Sorafenib (Nexavar ®)
Sorafenib (Nexavar ®) is a targeted therapy used to treat some types of kidney, liver and thyroid cancers. It may be used as a research trial for other cancers too.
Sorafenib works by blocking (inhibiting) signals within the cancer cells that make them grow. Blocking the signals causes the cells to die.
Sorafenib can also stop cancer cells developing new blood vessels. This reduces their supply of oxygen and nutrients, so the tumour shrinks or stops growing.
When sorafenib is used
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Sorafenib is licensed to treat people with:
kidney cancer that has spread outside the kidney (advanced or metastatic renal cell cancer) and who are no longer being helped by treatment with interferon alpha (IFN) or interleukin-2 (IL-2), or for whom these drugs are not suitable
liver cancer (hepatocellular carcinoma) that can’t be removed with surgery
differentiated thyroid cancer (DTC) that is no longer being controlled by radioactive iodine treatment.
Sorafenib may only be available in some situations. Your cancer doctor can tell you if it's appropriate for you. Some people may be given it as part of a clinical trial. If a drug isn’t routinely available on the NHS, there may be other ways you can get access to it. Your cancer doctor can give you advice.
Taking sorafenib tablets
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You take sorafenib twice a day. Take the tablets with a glass of water at the same times each day. You can take the tablets without food or with a low fat meal. If you are going to have a high fat meal, take sorafenib at least one hour before or two hours after the meal.
Always take your tablets exactly as your nurse or pharmacist explained. This is important to make sure they work as well as possible for you.
There are some important things to remember when taking your tablets:
If you forget to take your tablets, take them as soon as you remember. If it’s nearly time for your next dose, forget about the missed one and carry on as normal. Don’t take a double dose.
Keep tablets in the original package and at room temperature, away from heat and direct sunlight.
Keep them safe and out of the reach of children.
Get a new prescription before you run out of tablets and make sure you have plenty for holidays.
Return any unused tablets to the pharmacist if your treatment is stopped.
If you are sick just after taking the tablets, let your doctor know. You may need to take another dose. Don't take another dose without telling your doctor, nurse or pharmacist first.
You usually take sorafenib for as long as it keeps the cancer under control. Some people may need to stop taking sorafenib because of side effects.
Possible side effects of sorafenib
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We have included the most common side effects of sorafenib here. We haven’t included all the less common and rarer side effects. You may get some of the side effects we mention, but you will not get them all.
The side effects of sorafenib are generally mild and may get less during treatment as your body adjusts to the treatment. Sometimes, if a side effect is more severe, your doctors may need to reduce the dose or stop the treatment for a short time. Some people may need to stop taking the treatment completely.
Your doctor can prescribe drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist has explained.
If you have chemotherapy with sorafenib some side effects may be worse. You may also have side effects not listed here.
Serious and life threatening side effects
Sometimes cancer drugs can result in very severe reactions, which rarely may be life threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Your nurse will give you advice about managing side effects. After your treatment is over, side effects will start to improve. Always tell your doctor or nurse about the side effects you have.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
More information about this drug
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic medicines compendium (eMC).
Common side effects of sorafenib
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These side effects may affect more than 1 in 10 people (more than 10%).
This is very common. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks. If tiredness is making you feel drowsy or affects your concentration, don’t operate machinery or drive.
Changes to hands and feet
You may develop redness on the palms of your hands and soles of your feet. Sometimes the hands and feet become sore or swollen. There may also be changes in sensation, such as numbness or tingling. If your hands or feet are affected tell your doctor. They may give you lotions or moisturisers or painkillers. Keep your hands and feet cool and avoid hot water and tight shoes. Wear gloves to protect your hands when doing housework or gardening.
You may develop a rash, redness, dryness or itching. These side effects are usually mild. Tell your doctor or nurse if your skin is affected. They can advise you about creams or lotions to use, or prescribe medicines to relieve itching.
Changes in your bowel habits
The most common change in bowel habit is frequent loose bowel movements (diarrhoea) but some people become constipated. Diarrhoea can usually be controlled with medicine. If you have constipation increasing your intake of fibre and fruit may help. It's important to drink plenty of clear fluids, 8–10 glasses a day, if you have diarrhoea or constipation. Sometimes sorafenib can cause tummy (abdominal) pain. Tell your doctor if you have any pain or changes in your bowel habits.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe anti-sickness drugs to prevent, or greatly reduce, nausea and vomiting.
If the sickness isn't controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.
Loss of appetite
Some people lose their appetite. This may only last a few days. If it doesn’t improve or you are losing weight you can ask to see a dietitian or nurse at your hospital. They can give you advice on what to eat.
Joint and/or muscle pain
If you have joint or muscle pain during treatment tell your doctor. They can prescribe painkillers.
You may notice your hair becomes thinner. It's very unlikely all of your hair will fall out. Hair loss is temporary and the hair grows back once treatment finishes.
This drug may increase bleeding. You may have nosebleeds and bruise more easily.
Bleeding is usually mild but sometimes can be very serious. If you cough up blood, see blood in your urine, have black stools (poo), have a sudden severe headache, feel confused or have any other unusual bleeding contact your doctor straight away.
High blood pressure
Sorafenib may cause high blood pressure. You will have your blood pressure checked regularly. Some people may need to take tablets to control their blood pressure. Occasionally, if blood pressure is too high and cannot be controlled, sorafenib may be stopped permanently.
If you are already on treatment for your blood pressure you will have regular blood pressure checks to make sure it remains under control. Talk to your doctor if you have any concerns.
Effect on blood cells
The numbers of white blood cells, red blood cells or platelets in your blood may be reduced. This is generally mild and doesn’t usually need any treatment. You will have regular blood tests done to check the numbers of blood cells.
You are more likely to get infections while taking sorafenib. If you notice signs of infection such as smelly urine, pain passing urine, a cough or feeling hot and cold or shivery contact your doctor for advice.
Other possible side effects of sorafenib
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Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Doing this and drinking plenty of fluids can relieve dryness and help prevent infection. Tell your nurse or doctor if you have mouth problems. They can prescribe mouthwashes and medicine to prevent or clear mouth infections and to relieve pain.
Your voice may become hoarse or husky. This will usually go back to normal when treatment stops.
If your sense of taste is affected you may need to experiment with different types of food to find what tastes best to you. Your nurse can give you advice on coping with taste changes.
Some people have indigestion or acid reflux (acid comes up from the stomach into the gullet) when taking sorafenib. Tell your doctor if you are affected they can prescribe treatment to help.
Reduced levels of calcium, sodium or potassium in the blood
You will have regular blood tests to check the levels of these salts in your blood. Your doctor may give you supplements to take if the levels are too low.
Sorafenib may cause flu-like symptoms such as; feeling hot or cold and/or shivery, having a headache and aching. These symptoms can have other causes, such as an infection which may need treatment. If you feel unwell contact your doctor for advice.
Ringing in your ears (tinnitus)
Tell your doctor if you notice ringing in your ears (tinnitus), or if you have other hearing changes.
Some men have difficulty getting or maintaining an erection while on this treatment.
In some people sorafenib may cause problems with the blood supply to the heart. If you have chest pain, breathlessness or other symptoms, it may mean your heart is affected. Contact your doctor immediately.
Wounds may take longer to heal while you're having treatment with sorafenib. If you have any surgery planned, you may need to stop taking sorafenib before the operation and not start taking it again for a few weeks afterwards. Your doctor will give you more advice
Effects on the lungs
Rarely sorafenib can affect the lungs. If you feel breathless, or more breathless than usual, contact your doctor for advice.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
Other information about sorafenib
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Some medicines, including those that you can buy from a shop or pharmacy, can be harmful to take when you’re taking sorafenib. Tell your doctor about any medicines you take, including over-the-counter drugs, complementary therapies and herbal drugs. If you need to buy medicines over the counter tell your pharmacist you are taking sorafenib.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant while having sorafenib, as it may harm the developing baby. It’s important women who could become pregnant use effective contraception during treatment. You can discuss this with your doctor.
There is a potential risk that sorafenib may be present in breast milk, so women are advised not to breastfeed during treatment.
Medical or dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are taking sorafenib. Tell them the name of your cancer doctor so they can ask for advice.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a healthcare professional.
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