Sorafenib (Nexavar®) is used to treat some types of kidney, liver and thyroid. It is best to read this information with our general information about the type of cancer you have.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
Sorafenib comes as tablets, which 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.
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 is nearly time for your next dose, make a record of your missed dose and carry on as normal. Do not take a double dose.
- Keep your 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, tell your doctor. You may need to take another dose. Do not 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.
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.
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.
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.
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. Tell your doctor if your hands or feet are affected. 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.
This treatment may make your skin become red or feel dry. It can cause a rash, which may be itchy. Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help.
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.
This treatment can cause constipation. 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.
You may feel sick with this treatment. Your doctor will 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.
If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.
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.
You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth 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.
It is more common to have a sore mouth when you are having these drugs with chemotherapy. It will usually improve once you finish the chemotherapy.
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.
Your hair may get thinner during treatment. Rarely, this treatment can cause complete hair loss. Hair usually begins to grow back and thicken a few weeks after treatment ends.
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
- 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. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. 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.
Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Some people may need a drip to give them extra platelets. This is called a platelet transfusion.
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.
Sorafenib can affect the thyroid gland. Possible symptoms of thyroid changes include:
- feeling depressed
- difficulty concentrating
- weight gain
- 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:
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.
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.
Ringing in your ears (tinnitus)
Tell your doctor if you notice ringing in your ears (tinnitus), or if you have other hearing changes.
Difficulty getting an erection
You may have difficulty getting or keeping an erection while on this treatment.
Effects on the heart
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 straight away.
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.
Some medicines can affect your treatment or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.
Doctors do not know whether this drug may be present in breast milk, so women are advised not to breastfeed during treatment and for a few months afterwards.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that 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.