sorafenib can also increase your risk of stomach bleeding and tears (perforation) in your gut. Call your health care provider right away if you have any of the following signs of severe bleeding while taking sorafenib.

  • Pink, red, or brown urine (pee)
  • Vomit with blood that looks like coffee grounds
  • Red or black stools (which look like tar)
  • Coughing up blood or blood clots
  • Stomach pain that does not go away
  • Upset stomach
  • Feel faint

Increased Blood Pressure (Hypertension). Sorafenib may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your health care provider if your blood pressure increases while taking this medicine.

If you measure your blood pressure and the top number (systolic) is 180 or higher or the bottom number (diastolic) is 120 or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for and tell your health care provider right away if you have any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea or vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heartbeats

Severe Skin Reactions. Sorafenib can cause severe skin reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), that can lead to death if not treated. If you develop a rash, stop sorafenib and call your health care provider right away. Get emergency help if you have any of the following symptoms of SJS or TEN.

  • Painful red or purple skin that looks burned and peels off
  • Flat red rash or blisters on your skin, mouth, nose, and genitals
  • Red, painful, watery eyes
  • Flu-like symptoms, including fever, chills, and muscle aches

Wound Healing Issues. Sorafenib can make it difficult for your body to heal wounds. Tell your health care provider if you have any planned or emergency surgeries or if you have any injuries that occur while taking sorafenib.

Heart Rhythm Changes. Sorafenib may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or take medicines that can prolong the QT interval. Tell your health care provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.

Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking sorafenib. Call your health care provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Warnings & Precautions

Who should not use sorafenib?

Allergies to Ingredients. People who are allergic to any of the following should not take sorafenib.

  • Nexavar
  • Sorafenib
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in sorafenib.

Drug Interactions. Sorafenib should not be taken while you are using certain other medicines. Before taking sorafenib, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

What should I know about sorafenib before using it?

Do not take sorafenib unless it has been prescribed to you by a health care provider. Take it as prescribed.

Do not share sorafenib with other people, even if they have the same condition as you. It may harm them.

Keep sorafenib out of the reach of children.

Sorafenib should be taken on an empty stomach at least one hour before or two hours after eating. 

Sorafenib may make it difficult for you to get a partner pregnant. If you have concerns, talk to your health care provider.

Your health care provider will have you do regular blood tests before taking and while taking sorafenib. Make sure to attend all appointments so they can make sure that sorafenib is safe for you.

What should I tell my health care provider before using sorafenib?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if sorafenib is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Liver problems
  • High blood pressure
  • Heart problems, including chest pain, cardiomyopathy, heart failure, heart rhythm changes, and QT prolongation
  • Any family members who have heart problems like QT prolongation
  • Blood clot problems, including prior strokes
  • Bleeding problems
  • Stomach or digestive problems, including stomach ulcers
  • Thyroid problems
  • Prior or planned surgery
  • Wounds that are healing
  • Other cancers, including squamous cell lung cancer
  • Problems with magnesium, potassium, or calcium levels

Pregnancy. Sorafenib may cause harm to a fetus. Your health care provider will give you a test to make sure you are not pregnant before you start taking sorafenib. If you can get pregnant, you should use birth control while taking sorafenib and for six months after your last dose. If you are able to get a partner pregnant, you should use condoms while taking sorafenib and for three months after your last dose. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. It is not known if sorafenib passes into breast milk. You should not breastfeed while taking sorafenib and for two weeks after your last dose. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions

Does sorafenib interact with foods or drinks?

Sorafenib should be taken on an empty stomach at least one hour before or two hours after eating. 

Grapefruit interacts with sorafenib. It is important to avoid eating grapefruit or drinking grapefruit juice while taking sorafenib. This is because grapefruit can interfere with your body’s ability to break down sorafenib, which can lead to high levels of the medicine and an increased risk of side effects. 

It is unknown if drinking alcohol will affect sorafenib, but heavy drinking can slow your immune response and make it harder for your body to fight cancer.

Does sorafenib interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking sorafenib.

  • St. John’s wort, which is a supplement that may be used for depression
  • Any medicine that can cause QT prolongation, which is a potentially dangerous heart rhythm problem
  • Neomycin, which is a medicine used for certain infections
  • Warfarin, which is a blood thinner
  • Any other medicine used to treat cancer, especially chemotherapy such as carboplatin, paclitaxel, gemcitabine, or cisplatin
  • Ketoconazole, which is a medicine used for fungal infections
  • Rifampin (Rifadin), which is a medicine commonly used to treat an infection called tuberculosis

Many other medicines may alter the blood levels of sorafenib and vice versa. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with sorafenib. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much sorafenib?

If you or someone else has used too much sorafenib, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of sorafenib?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.