Sorafenib

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

  1. abdominal pain
  2. abdominal pain
  3. acne vulgaris
  4. acute respiratory distress syndrome (ARDS)
  5. alopecia
  6. alopecia
  7. anemia
  8. anemia
  9. angioedema
  10. anorexia
  11. anorexia
  12. arthralgia
  13. arthralgia
  14. asthenia
  15. bleeding
  16. bleeding
  17. bone pain
  18. cholangitis
  19. cholecystitis
  20. constipation
  21. constipation
  22. dehydration
  23. depression
  24. diarrhea
  25. diarrhea
  26. dysgeusia
  27. dyspepsia
  28. dysphagia
  29. dysphonia
  30. dysphonia
  31. dyspnea
  32. dyspnea
  33. eczema vaccinatum
  34. elevated hepatic enzymes
  35. elevated hepatic enzymes
  36. epistaxis
  37. erythema
  38. erythema multiforme
  39. exfoliative dermatitis
  40. fatigue
  41. fatigue
  42. fever
  43. fever
  44. flushing
  45. folliculitis
  46. gastritis
  47. GI bleeding
  48. GI perforation
  49. glossitis
  50. gynecomastia
  51. headache
  52. headache
  53. heart failure
  54. hepatic failure
  55. hepatitis
  56. hepatotoxicity
  57. hyperamylasemia
  58. hyperamylasemia
  59. hyperbilirubinemia
  60. hyperkeratosis
  61. hypertension
  62. hypertension
  63. hypertensive crisis
  64. hyperthyroidism
  65. hypoalbuminemia
  66. hypocalcemia
  67. hypocalcemia
  68. hypokalemia
  69. hypokalemia
  70. hyponatremia
  71. hypophosphatemia
  72. hypophosphatemia
  73. hypothyroidism
  74. impotence (erectile dysfunction)
  75. infection
  76. influenza
  77. intracranial bleeding
  78. jaundice
  79. leukoencephalopathy
  80. leukopenia
  81. lymphopenia
  82. lymphopenia
  83. muscle cramps
  84. myalgia
  85. myocardial infarction
  86. nausea
  87. nausea
  88. nephrotic syndrome
  89. neutropenia
  90. neutropenia
  91. new primary malignancy
  92. oral ulceration
  93. osteonecrosis
  94. palmar-plantar erythrodysesthesia (hand and foot syndrome)
  95. palmar-plantar erythrodysesthesia (hand and foot syndrome)
  96. pancreatitis
  97. peripheral neuropathy
  98. pneumonitis
  99. proteinuria
  100. pruritus
  101. pruritus
  102. QT prolongation
  103. rash
  104. rash
  105. renal failure (unspecified)
  106. rhabdomyolysis
  107. rhinorrhea
  108. serious hypersensitivity reactions or anaphylaxis
  109. Stevens-Johnson syndrome
  110. stomatitis
  111. stomatitis
  112. stroke
  113. thrombocytopenia
  114. thrombocytopenia
  115. thromboembolism
  116. thrombosis
  117. thrombotic microangiopathy
  118. tinnitus
  119. toxic epidermal necrolysis
  120. urticaria
  121. vomiting
  122. vomiting
  123. weight loss
  124. weight loss
  125. xerosis
  126. xerosis
  127. 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
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