Sorafenib

• Liver cancer ( hepatocellular carcinoma, HCC)
• Advanced kidney cancer (advanced renal cell carcinoma, RCC)
• Thyroid cancer

When should one not use Sorafenib

• If you are allergic to sorafenib or any other ingredient in this medicine, a serious allergic reaction may occur
• If you have squamous cell lung cancer and are receiving or planning to receive carboplatin and paclitaxel chemotherapy, as this combination has been linked with a significant increase in the risk of death

Common side effects of this drug are:

• Sorafenib can cause a range of side effects. The most common ones are listed below.
• Very common side effects (seen in more than 1 in 5 patients):
• Diarrhoea
• Fatigue and weakness
• Infections
• Hair thinning or patchy hair loss (alopecia)
• Hand-foot skin reaction (palmar-plantar erythrodysesthesia, PPE), causing redness, pain, swelling, and blistering on the palms and soles of the feet
• Skin rash and skin peeling
• Weight loss
• Reduced appetite
• Nausea
• Stomach and abdominal pain
• High blood pressure (hypertension)
• Bleeding (haemorrhage)
• Other commonly reported side effects:
• Vomiting and constipation
• Mouth sores (stomatitis), dry mouth, and voice changes (dysphonia)
• Joint pain (arthralgia) and muscle pain (myalgia)
• Headache and changes in taste (dysgeusia)
• Shortness of breath
• Nosebleeds (epistaxis)
• Dry skin and itching (pruritus)
• Raised liver enzyme readings in blood tests
• Low phosphate, potassium, and calcium levels in the blood
• Depression
• Nerve pain (sensory neuropathy)
• Kidney problems, including protein in the urine (proteinuria)
• Serious side effects requiring immediate medical attention:
• Heart problems, including heart attack, reduced blood flow to the heart, or heart failure. Symptoms may include chest pain, shortness of breath, or swelling of the legs.
• Serious bleeding, including bleeding from the stomach or intestines, lungs, or brain.
• Dangerously high blood pressure, which may require urgent treatment.
• Gastrointestinal perforation (a hole in the stomach or intestine), causing severe stomach pain, fever, nausea, or vomiting.
• Severe skin reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, causing blistering or peeling skin.
• Severe liver injury, which may cause yellowing of the skin or eyes and can lead to liver failure.
• Changes in heart rhythm (QT prolongation), which can sometimes cause dangerous irregular heartbeats.
• Reversible posterior leukoencephalopathy syndrome (RPLS), a rare brain condition that may cause seizures, severe headache, confusion, or vision changes.
• Severe inflammation of the pancreas (pancreatitis) or lungs (interstitial lung disease).
• Contact your doctor immediately if you develop chest pain, unusual bleeding, severe stomach pain, severe skin reactions, yellowing of the skin or eyes, seizures, confusion, or an irregular heartbeat.

Other General Warnings

• Consult your doctor if-
• You develop chest pain, shortness of breath, swelling, dizziness, or fainting, as Sorafenib can affect the heart.
• You notice unusual bleeding or unexplained bruising.
• You develop painful redness, swelling, blisters, or peeling on your hands or feet.
• You develop a severe rash, blistering, or peeling skin, especially with mouth sores.
• You have severe stomach pain, fever, nausea, or vomiting.
• You notice yellowing of the skin or eyes, dark urine, or abdominal pain, which may indicate liver problems.
• You experience irregular heartbeat, dizziness, or fainting, as Sorafenib can affect heart rhythm.
• You are planning surgery, as Sorafenib may delay wound healing.
• You have thyroid cancer, as regular TSH monitoring may be needed.
• You take warfarin or other blood thinners, as closer blood-clotting monitoring may be required.
• You are planning to have children, as Sorafenib may affect male fertility.
• Take Sorafenib consistently without food or with a low- or moderate-fat meal. Avoid high-fat meals around the time of dosing.
• Tell your doctor immediately about unusual bleeding, such as vomiting blood, blood in stools, coughing up blood, or prolonged nosebleeds.
• Have your blood pressure checked regularly, especially during the first few weeks of treatment.
• Report painful redness, swelling, or blisters on your hands or feet, as these may indicate hand-foot skin reaction.
• Tell your doctor immediately if you develop chest pain, shortness of breath, or an irregular heartbeat.
• Tell your doctor before any planned surgery, as Sorafenib may affect wound healing.
• If you have thyroid cancer, your doctor may monitor your TSH levels regularly during treatment.
• Women who could become pregnant should use effective contraception during treatment and as advised afterwards. Men with partners who could become pregnant should also use contraception as advised.
• Inform all your doctors, dentists, and emergency healthcare providers that you are taking Sorafenib.
• Keep out of reach of children and pets.

How Does It Work?

Interactions with other medicines

• Rifampicin, carbamazepine, phenytoin, phenobarbital, dexamethasone, rifabutin, and St. John’s Wort: These may lower sorafenib levels and make it less effective. Tell your doctor before using them.
• Neomycin: Taking oral neomycin may greatly reduce sorafenib levels, so it should be avoided if possible.
• Warfarin: Sorafenib may affect blood clotting and increase the risk of bleeding. Your doctor may monitor your INR and other blood-clotting tests more closely.
• Sorafenib may affect how some other medicines are processed in the body. Your doctor will check for possible interactions.
• Ketoconazole and omeprazole do not appear to significantly affect sorafenib levels.
• Tell your doctor about all medicines, vitamins, supplements, and herbal products you take.

Interactions with food items

Overdose

Missed a Dose