This page tells you about the biological therapy sorafenib and its possible side effects. There are sections about
Sorafenib is pronounced so-raf-en-ib. It is also known by its brand name Nexavar.
Sorafenib is a treatment for
- Kidney cancer that has spread
- A type of liver cancer called hepatocellular carcinoma
- Some types of thyroid cancer when radioactive iodine treatment has not worked
Sorafenib is a type of biological therapy called a protein tyrosine kinase inhibitor (TKI). Tyrosine kinase is a protein which acts as a chemical messenger (an enzyme). There are a number of different tyrosine kinases that encourage cancer cells to grow.
Sorafenib blocks some of the protein kinases and is called a multi kinase inhibitor. It works in two ways. It stops signals that tell cancer cells to grow. It also stops cancer cells forming blood vessels, which they need to grow. Treatment that stops blood vessels forming is called anti angiogenesis treatment.
Sorafenib is a tablet you take with a glass of water. You should take it either without food or with a meal that contains only low amounts of fat. A high fat meal may make sorafenib work less well. If you have a high fat meal, take the tablets at least 1 hour before or 2 hours afterwards.
You take sorafenib twice a day. You usually carry on taking it for as long as it is controlling the cancer.
It is very important that you take tablets according to the instructions your doctor or pharmacist gave you. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first. You need to take the tablets at about the same time each day.
Tell your doctor straight away if you accidentally take more than your prescribed dose. This may make side effects more likely or more severe.
If you miss a dose, take it as soon as you remember. If it is nearly time for the next dose, forget about the missed one and take the next dose at the scheduled time. Don't take a double dose.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We've listed the side effects associated with sorafenib below. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.
You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects may be different if you are having sorafenib with other drugs.
Tell your doctor or nurse straight away if any of the side effects get severe.
More than 10 in every 100 people have one or more of these.
- Soreness and redness of the palms of the hands and soles of the feet happens in 3 out of 10 people (30%). This is called hand-foot syndrome. One in 10 (10%) have a more severe reaction.
- Diarrhoea – this affects 3 out of 10 people (30%) and is usually mild but tell your doctor or nurse as you can have medicines to control it
- A rash, or red, dry itchy skin happens in about 3 out of 10 people (30%)
- Tiredness and weakness (fatigue) affects about 1 out of 6 people (15%) during and after treatment
- Hair thinning affects 1 in 4 people (25%)
- Feeling or being sick affects about 1 in 6 people (15%), but is usually well controlled with anti sickness medicines
- Raised blood pressure (hypertension)
- Increased risk of bleeding such as nosebleeds or bleeding gums – if you notice blood in your stool or vomit, contact your doctor or nurse straight away
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
- Flushing of the skin
- Pain in the mouth, tummy (abdomen), bone, joints, or area of the tumour – let your doctor or nurse know if you have this
- Bleeding into the brain, gut wall or lungs – let your doctor or nurse know straight away if you have dizziness, fainting, loss of control of any part of the body, darker poo (faeces), or if you cough up blood
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Loss of appetite
- Constipation – drink plenty of fluids and let your doctor or nurse know if the constipation gets severe of lasts for more than 3 days
- Weight loss
Between 1 and 10 in every 100 people have one or more of the side effects listed below.
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Aching joints or muscles
- A sore or dry mouth and tongue pain
- Flu like symptoms – taking paracetamol can help
- A hoarse voice
- A mild effect on the liver – you are unlikely to notice any symptoms from this. Your liver will almost certainly go back to normal after the treatment ends
- Difficulty swallowing
- Numbness or tingling in the fingers and toes – you may have trouble with fiddly tasks such as doing up buttons. This can start a few days or weeks after treatment and usually goes away within a few months of the treatment finishing
- Indigestion and heartburn
- Low levels of calcium in the blood – let your doctor or nurse know if you have painful muscle spasm and cramps or muscle twitching. Also tell them if you have numbness or tingling in your feet and hands or around your mouth
- Low levels of potassium in the blood
- Sadness or depression
- Erection problems for some men
- Heart problems, including chest pain – if you have any pain, contact your doctor or nurse as soon as possible
- Ringing in the ears (tinnitus)
- Kidney changes – you are unlikely to notice any symptoms from this and the changes will almost certainly go back to normal after the treatment ends
- Inflammation of the hair follicles causing skin reddening and soreness
- Higher levels of thyroid hormones (hyperthyroidism).You may lose weight or feel hot, anxious, or hyperactive
- You may feel hot, anxious a
- Taste changes
- A runny nose
- Slow growing skin cancers that are usually not harmful and can be removed
- Thickening of the outer layers of skin
- Muscle spasms
Fewer than 1 in 100 people have these.
- Breast tenderness and swelling because sorafenib may lower male sex hormone (testosterone) levels
- Bleeding of the stomach lining
- A runny nose
- Sudden pain in the tummy (abdomen) caused by inflammation of the pancreas, gallbladder or bile ducts – let your doctor or nurse know straight away if you have this
- Yellow skin or eyes (jaundice) caused by high levels of bile pigments in the blood
- A hole in the wall of the digestive system (gastrointestinal perforation) – let your doctor or nurse know straight away if you have a sudden abdominal pain, dizziness and feel ill
- Headaches, seizures (fits), confusion, changes in eye sight, excessive sleepiness, change in behaviour, possibly high blood pressure – doctors call this group of symptoms reversible posterior leucoencephalopathy syndrome (RPLS). Let your doctor or nurse know straight away if you have these
- A sudden, severe allergic reaction – let your doctor or nurse know straight away if you feel faint or have sudden breathlessness, or swelling of the face, lips, eyelids or throat
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Do not breastfeed during this treatment because the drug may come through in the breast milk.
You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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