Sorafenib | Side Effects, Dosage, Uses & More
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Generic Name:

sorafenib, Oral tablet

All Brands

  • Nexavar
SECTION 1 of 5

Highlights for sorafenib

Oral tablet
1

Sorafenib is used to treat certain types of liver, kidney, and thyroid cancers.

2

This drug comes as a tablet you take by mouth.

3

Sorafenib is available as the brand-name drug Nexavar. It isn’t available as a generic drug.

4

The more common side effects of this drug can include diarrhea, tiredness, infection, and hair loss. They can also include rash, nausea, decreased appetite, and weight loss.

5

In some cases, sorafenib can cause serious side effects. These can include bleeding, myocardial ischemia (lack of blood supply to your heart), heart attack, and severe skin reactions.

IMPORTANT INFORMATION

High blood pressure

This drug may increase your blood pressure. Your doctor may check your blood pressure every week during the first 6 weeks of treatment with this drug. They’ll keep checking your blood pressure regularly after that.

Serious side effects

This drug can cause serious side effects. In some cases, your doctor may tell you to stop taking the medication. These side effects can include bleeding, myocardial ischemia (lack of blood supply to your heart), heart attack, and skin reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis. They may also include liver problems and perforations (tears or open holes) in your stomach or intestines.

Thyroid stimulating hormone (TSH)

If you’re taking this drug for thyroid cancer, this medication may increase your TSH levels. This is because this medication may keep other medications from working to decrease your TSH levels. Your doctor should check your TSH levels each month during your treatment. Your doctor will increase or decrease your thyroid replacement based on these results.

What is sorafenib?

Sorafenib is a prescription drug. It’s available as a tablet you take by mouth.

Sorafenib is available as the brand-name drug Nexavar. It isn’t available as a generic drug.

This drug may be used as part of a combination therapy. This means you may need to take it with other medications.

Why it's used

Sorafenib is used to treat certain types of cancer.

More Details

How it works

Sorafenib belongs to a class of drugs called kinase inhibitors.

More Details

Why it's used

Sorafenib is used to treat certain types of cancer. These include:

  • Liver cancer. This drug is used when the tumor is unable to be completely removed with surgery.
  • Advanced kidney cancer
  • Thyroid cancer. This drug is used for a type of thyroid cancer that doesn’t respond to radioactive iodine treatment. It’s given when the cancer is recurrent (keeps coming back) or has metastasized (spread to other parts of your body) and is progressing.

How it works

Sorafenib belongs to a class of drugs called kinase inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Kinases are enzymes that cancer cells need to communicate and reproduce. Sorafenib works by stopping kinases from working. This may kill cancer cells.

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SECTION 2 of 5

sorafenib Side Effects

Oral tablet

More common side effects

The more common side effects of sorafenib can include:

  • diarrhea

  • tiredness

  • infection

  • hair loss

  • redness, pain, swelling, or blisters on the palms of your hands or soles of your feet

  • rash

  • loss of appetite

  • weight loss

  • nausea

  • stomach pain

  • high blood pressure

  • hemorrhage (severe bleeding)

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Heart rhythm problems. Symptoms can include:

    • faintness, lightheadedness, or dizziness
    • fast or irregular heart rhythm
  • Bleeding

  • Myocardial ischemia (lack of blood supply to your heart). Symptoms can include:

    • chest pain
  • Heart attack. Symptoms can include:

    • chest pain
    • shortness of breath
    • discomfort in your upper body
  • Severe or persistent skin reactions. These include serious conditions called Stevens-Johnson syndrome or toxic epidermal necrolysis. Symptoms can include:

    • blisters
    • peeling skin
    • painful rash
  • Perforations (tears or openings) in the wall of your stomach or intestines. Symptoms can include:

    • high fever
    • nausea
    • vomiting
    • severe stomach pain
  • Inflammation of your liver. This can cause increased liver function test results, which can be a sign of liver damage. It can also cause liver failure. This side effect may be fatal (cause death). Symptoms can include:

    • jaundice (yellowing of your skin or the whites of your eyes)
    • dark, tea-colored urine
    • light-colored stools
    • nausea or vomiting
    • pain in your abdominal area
  • Severe skin reactions. Symptoms can include:

    • redness, pain, swelling, or blisters on the palms of your hands or soles of your feet
    • skin rash
    • blistering and peeling of your skin or the inside of your mouth
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Sorafenib may cause extreme drowsiness.

This drug may increase your blood pressure. Your doctor will check your blood pressure every week during your first 6 weeks of treatment. They’ll check it regularly after that.

If you have severe side effects, skin reactions, or plan to have surgery, your doctor may have you stop taking this drug. Your doctor may or may not have you start taking it again. If they do, they may reduce your dose or reduce how often you take it.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 5

sorafenib May Interact with Other Medications

Oral tablet

Sorafenib can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Food interactions

You shouldn’t take sorafenib with food. High-fat meals decrease the amount of sorafenib in your body. Take this drug either 1 hour before you eat or 2 hours after.

Medications that might interact with this drug

Drugs you should not use with sorafenib

Do not take these drugs with sorafenib. Doing so can cause dangerous effects in the body. Examples of these drugs include:

  • Carboplatin and paclitaxel
    • If you have lung cancer, taking these drugs with sorafenib can be fatal. 

Interactions that increase your risk of side effects
  • Side effects from other drugs: Taking sorafenib with certain medications raises your risk of side effects from these drugs. This is because the amount of sorafenib in your body may be increased. Examples of these drugs include:
    • Warfarin
      • Sorafenib can increase your risk of bleeding from warfarin. Your doctor should monitor your international normalized ratio (INR) levels if you take these drugs together.

Interactions that can make your drugs less effective
  • When sorafenib is less effective: When sorafenib is used with certain drugs, it may not work as well to treat your condition. This is because the amount of sorafenib in your body may be decreased. Examples of these drugs include:
    • Phenobarbital, phenytoin, and carbamazepine
      • Your doctor may switch you to a different drug if you’re taking any of these drugs while you’re taking sorafenib.
    • Rifampin and rifabutin
      • Your doctor may switch you to a different drug  if you’re taking either of these drugs while you’re taking sorafenib.
    • Neomycin
      • Your doctor may switch you to a different drug to treat your infection while you’re taking sorafenib.
    • St. John’s wort
      • Your doctor may tell you to stop taking St. John’s wort while you’re taking sorafenib.
    • Proton pump inhibitors, such as omeprazole
      • If sorafenib isn’t working well, your doctor may tell you to stop taking the proton pump inhibitor.
    • Dexamethasone
      • Your doctor may have you stop taking this drug while you’re taking sorafenib.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Sorafenib warnings
blood pressure warning
People with high blood pressure

This drug may make your high blood pressure worse. If your blood pressure stays high even though you’re taking blood pressure medications, your doctor may have you stop taking this drug temporarily or permanently.

upcoming surgery warning
People with plans to have surgery

This drug may make it difficult for wounds to heal. Your doctor may tell you to stop taking this drug before, during, and after your surgery. Your doctor will decide when you should start taking it again based on how well your wounds heal.

heart rhythm warning
People with irregular heart rhythm

This drug can cause QT prolongation (changes in your heart rhythm). If you have an irregular rhythm in the ventricles of your heart, your doctor may put you on a different drug.

myocardial ischemia warning
People with myocardial ischemia

This drug can cause or worsen myocardial ischemia (lack of blood supply to your heart). Ask your doctor if this drug is safe for you if you have this condition.

heart attack warning
People with a history of heart attack

This drug can cause a heart attack in some people. If you have a history of heart attack, your doctor may give you a different medication instead of sorafenib.

liver problem warning
People with liver problems

This drug may increase your liver function test results, which can be a sign of liver damage. It can also cause hepatitis (swelling or inflammation of your liver) and other liver damage. These problems can lead to liver failure and may be fatal (cause death). If you have liver problems, your doctor may give you a different medication instead of sorafenib.

severe bleeding warning
People with hemorrhage (severe bleeding)

This drug may cause bleeding in some people. If you have active bleeding, you should not take this drug.

stomach and intestines
People with a perforation in their stomach or intestines

This drug may cause bleeding in some people. If you have bleeding due to a perforation (tear or open hole) in your stomach or intestines, you should not take this drug.

pregnancy warning
Pregnant women

Sorafenib is a category D pregnancy drug. That means two things:

  1. Research in humans has shown adverse effects to the fetus when the mother takes the drug.
  2. This drug should only be used during pregnancy in serious cases where it's needed to treat a dangerous condition in the mother.

Talk to your doctor if you’re pregnant or planning to become pregnant. Ask your doctor to tell you about the specific harm that may be done to the fetus. This drug should be only used if the potential risk to the fetus is acceptable given the drug’s potential benefit.

Women who take this drug should use effective birth control and avoid pregnancy during treatment. Men who take this drug should also use effective birth control. They should avoid getting a woman pregnant during treatment and for at least 2 weeks after stopping treatment.

breast feeding warning
Women who are breast-feeding

Sorafenib may pass into breast milk and cause side effects in a child who is breastfed.

Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

senior warning
For seniors

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. Your doctor may lower your dose of this drug.

childrens warning
For children

This drug hasn’t been studied in children. It shouldn’t be used in people younger than 18 years of age.

call the doctor
When to call the doctor

Call your doctor if:

  • You become pregnant while taking this drug.
  • You plan to have major surgery. This drug may make it difficult for the wounds from surgery to heal. Your doctor may tell you to stop taking this drug for a time before, during, and after the surgery.
allergy warning
Allergies

Sorafenib can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your throat or tongue

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

SECTION 4 of 5

How to Take sorafenib (Dosage)

Oral tablet

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • adverse reactions you have had because of sorafenib
  • how you react to the first dose

What are you taking this medication for?

Liver cancer

Brand: Nexavar

Form: oral tablet
Strength: 200 mg
Adult dosage (ages 18–64 years)
  • Typical starting dosage: Two tablets (400 mg total) taken twice per day. You should take this drug at least 1 hour before eating or 2 hours after.
  • Dosage decreases: Your doctor may reduce your dose or how often you take this drug if you have certain side effects, such as a severe skin reaction. You may even need to stop taking this medication.
  • Maximum dosage: 800 mg per day.
Child dosage (ages 0–17 years)

This drug hasn’t been studied in children. It shouldn’t be used in people younger than 18 years of age.

Kidney cancer

Brand: Nexavar

Form: oral tablet
Strength: 200 mg
Adult dosage (ages 18–64 years)
  • Typical starting dosage: Two tablets (400 mg total) taken twice per day. You should take this drug at least 1 hour before eating or 2 hours after.
  • Dosage decreases: Your doctor may reduce your dose or how often you take this drug if you have certain side effects, such as a severe skin reaction. You may even need to stop taking this medication.
  • Maximum dosage: 800 mg per day.
Child dosage (ages 0–17 years)

This drug hasn’t been studied in children. It shouldn’t be used in people younger than 18 years of age.

Thyroid cancer

Brand: Nexavar

Form: oral tablet
Strength: 200 mg
Adult dosage (ages 18–64 years)
  • Typical starting dosage: Two tablets (400 mg total) taken twice per day. You should take this drug at least 1 hour before eating or 2 hours after.
  • Dosage decreases: Your doctor may reduce your dose or how often you take this drug if you have certain side effects, such as a severe skin reaction. You may even need to stop taking this medication.
  • Maximum dosage: 800 mg per day.
Child dosage (ages 0–17 years)

This drug hasn’t been studied in children. It shouldn’t be used in people younger than 18 years of age.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Sorafenib comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all

Your cancer may get worse. This can be fatal (cause death).

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug include:

  • diarrhea
  • skin reactions

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away.

What to do if you miss a dose

If you miss a dose, take only your next dose at the regular time. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working

If your cancer causes symptoms, they should improve. Your doctor may also do an MRI scan to check if your cancer is responding to treatment with this drug.

Sorafenib is used for long-term treatment.

Important considerations for taking sorafenib
not with food
Don’t take sorafenib with food. Take this drug at least 1 hour before a meal or 2 hours after
timing considerations
Take sorafenib every 12 hours. Don't take it more often
do not crush
Do not cut or crush the tablet
storage considerations
Store this drug carefully
See Details
prescription is refillable
A prescription for this medication is refillable
See Details
travel considerations
Travel
See Details
self management considerations
Self-management
See Details
clinical monitoring considerations
Clinical monitoring
See Details
not usually stocked
Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead.
not usually stocked
Hidden costs
See Details
prior authorization needed
Insurance
See Details

Store this drug carefully

  • Store sorafenib at room temperature. Keep it between 59°F and 86°F (15°C and 30°C).
  • Don’t store this medication in moist or damp areas, such as bathrooms.

A prescription for this medication is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

This drug may increase your blood pressure. Your doctor may ask you to check your blood pressure at home using a blood pressure monitor. Your doctor, nurse, or pharmacist will show you how to use this device.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

  • Blood pressure. This drug may increase your blood pressure. Your doctor will check your blood pressure every week during the first 6 weeks of treatment. They will check it regularly after that.
  • Heart rhythm and heart function. If you have an increased risk of developing an irregular heart rhythm or have chest pain or ischemia, your doctor will check your heart with an electrocardiogram. They’ll also check your blood levels of electrolytes (potassium, magnesium, and calcium) during your treatment with this drug. If you develop an irregular heart rhythm, your doctor may stop your treatment for a time or permanently.
  • Liver function. Your doctor may do blood tests to check how well your liver is working. If your liver isn’t working well, your doctor may stop your treatment with this drug.
  • Thyroid function. If you’re taking this drug for thyroid cancer, it may increase your TSH levels. Your doctor will check your thyroid stimulating hormone (TSH) levels once a month during your treatment with this drug. If you take a thyroid replacement drug, your doctor will increase or decrease your dose based on the test results.
  • Blood cell counts. This drug may increase bleeding time and decrease your levels of platelets, red blood cells, and white blood cells. Your doctor may check your complete blood count during treatment. If your blood cell levels get too low, your doctor may decrease your dose or stop your treatment with this drug. If you’re taking certain blood thinners, your doctor will also monitor your international normalized ratio (INR) level.
  • Skin changes. This drug can cause severe skin reactions. Tell your doctor if you have any skin changes. If you have severe skin reactions, your doctor may stop your treatment with this drug.
  • Phosphate levels. This drug may cause low phosphate blood levels. Your doctor will check your phosphate levels during treatment. If your phosphate levels get too low, your doctor may decrease your dose or stop your treatment with this drug.
  • Weight. This drug can cause weight loss. Your doctor will check your weight.

Hidden costs

  • If your doctor tells you to check your blood pressure at home, you’ll need to purchase a home blood pressure monitor. These are available at most pharmacies.
  • You may need to have laboratory tests done or take other medications if you have side effects from this drug. The cost of these tests and medications will depend on your insurance coverage.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor may need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

SECTION 5 of 5

How Much Does sorafenib Cost?

Oral tablet

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These prices represent the lowest priced national pharmacies for sorafenib on GoodRx. They may be lower than your insurance.

Show Sources

  • Bayer HealthCare Pharmaceuticals, Inc. (2013, November). Nexavar (sorafenib) oral tablets [package insert]. Whippany, NJ.

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on February 8, 2016

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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