Sorafenib (Nexavar®)

About This Drug

Sorafenib is used to treat cancer. It is given orally (by mouth).

Possible Side Effects

  • Tiredness
  • Infection
  • Hair loss. Hair loss is often temporary, although with certain medicine, hair loss can sometimes be permanent. Hair loss may happen suddenly or gradually. If you lose hair, you may lose it from your head, face, armpits, pubic area, chest, and/or legs. You may also notice your hair getting thin.
  • Decreased appetite (decreased hunger)
  • Weight loss
  • Nausea
  • Pain in your abdomen
  • Loose bowel movements (diarrhea)
  • High blood pressure
  • Rash
  • Hand-and-foot syndrome. The palms of your hands or soles of your feet may tingle, become numb, painful, swollen, or red.
  • Abnormal bleeding – symptoms may be coughing up blood, throwing up blood (may look like coffee grounds), red or black tarry bowel movements, abnormally heavy menstrual flow, nosebleeds or any other unusual bleeding.

Note: Each of the side effects above was reported in 20% or greater of patients treated with sorafenib. Not all possible side effects are included above.

Warnings and Precautions

  • Changes in your heart function, abnormal heart beat and heart attack
  • Abnormal bleeding which can very rarely be life-threatening
  • High blood pressure
  • Perforation- a hole in your stomach, small and/or large intestine
  • Changes in your liver function
  • Changes in your thyroid function
  • Severe allergic skin reaction. You may develop blisters on your skin that are filled with fluid or a severe red rash all over your body that may be painful.
  • Slow wound healing

Note: Some of the side effects above are very rare. If you have concerns and/or questions, please discuss them with your medical team.

Important Information

  • Sorafenib may cause slow wound healing. It should not be given before surgery. If you must have emergency surgery or have an accident that results in a wound, tell the doctor that you are on sorafenib.

How to Take Your Medication

  • Take this drug by mouth without food, at least 1 hour before you eat or 2 hours after you eat
  • Missed dose: If you vomit or miss a dose, take your next dose at the regular time. Do not take 2 doses at the same time, instead, continue with your regular dosing schedule and contact your physician.
  • Handling: Wash your hands after handling your medicine, your caretakers should not handle your medicine with bare hands and should wear latex gloves.
  • This drug may be present in the saliva, tears, sweat, urine, stool, vomit, semen, and vaginal secretions. Talk to your doctor and/or your nurse about the necessary precautions to take during this time.
  • Storage: Store this medicine in the original container at room temperature. Discuss with your nurse or your doctor how to dispose of unused medicine

Treating Side Effects

  • To help with hair loss, wash with a mild shampoo and avoid washing your hair every day.
  • Avoid rubbing your scalp, pat your hair or scalp dry.
  • Avoid coloring your hair.
  • Limit your use of hair spray, electric curlers, blow dryers, and curling irons.
  • If you are interested in getting a wig, talk to your nurse. You can also call the American Cancer Society at 800-ACS-2345 to find out information about the “Look Good, Feel Better” program close to where you live. It is a free program where women getting chemotherapy can learn about wigs, turbans and scarves as well as makeup techniques and skin and nail care.
  • Drink plenty of fluids (a minimum of eight glasses per day is recommended).
  • If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack water in the body from losing too much fluid).
  • If you get diarrhea, eat low-fiber foods that are high in protein and calories and avoid foods that can irritate your digestive tracts or lead to cramping.
  • Ask your nurse or doctor about medicine that can lessen or stop your diarrhea.
  • To help with nausea and vomiting, eat small, frequent meals instead of three large meals a day. Choose foods and drinks that are at room temperature. Ask your nurse or doctor about other helpful tips and medicine that is available to help or stop lessen these symptoms.
  • To help with decreased appetite, eat high caloric food such as pudding, ice cream, yogurt and milkshakes.
  • Avoid sun exposure and apply sunscreen routinely when outdoors.
  • If you get a rash do not put anything on it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if your rash bothers you.
  • Keeping your pain under control is important to your well-being. Please tell your doctor or nurse if you are experiencing pain.

Food and Drug Interactions

  • There are no known interactions of sorafenib with food, however this medication should be taken on an empty stomach.
  • Check with your doctor or pharmacist about all other prescription medicines and dietary supplements you are taking before starting this medicine as there are known drug interactions with sorafenib. Also, check with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplement to make sure that there are no interactions.
  • Avoid the use of St. John’s Wort while taking sorafenib as this may lower the levels of the drug in your body, which can make it less effective.
  • There are known interactions of sorafenib with blood thinning medicine such as warfarin. You may have an increased risk of bleeding. Ask your doctor what precautions you should take.

When to Call the Doctor

Call your doctor or nurse if you have any of these symptoms and/or any new or unusual symptoms:

  • Fever of 100.5 F (38 C) or higher
  • Chills
  • A headache that does not go away
  • Blurry vision or other changes in eyesight
  • Feeling that your heart is beating in a fast or not normal way (palpitations)
  • Feeling Dizzy or Lightheaded
  • Fatigue that interferes with your daily activities
  • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back or it can be constant. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
  • Easy bleeding or bruising
  • Blood in your urine, vomit (bright red or coffee-ground) and/or stools ( bright red, or black/tarry)
  • Coughing up blood
  • Pain in your abdomen that does not go away
  • Nausea that stops you from eating or drinking and/or is not relieved by prescribed medicines
  • Lasting loss of appetite or rapid weight loss of five pounds in a week
  • Loose bowel movements (diarrhea) 4 times a day or loose bowel movements with lack of strength or a feeling of being dizzy
  • Signs of possible liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin
  • Painful, red, or swollen areas on your hands or feet
  • Numbness and/or tingling of your hands and/or feet
  • A new rash or a rash that is not relieved by prescribed medicines
  • Flu-like symptoms: fever, headache, muscle and joint aches, and fatigue (low energy, feeling weak)
  • If you think you may be pregnant or may have impregnated your partner

Reproduction Warnings

  • Pregnancy warning: This drug can have harmful effects on the unborn baby. Women of child bearing potential should use effective methods of birth control during your cancer treatment and for at least 2 weeks after treatment. Men with female partners of child bearing potential should use effective methods of birth control during your cancer treatment and for at least 2 weeks after your cancer treatment. Let your doctor know right away if you think you may be pregnant or may have impregnated your partner.
  • Breastfeeding warning: Women should not breast feed during treatment because this drug could enter the breast milk and cause harm to a breast feeding baby.
  • Fertility warning: Human fertility studies have not been done with this drug. Talk with your doctor or nurse if you plan to have children. Ask for information on sperm or egg banking.

Revised January 2018