1 What is this medicine
and what is it used for?
Sorafenib is a multikinase inhibitor — an oral targeted
cancer medicine that blocks several tyrosine and serine/threonine kinase
enzymes involved in tumour cell proliferation and tumour angiogenesis (blood
vessel growth). The key kinases blocked include VEGFR-1, -2, -3, PDGFR-beta,
RAF kinases (CRAF, BRAF), KIT, FLT-3, and RET.
It is used to treat adults with:
• Hepatocellular carcinoma (HCC) —
unresectable primary liver cancer (first-line treatment).
• Advanced renal cell carcinoma (RCC) —
after failure of interferon-alfa or interleukin-2 based therapy.
• Differentiated thyroid carcinoma
(DTC) — locally advanced or metastatic, progressive, radioactive
iodine-refractory.
2 How to take this
medicine
The standard dose is 400 mg (two 200 mg tablets) taken twice
daily — morning and evening — on an empty stomach or with a low-fat meal. Do
not take with a high-fat meal as this reduces absorption by up to 29%. Swallow
tablets whole with water. Take at the same times each day.
|
Take 1 hour before or
2 hours after eating for best absorption. A plain, low-fat breakfast is
acceptable if needed. Avoid grapefruit and
grapefruit juice — they can increase sorafenib blood levels and worsen side
effects. Note your dose clearly
— 2 tablets in the morning AND 2 tablets in the evening = 800 mg total daily
dose. |
3 Possible side effects
|
Frequency |
Side Effect |
What to Do |
|
Very Common (>10%) |
Hand-foot skin
reaction (HFSR / palmar-plantar erythrodysaesthesia) |
Apply thick emollient
cream preventively from day 1. Cushioned footwear. Report to care team early
for dose adjustment. |
|
Very Common (>10%) |
Diarrhoea |
Hydrate well; use
loperamide as directed; contact team if severe (>4 stools/day above
baseline). |
|
Very Common (>10%) |
Fatigue |
Balance rest and
activity; tell team if debilitating. |
|
Very Common (>10%) |
Hypertension |
Blood pressure
monitored weekly for first 6 weeks; take prescribed antihypertensives; report
headache/visual changes. |
|
Very Common (>10%) |
Alopecia (hair loss) |
Usually reversible
after stopping. Discuss with nurse specialist. |
|
Very Common (>10%) |
Rash / skin changes |
Moisturise regularly;
avoid sun exposure; report severe rashes. |
|
Common (1–10%) |
Elevated liver enzymes |
Regular LFT
monitoring; report jaundice or dark urine. |
|
Common (1–10%) |
Haemorrhage (bleeding) |
Report any unusual
bleeding immediately. |
|
Seek help urgently |
Chest pain, shortness
of breath — possible cardiac ischaemia |
Stop sorafenib and
seek emergency medical attention. |
|
Seek help urgently |
Severe HFSR: deep
painful blisters, inability to walk |
Contact oncology team
immediately for dose interruption. |
4 Who should not take
this medicine
|
Do NOT use Sorafenib if: You are pregnant or breastfeeding —
teratogenic; effective contraception required during treatment and for 6
months after. You are taking carboplatin/paclitaxel
combination for squamous cell lung cancer — increased toxicity with no added
benefit. You have known hypersensitivity to sorafenib or
excipients. Use with extreme caution in severe hepatic
impairment (Child-Pugh C). |
Use with caution in: uncontrolled hypertension; history of
cardiac ischaemia or infarction; QT prolongation; congenital long QT syndrome;
or if taking other QT-prolonging drugs.
5 Medicines that interact
with this treatment
• Strong CYP3A4 inducers (rifampicin,
phenytoin, St John's Wort): reduce sorafenib levels significantly — avoid.
• Warfarin / anticoagulants: increased
INR and bleeding risk — monitor closely.
• Docetaxel: sorafenib increases
docetaxel exposure — use with caution.
• QT-prolonging agents: additive QT
risk — avoid or monitor ECG.
• UGT1A1/1A9 substrates (irinotecan):
sorafenib inhibits these pathways — monitor.
6 How to store this
medicine
Store below 25°C. Keep in original packaging away from
moisture. Keep out of reach of children. Do not use after the expiry date.
7 Prescription
requirement
|
PRESCRIPTION ONLY
MEDICINE (POM) — Initiated and managed by a specialist oncologist. Monitoring: BP weekly
for 6 weeks then regularly; LFTs, renal function, lipase, blood counts at
baseline and throughout treatment. |
8 Guidance for patients
& caregivers
Hand-foot skin reaction is the most common reason for dose
reductions and treatment interruptions. Prevention is far easier than
treatment: apply urea-based thick emollient cream to hands and feet from the
first day of treatment. Wear well-cushioned, comfortable footwear. Avoid
pressure on hands (gardening gloves for activities; padded insoles in shoes).
Women of childbearing potential must use effective
non-hormonal contraception during treatment and for at least 6 months after the
last dose. Male patients should also use contraception and avoid fathering a
child during treatment and for 3 months after.
Blood pressure rises in approximately 20–30% of patients —
home blood pressure monitoring is recommended. Keep a log and bring it to each
appointment.
9 Pharmacist &
prescriber notes
Sorafenib 200 mg tablets: standard dose is 400 mg (2 tablets)
twice daily = 800 mg/day. Dose reductions follow a stepwise schedule: 400 mg
twice daily → 400 mg once daily → 400 mg every other day for toxicity
management. In HCC, sorafenib remains a standard option in Child-Pugh A/B
patients.
In advanced HCC, newer agents (atezolizumab/bevacizumab,
lenvatinib) are now preferred first-line in many guidelines — confirm
indication with current NCCN/ESMO protocols. HFSR management: Grade 1 —
continue; Grade 2 — dose reduce/interrupt; Grade 3 — interrupt until resolved
to Grade 1, then reduce dose. QTc monitoring recommended at baseline and
periodically. Sorafenib inhibits UGT1A1 and UGT1A9 — monitor co-administered
drugs metabolised via these pathways.
10 Frequently asked
questions
Why must I take sorafenib on an empty stomach?
Food — particularly high-fat meals —
reduces sorafenib absorption significantly. Taking it at least 1 hour before or
2 hours after eating ensures your body absorbs the full dose.
My hands and feet are getting very sore and red — what
should I do?
This is hand-foot skin reaction — the
most common sorafenib side effect. Apply thick emollient cream (urea cream)
frequently, wear cushioned footwear, and contact your oncology team immediately
— a dose reduction or brief break in treatment may be needed.
Can I take herbal remedies or St John's Wort?
No — St John's Wort significantly
reduces sorafenib levels in the blood, potentially making your cancer treatment
ineffective. Avoid all herbal remedies unless specifically approved by your
oncologist.
What do I do if I miss a dose?
Take the missed dose as soon as you
remember the same day. If it is already the time of your next dose, skip the
missed dose. Do not double up.
There are no product reviews yet.