What is Sorafenib
Sorafenib is a multi-kinase inhibitor targeting several intracellular and cell surface kinases, including c-CRAF, BRAF, mutant BRAF, vascular endothelial growth factor (VEGF) receptors -1, -2 and -3, platelet-derived growth factor receptor-beta (PDGFR-beta), KIT, FLT-3, and RET.
It is indicated as monotherapy for the treatment of unresectable hepatocellular carcinoma, advanced renal cell carcinoma, and locally recurrent or metastatic, progressive, differentiated thyroid cancer refractory to radioactive iodine treatment.
Dermatologic toxicities are among the most common adverse reactions associated with sorafenib treatment and may require an interruption of therapy or dose reduction.
Additional common adverse reactions include diarrhea, fatigue, hypertension, and bleeding.
Brand Name
Nexavar
Indications & Dosage
- hepatocellular cancer
- malignant melanoma
- renal cell cancer
- thyroid cancer
Side Effects
- abdominal pain
- abdominal pain
- acne vulgaris
- acute respiratory distress syndrome (ARDS)
- alopecia
- alopecia
- anemia
- anemia
- angioedema
- anorexia
- anorexia
- arthralgia
- arthralgia
- asthenia
- bleeding
- bleeding
- bone pain
- cholangitis
- cholecystitis
- constipation
- constipation
- dehydration
- depression
- diarrhea
- diarrhea
- dysgeusia
- dyspepsia
- dysphagia
- dysphonia
- dysphonia
- dyspnea
- dyspnea
- eczema vaccinatum
- elevated hepatic enzymes
- elevated hepatic enzymes
- epistaxis
- erythema
- erythema multiforme
- exfoliative dermatitis
- fatigue
- fatigue
- fever
- fever
- flushing
- folliculitis
- gastritis
- GI bleeding
- GI perforation
- glossitis
- gynecomastia
- headache
- headache
- heart failure
- hepatic failure
- hepatitis
- hepatotoxicity
- hyperamylasemia
- hyperamylasemia
- hyperbilirubinemia
- hyperkeratosis
- hypertension
- hypertension
- hypertensive crisis
- hyperthyroidism
- hypoalbuminemia
- hypocalcemia
- hypocalcemia
- hypokalemia
- hypokalemia
- hyponatremia
- hypophosphatemia
- hypophosphatemia
- hypothyroidism
- impotence (erectile dysfunction)
- infection
- influenza
- intracranial bleeding
- jaundice
- leukoencephalopathy
- leukopenia
- lymphopenia
- lymphopenia
- muscle cramps
- myalgia
- myocardial infarction
- nausea
- nausea
- nephrotic syndrome
- neutropenia
- neutropenia
- new primary malignancy
- oral ulceration
- osteonecrosis
- palmar-plantar erythrodysesthesia (hand and foot syndrome)
- palmar-plantar erythrodysesthesia (hand and foot syndrome)
- pancreatitis
- peripheral neuropathy
- pneumonitis
- proteinuria
- pruritus
- pruritus
- QT prolongation
- rash
- rash
- renal failure (unspecified)
- rhabdomyolysis
- rhinorrhea
- serious hypersensitivity reactions or anaphylaxis
- Stevens-Johnson syndrome
- stomatitis
- stomatitis
- stroke
- thrombocytopenia
- thrombocytopenia
- thromboembolism
- thrombosis
- thrombotic microangiopathy
- tinnitus
- toxic epidermal necrolysis
- urticaria
- vomiting
- vomiting
- weight loss
- weight loss
- xerosis
- xerosis
- xerostomia
Monitoring Parameters
- blood pressure
- LFTs
- pregnancy testing
- thyroid function tests (TFTs)
Contraindications
- alcoholism
- bleeding
- bradycardia
- breast-feeding
- cardiac arrhythmias
- cardiac disease
- contraception requirements
- coronary artery disease
- diabetes mellitus
- females
- geriatric
- GI bleeding
- GI perforation
- heart failure
- hepatic disease
- hepatitis
- hepatotoxicity
- hypertension
- hypocalcemia
- hypokalemia
- hypomagnesemia
- infertility
- intracranial bleeding
- long QT syndrome
- lung cancer
- male-mediated teratogenicity
- malnutrition
- mortality
- myocardial infarction
- pregnancy
- pregnancy testing
- QT prolongation
- reproductive risk
- skin disease
- surgery
- thyroid disease
Interactions
- Abacavir; Dolutegravir; Lamivudine
- Afatinib
- Alfuzosin
- Amiodarone
- Amitriptyline
- Amitriptyline; Chlordiazepoxide
- Amlodipine; Atorvastatin
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Anagrelide
- Apalutamide
- Apomorphine
- Aripiprazole
- Arsenic Trioxide
- Artemether; Lumefantrine
- Asenapine
- Atomoxetine
- Atorvastatin
- Atorvastatin; Ezetimibe
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azithromycin
- Bedaquiline
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Betrixaban
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Buprenorphine
- Buprenorphine; Naloxone
- Carbamazepine
- Ceritinib
- Chloroquine
- Chlorpromazine
- Ciprofloxacin
- Cisapride
- Citalopram
- Clarithromycin
- Clofazimine
- Clomipramine
- Clozapine
- Cobimetinib
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Colchicine
- Colchicine; Probenecid
- Crizotinib
- Cyclosporine
- Dabigatran
- Dapagliflozin; Saxagliptin
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Dasatinib
- Degarelix
- Desipramine
- Deutetrabenazine
- Dexamethasone
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Digoxin
- Disopyramide
- Dofetilide
- Dolasetron
- Dolutegravir
- Dolutegravir; Lamivudine
- Dolutegravir; Rilpivirine
- Donepezil
- Donepezil; Memantine
- Doravirine; Lamivudine; Tenofovir disoproxil fumarate
- Doxepin
- Doxorubicin
- Dronedarone
- Droperidol
- Edoxaban
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Eliglustat
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Emtricitabine; Tenofovir disoproxil fumarate
- Encorafenib
- Entrectinib
- Enzalutamide
- Eribulin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Escitalopram
- Ezogabine
- Fingolimod
- Flecainide
- Fluconazole
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurbiprofen
- Fluticasone; Umeclidinium; Vilanterol
- Fluvoxamine
- Foscarnet
- Fosphenytoin
- Gemifloxacin
- Gemtuzumab Ozogamicin
- Gilteritinib
- Glasdegib
- Glecaprevir; Pibrentasvir
- Glyburide
- Glyburide; Metformin
- Goserelin
- Granisetron
- Halogenated Anesthetics
- Haloperidol
- Histrelin
- Hydroxychloroquine
- Hydroxyzine
- Ibutilide
- Iloperidone
- Imipramine
- Indinavir
- Indomethacin
- Inotuzumab Ozogamicin
- Irinotecan
- Irinotecan Liposomal
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Itraconazole
- Ivosidenib
- Ketoconazole
- Lamivudine; Tenofovir Disoproxil Fumarate
- Lapatinib
- Lefamulin
- Lenvatinib
- Leuprolide
- Leuprolide; Norethindrone
- Levofloxacin
- Lithium
- Lofexidine
- Long-acting beta-agonists
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Lumacaftor; Ivacaftor
- Lumacaftor; Ivacaftor
- Macimorelin
- Maprotiline
- Maraviroc
- Mefloquine
- Meperidine; Promethazine
- Metformin; Saxagliptin
- Methadone
- Metronidazole
- Midostaurin
- Mifepristone
- Mirtazapine
- Mitotane
- Modafinil
- Morphine
- Morphine; Naltrexone
- Moxifloxacin
- Naldemedine
- Neomycin
- Nilotinib
- Nortriptyline
- Octreotide
- Ofloxacin
- Olanzapine
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Ozanimod
- Paliperidone
- Panobinostat
- Pasireotide
- Pazopanib
- Pentamidine
- Perphenazine
- Perphenazine; Amitriptyline
- Pexidartinib
- Phenobarbital
- Phenylephrine; Promethazine
- Phenytoin
- Pimavanserin
- Pimozide
- Pitolisant
- Posaconazole
- Primaquine
- Primidone
- Procainamide
- Prochlorperazine
- Promethazine
- Propafenone
- Protriptyline
- Quetiapine
- Quinidine
- Quinine
- Ranolazine
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifaximin
- Rilpivirine
- Rimegepant
- Risperidone
- Romidepsin
- Saquinavir
- Saxagliptin
- Selpercatinib
- Sertraline
- Short-acting beta-agonists
- Simeprevir
- Siponimod
- Sirolimus
- Solifenacin
- Sotalol
- St. John’s Wort, Hypericum perforatum
- Sunitinib
- Tacrolimus
- Talazoparib
- Tamoxifen
- Telavancin
- Telithromycin
- Temsirolimus
- Tenofovir, PMPA
- Tetrabenazine
- Thioridazine
- Ticagrelor
- Tinzaparin
- Tipranavir
- Tolterodine
- Tolvaptan
- Topotecan
- Toremifene
- Trandolapril; Verapamil
- Trazodone
- Tricyclic antidepressants
- Trifluoperazine
- Trimipramine
- Triptorelin
- Ubrogepant
- Umeclidinium
- Umeclidinium; Vilanterol
- Vandetanib
- Vardenafil
- Vemurafenib
- Venetoclax
- Venlafaxine
- Verapamil
- Vincristine
- Vincristine Liposomal
- Voriconazole
- Vorinostat
- Warfarin
- Ziprasidone
