Nexavar-Sorafenib

Patient Education Quick Reference Guide Diablo Valley Oncology/Hematology Medical Group Phone Number: 925-677-5041

Uses For This Medication

  • Sorafenib is used to treat adults with advanced kidney cancer.
  • Sorafenib is being studied for the treatment of other tumors and blood-based cancers, including liver cancer, melanoma, colorectal cancer, breast cancer, soft tissue sarcoma, gallbladder cancer, uterine cancer, lung cancer, non-Hodgkin’s lymphoma, thyroid cancer, pancreatic cancer, prostate cancer, and multiple myeloma.
  • This medication may also be given for other conditions as determined by your doctor.
 

How This Medication Works

Sorafenib works by blocking the action of multiple kinases, chemicals (enzymes) in the body that are involved in both tumor cell growth as well as tumor angiogenesis, the development of new blood vessels (i.e. tumor blood supply). In order for a cancer to grow and spread, it must be supplied with oxygen and nutrients by blood vessels. During tumor growth and progression, blood vessels from surrounding tissues develop and help to feed the tumor. Sorafenib works, in part, by blocking, or inhibiting, the development of these blood vessels, thus preventing oxygen and nutrients from reaching the tumor.   Benefits Of This Medication For some patients with advanced kidney cancer, sorafenib has been shown to delay the progression of the disease. The benefit of sorafenib in the treatment of other cancers is not yet known.   Who Should Not Take This Medication You should not take this medication if you:
  • Are allergic to sorafenib or any of its components
  Precautions To Be Aware Of Before Taking This Medication

Blood related precautions

  • Rarely, this medication may temporarily reduce the number of platelets in your blood. This can increase your risk of bleeding. Contact your doctor or healthcare provider if you notice unusual bleeding or bruising, have black or tar-like stools, see blood in your urine, or develop pinpoint red spots on your skin. If your platelet levels become too low, your doctor or healthcare provider may recommend that your treatment be delayed, that you receive a platelet transfusion, and/or that you take medication to help increase the number of platelets in your blood. To lower your chance of bleeding, do not use aspirin, aspirin-containing medications, or aspirin-like medications (for example ibuprofen, naproxen). Use caution with sharp objects like razors and nail cutters, and avoid activities that can cause cuts, bumps and bruises.
  • Rarely, this medication may temporarily reduce the number of germ fighting white blood cells in your blood. This can increase your risk of infection. Contact your doctor or healthcare provider promptly if you develop any signs of an infection such as fever, painful urination, chills or a sore throat that doesn’t go away. If your white blood cell levels become too low, your doctor or healthcare provider may recommend that your treatment be delayed and/or you receive medication to increase the number of white cells in your blood. To lower your risk of infection, stay away from crowds and people with colds or other illnesses, wash your hands well and often, and brush and floss your teeth daily.
  • Rarely, this medication may temporarily lower the number of red cells in your blood. This can increase your risk of anemia. If your red blood cell level becomes low, you may feel tired and weak. If your red blood cell level becomes too low, your doctor or healthcare provider may recommend that your treatment be delayed, that you receive a red blood cell transfusion, and/or you receive a medication to help increase the red cells in your blood.
  • Rarely, this medication may increase your risk of bleeding. If you experience any excessive bleeding, have a history of bleeding, or are currently taking warfarin (Coumadin®), let your doctor or healthcare provider know.
 

Heart related precautions

The incidence of angina and heart attack appears to be higher in patients receiving sorafenib. Your doctor or healthcare provider will check your heart regularly while you are on this medication to make sure that your heart is working properly. If you have any problems with your heart before starting this medication, make sure to tell your doctor or healthcare provider. In addition, if you experience sudden shortness of breath or difficulty breathing, sharp chest pain, or pain that radiates down the shoulder and arm, contact your doctor right away.  

Skin related precautions

This medication can cause a rash as well as hand-and-foot syndrome. This condition can cause the hands or soles of the feet to tingle, become numb, painful, swollen or red. Contact your doctor or healthcare provider if you experience new symptoms, if your symptoms become painful or worsen, or if you are unable to perform routine daily activities as a result of this condition. If you do develop this condition, you should try to protect your feet and hands. Prevent injuring them and avoid prolonged heat (for example taking hot baths) or pressure (for example wearing tight-fitting shoes). In addition, rubbing petroleum jelly (Vaseline or a similar type cream or ointment) on your hands and feet at bedtime and covering them with cotton gloves and/or socks may be helpful.  

Miscellaneous Precautions

  • This medication may increase your blood pressure, especially during the first six weeks of treatment. Most people usually don’t feel any different when their blood pressure is raised. However, severe increases in blood pressure can cause headache, visual disturbances, confusion, or sleepiness. Contact your doctor or healthcare provider if you have these symptoms. In addition, your doctor or healthcare provider should monitor your blood pressure regularly while you are on this medication.
  • This medication should be stopped in patients who to have undergo major surgical procedures since it may slow wound healing. It is not clear when sorafenib should be resumed, or started again, following major surgery and this decision should be made on a case by case basis depending on wound healing.
  • Do not receive any immunizations (vaccinations) while on this medication without your doctor or healthcare provider’s approval. This medication can increase your risk of infection. For certain immunizations, you may develop the infection that the immunization is intended to prevent.
 

Patient specific precautions

  • It is not known if this medication is safe and effective in children.
 

Pregnancy and Breastfeeding Precautions

  • This medication may cause fetal harm. When taking this medication and for two weeks after stopping, you should use effective birth control to prevent pregnancy. Tell your doctor or healthcare provider right away if you or your spouse/partner becomes pregnant.
  • It is not known whether this medication is found or excreted in breast milk. Since many medications are excreted in breast milk and because this medication can cause serious harmful reactions in infants, breastfeeding should be avoided.
  • Many anti-cancer therapies can cause sterility. Notify your doctor or healthcare provider if you want to have children in the future.
 

Medication and Food Interactions

Before using this medication, tell your doctor or healthcare provider of all prescription or over-the-counter products you are taking, including dietary supplements or vitamins, herbal medicines and homeopathic remedies. Do not start or stop any medication without your doctor or healthcare provider’s approval. Possible interactions can occur with sorafenib and the following foods or medications:
  • Amiodarone (Cordarone®)
  • Aprepitant (Emend®)
  • Atazanavir (Reyataz®)
  • Bupropion (Wellbutrin®, Zyban®
  • Carbamazepine
  • Cerivastatin
  • Clarithromycin (Biaxin®)
  • Cyclophosphamide (Cytoxan®, Neosar®)
  • Doxorubicin (Rubex®, Adriamycin®)
  • Efavirenz (Sustiva®)
  • Erythromycin
  • Fluconazole (Diflucan®)
  • Grapefruit or grapefruit juice
  • Ifosfamide (Ifex®)
  • Imatinib mesylate (Gleevec®)
  • Indinavir (Crixivan®)
  • Irinotecan (Camptosar®)
  • Itraconazole (Sporanox®)
  • Ketoconazole (Nizoral®)
  • Methadone (Dolophine®)
  • Nefazodone (Serzone®)
  • Nelfinavir (Viracept®)
  • Paclitaxel (Taxol®)
  • Phenytoin (Dilantin®)
  • Phenobarbital
  • Repaglinide (Prandin®)
  • Rifampin (Rifadin®)
  • Rifabutin (Mycobutin®)
  • Ritonavir (Norvir®)
  • Saquinavir
  • St.John’s wort
  • Torsemide (Demadex®)
  • Warfarin (Coumadin®)
  • Voriconazole (Vfend®)
NOTE: This list may not include all medications that can have interactions with sorafenib.

Side Effects

  • All medications can cause side effects. However, not all patients will experience these side effects. In addition, other side effects not listed can also occur in some patients. You should call your doctor or healthcare provider if you have any questions or concerns while you are on this medication.
  • You should contact your doctor or healthcare provider if you experience any side effect(s) which don’t go away, worsen, are serious in nature, or are worrisome to you.
  • Side effects can occur when sorafenib is given alone or together with other chemotherapy medications. The side effects listed below are those reported in patients who were treated with sorafenib alone.
 

More common side effects

  • Rash, itching
  • Diarrhea, nausea
  • Hand-foot syndrome (pain, swelling, and redness of the hands and/or feet) (see Precautions To Be Aware Of Before Taking This Medication)
  • Fatigue
  • Hair loss, hair growth (when receiving the medication for > 6 months)
  • Low levels of phosphorus in the blood (that may require supplements)
 

Less common side effects

  • Increased blood pressure (see Precautions To Be Aware Of Before Taking This Medication)
  • Vomiting, constipation
  • Loss of appetite
  • Bleeding (see Precautions To Be Aware Of Before Taking This Medication)
  • Decreased platelet, red blood cell, and/or white blood cell levels (see Precautions To Be Aware Of Before Taking This Medication)
  Rare side effects This is not a complete list of the rare side effects reported with sorafenib. For a complete list, please talk with your doctor or healthcare provider about reviewing a copy of the package insert.
  • Headache
  • Joint pain, muscle pain
  • Redness of the skin, acne, flushing
  • Stomach pain
  • Chest pain, heart attack (see Precautions To Be Aware Of Before Taking This Medication)
  • Sores on the mouth and/or lips
  • Hoarseness
  • Elevated levels of pancreatic enzymes
 

How To Take This Medication

  • This medication is taken by mouth (orally) and is usually taken twice a day. Take this medication exactly as directed by your doctor or healthcare provider. If you do not understand these instructions, ask your doctor or healthcare provider to explain them to you. This medication can be given in different doses depending on the type of condition being treated.
  • It is important that you only use this medication when it’s been prescribed for you. Sharing this medication with someone for whom it is not prescribed could cause harm.
  • If you accidentally take too many pills or someone else accidentally takes your medication, contact your doctor, your local poison control center at 1-800-222-1222, or emergency services immediately.
 

Proper Storage

  • Store this medication at room temperature.
  • Keep this medication out of the reach of children or pets.
  • Ask your doctor or healthcare provider how to dispose of any medication that you no longer use.