Sorafenib

What is Sorafenib?

Sorafenib is a prescription cancer medicine. It belongs to a drug class called multikinase inhibitors, a type of targeted therapy. It was first sold under the brand name Nexavar, and generic versions are also available.

Approved uses: In the United States, sorafenib is approved for adults with:

• Unresectable hepatocellular carcinoma (HCC): a type of liver cancer that cannot be removed by surgery
• Advanced renal cell carcinoma (RCC): a type of kidney cancer
• Differentiated thyroid carcinoma (DTC): locally recurrent or metastatic, progressing cancer that no longer responds to radioactive iodine treatment

Formulation and strength: Sorafenib is taken by mouth as a 200 mg film-coated tablet. Other uses should be discussed only with your oncologist.

What is the Recommended Dosage of Sorafenib?

Your dose is set by your oncologist and should always follow their instructions and your pharmacy label. Sorafenib is a tablet taken by mouth, usually twice a day, on an empty stomach (generally at least 1 hour before or 2 hours after a meal). Your care team will tell you exactly how many tablets to take and when.

Your care team may adjust the dose or schedule based on:

• Your condition and tolerance: Treatment may be paused, lowered, or stopped if side effects such as skin reactions or high blood pressure occur.
• Liver function: Blood tests help guide decisions. People with severe liver impairment have not been well studied.
• Kidney function: Little change is usually needed for mild to moderate kidney problems. People on dialysis have not been well studied.
• Other medicines: Some drugs change how much sorafenib is in your body.
• Overall health: Age and other conditions can matter.

Do not change, skip, or stop doses on your own. If you have trouble swallowing tablets, ask your care team or pharmacist for options instead of crushing or splitting the tablets yourself.

How Sorafenib Works

Cancer cells depend on proteins called kinases to send signals that tell them to grow and divide. Tumors also build new blood vessels to get nutrients. Sorafenib blocks several of these kinases, including some involved in tumor cell growth and in the formation of tumor blood vessels.

By interfering with both of these processes, sorafenib can slow the growth or spread of certain cancers. It is used to control the disease and is not considered a cure. Regular scans and follow-up visits help your care team see how well treatment is working.

Is a Prescription Required to Buy Sorafenib Online?

Yes. Sorafenib is prescription-only. It should be prescribed and monitored by a licensed medical oncologist (a cancer specialist). Depending on the cancer type, your team may also include a hepatologist or gastroenterologist (liver cancer), a urologic oncologist (kidney cancer), or an endocrinologist (thyroid cancer).

• Buy only from a licensed pharmacy that requires a valid prescription.
• Counterfeit or substandard cancer medicines exist. Be cautious of websites that sell without a prescription or ship from unclear sources.
• Check that the tablets match what your pharmacist describes, and ask your pharmacist if packaging or appearance looks different.

Side Effects of Sorafenib

Not everyone gets every side effect. Many can be managed with help from your care team.

Common Side Effects

• Hand-foot skin reaction (redness, pain, swelling, blisters, or thickened skin on palms and soles)
• Skin rash, dry or itchy skin
• Diarrhea
• High blood pressure
• Tiredness or weakness
• Hair thinning or hair loss
• Nausea, decreased appetite, or weight loss
• Stomach pain
• Voice changes or hoarseness
• Abnormal blood tests, such as low phosphate or raised pancreatic enzymes, found through lab monitoring

Serious Side Effects

These are less common but need prompt attention:

• Heart problems: chest pain, pressure, or shortness of breath (reduced blood flow to the heart, heart attack)
• Bleeding: unusual or severe bleeding, black or bloody stools, vomiting blood, or coughing up blood
• Very high blood pressure: severe headache, confusion, vision changes
• Liver problems: yellowing of the skin or eyes, dark urine, severe stomach pain, or unusual tiredness
• Severe stomach or bowel problems: severe belly pain or a tear in the stomach or intestine
• Severe skin reactions: widespread blistering, peeling skin, or mouth sores
• Slow wound healing
• Heart rhythm changes (QT prolongation): fainting, dizziness, or a racing or irregular heartbeat
• Pancreatitis: severe upper belly pain, sometimes with nausea or vomiting

Seek immediate medical care if you have chest pain, trouble breathing, severe bleeding, severe belly pain, signs of liver injury, severe blistering skin reactions, or sudden vision changes. Contact your oncology team promptly for a worsening skin reaction, persistent diarrhea, or high blood pressure readings.

Drug Interactions

Tell your oncologist and pharmacist about everything you take, including prescription drugs, over-the-counter (OTC) products, vitamins, supplements, and herbal products. Major categories include:

• Strong CYP3A4 inducers (such as rifampin, phenytoin, carbamazepine) can lower sorafenib levels and may make it less effective.
• Warfarin and other blood thinners: Bleeding or INR changes have been reported, so closer monitoring may be needed.
• Certain chemotherapy medicines (such as docetaxel, doxorubicin, and irinotecan) can have higher levels when taken with sorafenib. Your oncologist will decide if and how they are combined.
• Medicines that affect heart rhythm (QT prolongation): Combining them may raise the risk of rhythm problems.
• Certain antibiotics such as neomycin may lower sorafenib levels.
• Herbal products, especially St. John’s wort, can lower sorafenib levels. Ask your pharmacist before using any herbal or dietary supplement.

Bring a complete, updated medication list to every appointment.

Safety & Important Considerations

• Liver disease: Liver function is checked during treatment. Liver injury can occur, and dose changes or stopping the drug may be needed.
• Kidney disease: Little change is expected for mild to moderate kidney impairment. Discuss severe kidney disease or dialysis with your specialist.
• Heart disease: Sorafenib can affect the heart and blood pressure. Tell your team about any heart conditions.
• Blood pressure: Blood pressure is monitored weekly during the first 6 weeks and regularly afterward. Home readings may be requested.
• Thyroid cancer: Thyroid hormone levels and calcium levels may need monitoring.
• Surgery and procedures: Treatment is often paused before and after major surgery because of bleeding and wound-healing risks. Tell any surgeon or dentist you take sorafenib.
• Pregnancy: Sorafenib can harm an unborn baby. Effective contraception is advised during treatment and for at least 2 weeks after the last dose for women, and about 3 months for men, according to U.S. labeling. Tell your oncologist right away if you are or may become pregnant.
• Breastfeeding: Breastfeeding is not recommended during treatment and for at least 2 weeks after the last dose.
• Older adults and children: No special dose change is routinely needed for older adults, but they are monitored closely. Safety and effectiveness in children have not been established.
• Monitoring: Expect regular visits, imaging scans, blood pressure checks, and blood tests.
• Skin care: Gentle skin and foot care, comfortable footwear, and sun protection may help with skin reactions. Follow your care team’s specific advice.

Who This Medication Is For

Sorafenib is intended for adults with unresectable HCC, advanced RCC, or radioactive iodine-refractory differentiated thyroid carcinoma, as decided by their oncology team. Treatment plans differ from person to person.

Who Should Not Take Sorafenib

Sorafenib should not be used by people with a known severe allergic reaction to sorafenib or any ingredient in the tablet.

Discuss with your oncologist before starting if you:

• Have liver disease or kidney disease
• Have heart disease, high blood pressure, or a history of heart attack
• Have a bleeding problem or take blood thinners
• Have a history of stomach or bowel problems
• Have an irregular heartbeat or take medicines that affect heart rhythm
• Have a planned surgery or dental procedure
• Are pregnant, planning pregnancy, or breastfeeding
• Take medicines that interact with sorafenib

Sorafenib is not approved for use together with certain chemotherapy regimens in lung cancer, and such use should only be discussed with your oncologist.

What to Do If You Miss a Dose

• Take the missed dose as soon as you remember, unless it is close to the time of your next dose. In that case, skip the missed dose and continue with your regular schedule.
• Never take two doses at once to make up for a missed one.
• If you are unsure what to do, or you miss several doses, contact your oncology team or pharmacist.

Related medications to Sorafenib

Other medicines are used for the same cancers, depending on the cancer type and stage:

• Liver cancer (HCC): lenvatinib, regorafenib, cabozantinib, and immunotherapy-based combinations such as atezolizumab with bevacizumab or durvalumab with tremelimumab
• Kidney cancer (RCC): sunitinib, pazopanib, axitinib, cabozantinib, lenvatinib with everolimus, and immunotherapy-based combinations
• Thyroid cancer (DTC): lenvatinib, cabozantinib, and other targeted therapies when specific gene changes are found

These medicines differ in side effects, interactions, and approved uses. Switching or combining treatments must be decided together with your oncologist.

Storage Instructions

• Store at room temperature, about 68°F to 77°F (20°C to 25°C), with brief trips between 59°F and 86°F (15°C to 30°C) allowed.
• Keep tablets in the original container with the lid tightly closed, away from moisture (not in the bathroom) and light.
• Keep out of reach of children and pets.
• Do not use tablets past the expiration date. Ask your pharmacist about safe disposal of unused medicine.
• Caregivers handling the tablets should wash their hands afterward, and pregnant caregivers should ask the care team about handling precautions.

Disclaimer:

This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Patients must consult a licensed medical oncologist before starting, changing, or stopping treatment. Treatment decisions must be based on a full clinical evaluation by a qualified specialist.