Sorafenib

Sorafenib (Nexavar®) is a targeted therapy drug. It is used to treat some types of kidney, liver and thyroid cancers.

What is sorafenib?

Sorafenib (Nexavar®) is used to treat some types of the following cancers: 

It may sometimes be used to treat other cancers. It is best to read this information with our general information about the type of cancer you have.

Sorafenib belongs to a group of targeted therapy drugs known as angiogenesis inhibitors and cancer growth inhibitors.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

How is sorafenib given?

You will be given sorafenib to take at home. Sorafenib can be given on its own or with chemotherapy. 

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information. You will have regular blood samples taken to check different things. For example, the level of your blood cells and how well your liver and kidneys are working.

Taking sorafenib tablets

Sorafenib comes as tablets you can take at home. You take sorafenib twice a day. Take the tablets with a glass of water at the same times each day. The tablets should be taken 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 has explained. This is important to make sure they work as well as possible for you.

If you forget to take the tablets you should take the missed dose as soon as possible within the same day. If a full day has gone by, let your doctor or nurse know. Do not take a double dose.

Other things to remember about your capsules:

  • Keep them in the original package and at room temperature, away from heat and direct sunlight.
  • Keep them safe and out of sight and reach of children.
  • If you are going on holiday, make sure you have plenty of tablets to take with you.
  • If you are sick just after taking the tablets, contact the hospital. Do not take another dose. 
  • If your treatment is stopped, return any unused tablets to the pharmacist.

Your course of treatment

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

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Common side effects

Tiredness

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Sore and red palms of hands and soles of feet

You may get sore and red palms of hands and soles of feet. The skin may also begin to peel. This is called palmar-plantar or hand-foot syndrome. It usually gets better after treatment ends.

Tell your doctor or nurse about any changes to your hands or feet. They can give you advice and prescribe creams to improve any symptoms you have. It can help to:

  • keep your hands and feet cool
  • moisturise your hands and feet regularly
  • avoid tight-fitting socks, shoes and gloves.

Skin changes

You may develop a rash, redness, dryness or itching. These side effects are usually mild. Always tell your doctor or nurse straight away if you notice any skin changes. They can advise you about creams or lotions to use, or prescribe medicines to relieve itching.

If you are out in the sun, use a sun cream with a high sun protection factor (at least SPF 30) to protect your skin.

Rarely, a much more serious skin condition can develop. You may have a skin rash which then blisters, and your skin can peel. You may also feel unwell with flu-like symptoms such as a high temperature and joint pain. If you have any of these symptoms, contact your doctor or hospital immediately.

Diarrhoea

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

  • try to drink at least 2 litres (3½ pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
  • contact the hospital for advice.

Constipation

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

  • Drink at least 2 litres (3½ pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Feeling sick

If you feel sick tell your doctor. They can give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

Changes to your taste

You may get a bitter or metallic taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste bad or have no taste. Try different foods to find out what tastes best to you. Your nurse can give you more advice.

Sore mouth and throat

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth or throat is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth and throat.

Sucking ice chips may sometimes help relieve mouth or throat pain. But if you are having radiotherapy to the head or neck, do not suck on ice. It can cause damage.

Indigestion

Some people have indigestion or acid reflux when taking sorafenib. Acid reflux is when acid comes up from the stomach into the gullet. Tell your doctor if you are affected. They can prescribe treatment to help.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Joint and muscle pain

You may have pain and stiffness in your joints, and sometimes in your muscles. Tell your doctor or nurse if this happens. They can prescribe painkillers and give you advice.

Pain

Some people may get tummy pain, mouth pain, have headaches or pain in the area of the cancer. Tell your doctor if you have pain.

Hair loss

Your hair may get thinner. But you are unlikely to lose all the hair from your head. Your nurse can give you advice about coping with hair loss.

High blood pressure

This treatment may cause high blood pressure (hypertension). You will have your blood pressure checked regularly. Some people may need to take tablets to control their blood pressure. Sometimes, if your blood pressure is too high and cannot be controlled, this treatment may be stopped permanently.

If you are already on treatment for blood pressure, you will have regular blood pressure checks to make sure it stays under control. Talk to your doctor if you have any concerns.

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:

  • pale skin
  • lack of energy
  • feeling breathless
  • feeling dizzy and light-headed.

Tell your doctor or nurse if you have these symptoms.

If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

  • nosebleeds
  • bleeding gums
  • heavy periods
  • blood in your urine (pee) or stools (poo)
  • tiny red or purple spots on the skin that may look like a rash.

Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.

Hoarse voice

You may notice your voice sounds hoarse or you may feel like you have a lump in your throat. Tell your doctor if you experience this. It will usually go back to normal when treatment stops.

Runny nose

You may have a runny nose. Tell your doctor if this happens.

Thyroid changes

Sorafenib can affect the thyroid gland. Possible symptoms of thyroid changes include:

  • tiredness
  • feeling depressed
  • difficulty concentrating
  • weight gain
  • constipation
  • feeling cold
  • dry skin and hair.

During treatment, you will have regular blood tests to check how well your thyroid is working. But if you notice any symptoms, let your doctor know.

Reduced mineral levels in the blood

You may have reduced levels of some minerals in your blood, including:

  • calcium
  • sodium
  • phosphorus
  • potassium.

You will have regular blood tests to check the levels of these minerals in your blood. Your doctor may give you supplements to take if the levels are too low.

Flu-like symptoms

Sorafenib may cause flu-like symptoms such as:

  • feeling hot or cold
  • feeling shivery
  • having a headache
  • aching body.

These symptoms can have other causes, such as an infection which may need treatment. If you feel unwell, contact your doctor for advice.

Low blood sugar levels

Sorafenib may lower blood sugar levels. If you have diabetes you may need to check your blood sugar levels more often. Your doctor will talk to you about how to manage this and you may be referred to a dietitian for some advice.

Ringing in your ears (tinnitus)

Tell your doctor if you notice ringing in your ears (tinnitus), or if you have other hearing changes.

Erectile dysfunction

Some men have difficulty getting or maintaining an erection while on this treatment. Contact your doctor for advice.

Effects on the kidneys

This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment finishes. You will have blood tests to check how well your kidneys are working. Tell your doctor or nurse if you have blood in your urine (pee) or you are passing urine less than usual.

It is important to drink at least 2 litres (3½ pints) of non-alcoholic fluid each day to help protect your kidneys.

Effects on the heart

This treatment can affect the way your heart works. Your doctor may do tests to see how well your heart is working. You may have these tests before, during, and sometimes after treatment.

Contact a doctor straight away if you:

  • have pain or tightness in your chest
  • feel breathless or dizzy
  • feel your heart is beating too fast or too slowly.

Other conditions can cause these symptoms. But it is important to get them checked by a doctor.

Slow wound-healing

Wounds may take longer to heal while you are having treatment. 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.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Less common side effects

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop:

  • a cough
  • wheezing
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Effects on the nervous system

This treatment can affect the nervous system. Very rarely, it can cause a condition called PRES (posterior reversible encephalopathy syndrome). Symptoms include:

  • headaches
  • confusion
  • changes in your eyesight
  • seizures (fits).

Contact the hospital straight away if you have any of these symptoms. It is important not to drive or operate machinery if you notice these effects.

Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • throbbing pain, redness or swelling in a leg or arm
  • suddenly feeling breathless or coughing
  • sharp chest pain, which may be worse when you cough or take a deep breath.

If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.

A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.

You can help reduce the risk of developing a blood clot by:
  • staying active during treatment
  • drinking plenty of fluids, especially water.

You may be given anticoagulants to help prevent a clot.

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Vaccinations

Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.

Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.

If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Breastfeeding

You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.

Your doctor or nurse can give you more information.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.