Sorafenib (Oral Route)

Sorafenib, also marketed under the name of NexAVAR, is an oral tablet form of medication prescribed by doctors to treat kidney cancer in its later stage as well as thyroid and liver cancers.

Overview

What is Sorafenib?

Sorafenib is an antineoplastic agent drug that impedes the division and growth of advanced renal cell carcinoma or kidney cancer. Sorafenib is also prescribed for other cancers such as hepatocellular carcinoma as well as metastatic, differentiated and progressive thyroid carcinoma. These cancers are also known as cancer of the liver and cancer of the thyroid.

How does Sorafenib work?

Treatment with an antineoplastic drug such as Sorafenib causes cancer cells to go into a state called autophagy. Autophagy is a natural method of destruction that cells use to get rid of components they deem dysfunctional or unnecessary. By blocking the signals that cancer cells send to each other in order to grow, Sorafenib fools them into a state of self-destruction.

In diseases like cancer, autophagy to promote the death of cancer cells can stop the growth of a tumor and, in some cases, even shrink the tumor. Sorafenib is considered a targeted drug and therefore is approved for prescription only to thyroid, kidney, and liver cancer patients.

Who is prescribed Sorafenib?

Kidney cancer that has become advanced and has spread to healthy cells outside of the kidney and who are not responding or cannot be treated with interleukin-2 or interferon alpha will likely be prescribed a treatment regimen of Sorafenib. Liver cancer patients who are not candidates for surgical removal of the cancer are also good candidates for response to treatment with Sorafenib. Thyroid cancer patients that do not respond to treatment with radioactive iodine may also find themselves prescribed Sorafenib therapy. Other cancers may also respond to Sorafenib, but as yet any other applications of this drug are trial only.

Conditions Treated

  • Kidney cancer
  • Liver cancer
  • Thyroid cancer

Type of medicine

  • Antineoplastic agent

Side Effects

Sorafenib, due to the direct effect it has on cancerous cells, may also affect other cells and cause effects that are not desired. Not all patients will experience the side effects listed, but if they do, immediate medical care is advised.

If you experience the side effects below, get in touch with your physician right away:

  • Headache
  • Increase of menstrual flow
  • Stools that are light in color
  • Vomiting
  • Feeling nauseous
  • Feeling nervous
  • Pain in the stomach or abdomen
  • Gums that bleed
  • Bloated stomach or abdomen
  • Urine or stools showing blood
  • Bleeding from the nose
  • Temporary paralysis
  • Vision blurred or fuzzy
  • Stools that appear clay-like in color
  • Pounding ears
  • Cuts that are slow to clot
  • Stools that are tarry, black or red
  • Urine that is dark brown or red
  • Productive cough with blood
  • Urine that is dark in color
  • Cough
  • Depression
  • Low urine production
  • Finding it hard to move
  • Hair or skin that is dry
  • Rapid heartbeat
  • Difficulty when swallowing or breathing
  • Feeling dizzy
  • Pupils of the eyes are enlarged
  • Constant cold feeling
  • Loss of hair
  • Vomiting up blood
  • Yellow tinged skin or eyes
  • Pain in bones
  • Pain or discomfort in the chest area
  • Loss of hearing
  • Hives
  • Husky, hoarse voice
  • Sensitive to light
  • Sweating increased due to fever
  • Thirsty
  • Sour stomach
  • Fever and chills
  • Skin that is clammy
  • Constipation
  • Itching
  • Pain in joints
  • No appetite
  • Pain in lower back or side
  • Stiff, cramped, painful muscles
  • Discomfort or pain in neck, jaw, arms or back
  • Pain when urinating
  • Stomach or side pains that radiate to the back
  • Confusion
  • Seizures
  • Pale, wan appearance
  • Tiny reddish spots on skin surface
  • Skin redness near ears
  • Buzzing or ringing in the ears
  • Chest pain that is severe
  • Headache that is severe
  • Throat soreness
  • White spots, ulcers or sores in the mouth or on the lips
  • Sore neck with stiffness
  • Swollen face, eyes, nose, hands or ankles
  • Swelling of the glands
  • Hives on sex organs, feet, legs, hands, throat, face, lips, tongue or eyelids
  • Lesions on skin with purple centers
  • Swelling of the joints
  • Labored breathing
  • Halitosis (bad breath)
  • Bruising or bleeding in unusual places
  • Fatigue or weakness not caused by exertion
  • Gaining weight
  • Loose, blistered, peeling skin
  • Diarrhea
  • Red eyes that are irritated

Other side effects caused by Sorafenib are annoying but do not constitute an emergency or require attention from medical professionals. These side effects typically lessen or disappear over time as your system makes adjustments to the drug regimen. Your physician will be able to assist you with information on how to ease or prevent side effects.

Contact your healthcare team if you experience the following effects and find them prolonged or severe:

  • Palms or soles that are swollen, red, peeling or blistered
  • Numbness, pain, burning or tingling in the arms, legs, hands or feet
  • Strange sensations in the palms or soles
  • Pins and needles sensations
  • Pain that is like being stabbed
  • Chest tightness
  • Thinning hair
  • Loss of weight
  • Sour, acid stomach
  • Belching
  • Acne
  • Loosening, peeling or blistering skin
  • Burning sensation in the stomach or chest
  • Hairy areas of the body that burn, itch or are painful
  • Lips are cracked
  • Skin is cracked
  • Poor appetite
  • No interest in sex
  • Feeling down
  • Mouth dryness
  • Unusual skin warmness
  • Skin appears more wrinkled than normal
  • Passing out
  • Feeling desolate, empty, sad
  • Red, flushed skin
  • Gas
  • Feeling of illness or discomfort
  • Erectile dysfunction
  • Heartburn
  • Rapid heartbeat
  • Irritable
  • No strength for any task
  • Feeling faint
  • Loss of sexual performance, drive, ability or desire
  • Unable to comprehend language or speech
  • Body heat loss
  • No pleasure or interest in anything
  • Pain in mouth
  • Hair roots exhibit pus
  • Fast, shallow breathing
  • Red skin that may be swollen especially in the upper chest, arms, face or neck
  • Nose runs constantly
  • Skin appears scaly
  • Shivering
  • Rash on skin that is scaly, crusted or oozing
  • Eyes appear sunken
  • Breast tenderness
  • Inflammation or swelling near the mouth
  • Stomach tenderness
  • Wandering mind
  • Thirst
  • Insomnia

You may also experience some health issues while on a treatment regimen with Sorafenib that are not listed, in which case, you should check with your physician for advice on side effects with this medication.

Dosage

Sorafenib should be taken exactly as your doctor has prescribed for you. Do not increase the dose, take it more frequently or take it for a longer period of time that you have been instructed on. Changing the treatment regimen prescribed by your doctor may have severe ill effects on your health and will in no way increase how effectively Sorafenib treats your cancer.

Patients vary and so do their cancer symptoms; fighting cancer with drugs like Sorafenib requires treatment that is tailored to each patient’s needs. The following dosage information may not be like what you have been prescribed as it is general information. You should always follow your doctor’s prescription.

Adult patients with thyroid, liver or kidney cancer will typically receive 400-milligram doses twice daily. Children’s prescriptions and dosage instruction will be individually determined by their physician for the most effective route of treatment.

It is advised that, if you miss a dose of Sorafenib, that you skip that dose and keep to the dosing schedule going forward. Taking two doses to make up a missed dose is not advised.

Tablets of Sorafenib have been formulated to be taken without breaking, chewing or crushing, and should be swallowed whole with a full glass of water on an empty stomach. Wait two hours after you have eaten to take this medication; take it at least one hour prior to eating.

Inside the packaging of Sorafenib, you will find full information on the drug that is current and useful. Read and understand the information provided and direct any questions to your doctor or pharmacist prior to taking Sorafenib.

Interactions

Sorafenib, like other cancer drugs, are extremely powerful and can have effects on the body that are unexpected and sometimes dangerous. Discuss all effects of Sorafenib with your health care advisors prior to treatment and let them know of any other medications you are currently taking. Include all information on non-prescription as well as prescription medication and even holistic, herbal and vitamin supplements.

There are certain medications that should never be prescribed together for any reason and others that work harmoniously to fight the diseases from different angles. Your physician will want to know about all medications you are taking prior to prescribing treatment with Sorafenib in case adjustment needs to be made to doses of other medications.

If you are taking any of the medications below, let your doctor know immediately as it is not recommended that you combine the two:

  • Amifampridine
  • Bepridil
  • Amisulpride
  • Dronedarone
  • Cisapride
  • Ketoconazole
  • Fluconazole
  • Ziprasidone
  • Terfenadine
  • Levomethadyl
  • Thioridazine
  • Mesoridazine
  • Pimozide
  • Nelfinavir
  • Piperaquine
  • Saquinavir
  • Posaconazole
  • Sparfloxacin

The following medicines may pose a health or side-effect risk when taken with Sorafenib, but it may be mandatory for you to stay on your drug therapy.

Let your physician know if you are taking any of the following so that dose adjustment can be made:

  • Alfuzosin
  • Amoxapine
  • Amiodarone
  • Apomorphine
  • Amitriptyline
  • Arsenic Trioxide
  • Anagrelide
  • Astemizole
  • Aripiprazole
  • Bupropion
  • Asenapine
  • Ceritinib
  • Azithromycin
  • Chlorpromazine
  • Buserelin
  • Citalopram
  • Chloroquine
  • Clomipramine
  • Ciprofloxacin
  • Crizotinib
  • Clarithromycin
  • Dasabuvir
  • Clozapine
  • Degarelix
  • Dabrafenib
  • Desipramine
  • Dasatinib
  • Disopyramide
  • Delamanid
  • Dolasetron
  • Deslorelin
  • Donepezil
  • Dofetilide
  • Efavirenz
  • Domperidone
  • Erythromycin
  • Droperidol
  • Fingolimod
  • Enzalutamide
  • Gemifloxacin
  • Fluoxetine
  • Escitalopram
  • Gatifloxacin
  • Fosphenytoin
  • Gonadorelin
  • Flecainide
  • Granisetron
  • Goserelin
  • Haloperidol
  • Halofantrine
  • Hydroxychloroquine
  • Histrelin
  • Ibutilide
  • Hydroxyzine
  • Ifosfamide
  • Idelalisib
  • Imipramine
  • Iloperidone
  • Lapatinib
  • Ivabradine
  • Levofloxacin
  • Leuprolide
  • Lumefantrine
  • Lopinavir
  • Methadone
  • Mefloquine
  • Mifepristone
  • Neomycin
  • Nafarelin
  • Metronidazole
  • Moxifloxacin
  • Norfloxacin
  • Nilotinib
  • Octreotide
  • Nortriptyline
  • Ondansetron
  • Ofloxacin
  • Panobinostat
  • Pazopanib
  • Pasireotide
  • Paliperidone
  • Pimavanserin
  • Perflutren
  • Prednisolone
  • Procainamide
  • Phenytoin
  • Promethazine
  • Pitolisant
  • Prochlorperazine
  • Quetiapine
  • Propafenone
  • Quinine
  • Protriptyline
  • Ranolazine
  • Quinidine
  • Rifampin
  • Salmeterol
  • Rifapentine
  • Rifabutin
  • Sevoflurane
  • Sodium Phosphate, various types
  • Sotalol
  • Sunitinib
  • Sulpiride
  • Solifenacin
  • St. John's Wort
  • Telavancin
  • Tacrolimus
  • Tetrabenazine
  • Telithromycin
  • Trazodone
  • Toremifene
  • Trimipramine
  • Vandetanib
  • Triptorelin
  • Trifluoperazine
  • Vemurafenib
  • Vardenafil
  • Vinflunine
  • Zuclopenthixol
  • Voriconazole

Some side effects could become severe if you are taking Sorafenib with any of the following drugs:

  • Docetaxel
  • Warfarin
  • Doxorubicin
  • Thiotepa
  • Doxorubicin Hydrochloride Liposome

This may, however, be a necessary phase of your treatment. Your physician will determine the best dose and frequency of both medications.

Sorafenib has been known to cause nausea with vomiting if taken around the same time as a meal. For this reason, tablets of Sorafenib should be taken without breaking, chewing or crushing; rather they should be swallowed whole with a full glass of water on an empty stomach. Wait two hours after you have eaten to take this medication; take it at least one hour prior to eating.

The following health issues could have an effect on the way Sorafenib fights the cancer in your body and they may even worsen on this medication.

Inform your health care provider of any diagnoses you have, especially:

  • Heart problems such as angina, congestive heart failure
  • Hepatitis
  • Hypertension or blood pressure that is too high or low
  • Bleeding issues
  • Perforation in the bowel or stomach
  • Imbalance in calcium, potassium or magnesium levels in the blood; known as electrolytes
  • Problems with heart rhythm such as slow pulse or long QT syndrome

Warnings

Patients who are under a drug treatment regime with Sorafenib will be required to visit their doctor’s office on a regular basis to monitor the progress the medication is having on their cancer as well as monitor them for health risks and unwanted side effects because of the drug.

For the first six week period after the start of your treatment with Sorafenib, your physician will be especially careful to monitor your blood pressure on a weekly basis, either during office visits or instructing you to do so at home. Sorafenib has been known to cause hypertension in certain patients, so symptoms such as rapid or slow heartbeat, pounding in your ears, nervousness, dizziness, blurry vision or headache should be reported immediately so you can be treated for blood pressure issues.

This medication has caused heart attacks and other serious heart issues in some patients. Chest pains or any nausea, discomfort in the jaw, back, arms or neck as well as shortness of breath, vomiting or sweating should be cause for you to alert your healthcare provider right away that you may be experiencing serious side effects.

Changes in the rhythm of the heart known as Long QT Syndrome have been reported in patients on a course of treatment with Sorafenib. Your heart may beat differently and cause serious side effects or cause you to pass out while performing normal tasks. Report side effects such as pounding, irregular, fast heartbeats to your physician as soon as possible.

Sorafenib has been known to cause serious reactions to the skin; therefore symptoms such as pain, swelling or blisters on the soles of the feet or palms of hands, redness, peeling, loosening skin, red lesions, acne or rashes, ulcers or sores should be reported right away, as should any chills or fever type symptoms.

Bowel problems have been experienced by patients taking a course of treatment with Sorafenib. Report symptoms such as cramps, stomach pain, tar-colored black stools, and stools with blood, severe burning, labored breathing, indigestion, nausea, heartburn or vomiting substances that resemble ground coffee to your health care provider as soon as possible to prevent long-term health complications.

Some patients have developed hepatitis, a serious liver disease, while on Sorafenib. Symptoms of hepatitis include pale colored stools, urine that is darker than normal, no appetite, upper stomach pain, nausea, vomiting and a yellowish tinge to the whites of the eyes or skin. Contact your health care provider and notify them immediately if you experience these symptoms.

Women who are pregnant and women who may become pregnant, as well as men who may get their partner pregnant, should practice effective birth control during treatment with Sorafenib and for two weeks after the last dose. Sorafenib has been known to have adverse side effects in fetal development and can be passed on from the mother or the father if it is in their bloodstream. If you think your partner or you yourself have become pregnant while using Sorafenib, notify your physician right away.

Sorafenib dosage should be stopped several days prior to any surgery you must have; for this reason, informing any doctor who is treating you that you are on Sorafenib is absolutely necessary. Some medical test results have been skewed because of this drug, which is another reason to inform any healthcare professional you consult that you are taking it.

Taking other prescribed medicines, non-prescription, vitamin, herbal or holistic therapies while on Sorafenib should be done with extreme caution and detailed discussion with your healthcare provider. Any pre-existing health conditions, whether formally diagnosed or not, should also be disclosed to your health treatment professionals prior to taking this drug.

Storage

Maintain the original packaging for your prescription of Sorafenib, which is perfect for storing it. Keep it from freezing or direct exposure to sources of heat, light, and moisture. Store Sorafenib out of sight and reach of children and pets at all times. Unused or expired doses of Sorafenib should be disposed of following the instructions for safe disposal available from your doctor or pharmacist.

Summary

Sorafenib is an oral tablet medication prescribed by doctors for treatment of thyroid cancer, liver cancer, and kidney cancer. Sometimes these cancers are in their late stages before treatment of Sorafenib begins as this is a very aggressive, targeted, powerful drug.

Sorafenib employs a method of cell destruction called autophagy, which is a natural process that cells use to get rid of components they deem dysfunctional or unnecessary. The drug creates a block to stop the signals that cancer cells send to each other in order to grow, fooling them into a state of self-destruction. Sorafenib is a targeted drug and is approved for prescription only for thyroid, kidney, and liver cancer patients.

Typically prescribed in doses of 400 milligrams to be taken on a twice-daily basis, Sorafenib is not to be taken with food or near meal times; it is preferred to take this medication on an empty stomach to avoid any vomiting or nausea. The list of side effects that are caused by Sorafenib is long, but not all patients will experience all side effects. Report any severe or prolonged side effects to your physician at once.

This medication has been known to cause serious side effects in the fetus of women who are pregnant and having treatment with Sorafenib. Women who are pregnant or who may become pregnant, as well as men with partners who may become pregnant during a regime of this medication, should use effective birth control during this time.

Sorafenib has been known to cause serious side effects to the heart and the heart rhythms as well as blood pressure. For this reason, regular monitoring by your doctor will be performed during office visits to observe any signs of these problems. Sorafenib has also been known to cause dangerous skin conditions and bowel issues as well as hepatitis. Symptoms associated with these conditions should be immediately reported to your healthcare provider.

Store this and other drugs out of sight and reach of children and pets, in the original packaging and at room temperature without exposure to cold, heat, light or moisture. Dispose of any unused or expired Sorafenib in a safe manner, following the instructions of your healthcare provider.