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Sorafenib ( Nexavar)

 

Warning: Using Sorafenib puts patients are an elevated risk for heart problems such as ischemia and heart attack (infarction). Hemorrhage and high blood pressure (hypertension) are also common risks. The most frequently reported side effects affect the skin of the feet and hands. Blistering, oozing, and rashes are frequently observed. Severe pain experienced on the soles of the feet and palms of the hands has also been reported. Other side effects include easy bleeding and bruising, nausea, sweating, feeling short of breath, rapid weight gain, and loss of balance.

Rated D for use during pregnancy, this drug can cause birth defects and/or fetal loss. Nursing mothers should avoid the use of this drug, and those using this drug should be on birth control prior to and during treatment, as well as at least two weeks after the cessation of treatment.

Indications:  Nexavar is an anti-cancer drug and Sorafenib is a generic name under which this drug is administered. It is indicated for the treatment of specific liver and kidney cancers. It is intended for use in the treatment of inoperable hepatocellular carncinoma and advanced renal cell carcinoma.

By interfering with cell growth in these forms of cancer, serafenib slows the spread of liver and kidney cancer cells through the body.

Dosage:  This drug comes in tablet form and is intended for oral use. The prescribed daily dose is 400 mg per day. This total daily dose is to be taken in two divided doses of 200 mg each. For highest bioavailability, this drug should be taken on an empty stomach, with water, at least an hour prior or two hours after food ingestion.

Missed doses should be taken as soon as they are remembered, unless it is nearly time for the next dose. More than one dose should never be taken at any given time, despite the missing of previous doses. If it is suspected that multiple doses have been ingested at one time, medical attention should be sought.  

Overdose: Sorafenib overdose can be dangerous if taken for a long term. Chemotherapy drugs, including Sorafenib, tend to lead to a decrease in white blood cells and platelets which puts you at risk of serious infections. Follow the directions on the prescription label, or talk to your physician or pharmacist if you don’t understand the indication. Sorafenib is a strong medication; take it as prescribed.  

Missing dose: It is very important to take the medication around the same time every day.  In case you forget to take a dose, take the missed one as soon as you remember it. However, if it is time for your next dose,  do not double the next dose to recover the missed one; it can be dangerous. Contact your doctor or wait to go back to your regular schedule. 

Storage: store Sorafenib at room temperature, away from direct sunlight, moisture and heat. Keep Sorafenib and all medications out of the reach of children. Do not store Sorafenib in the bathroom. Sorafenib and all other medications should not be used beyond the expiration date printed on the container.  

Contraindications: Patients who have a history of allergic reaction to Nexavar should not take Sorafenib. Patients suffering from squamous cell lung cancer should not take this drug concurrently with carboplatin and paclitaxel.

Mechanism of action (MOA): Sorafenib is a multikinase inhibitor; by its antiangiogenic action, it slows or stops the growth of cancerous cells, and delay the growth of new blood vessels that feed cancer cells.  

Interactions: Serafenib bioavailability was inhibited by concurrent use with other CYP3A4 activity inducers. Examples of CYP3A4 activity inducers include phenobarbital, rifabutin, carbamazepine, St. John's wort, rifampin, phenytoin, dexamethasone, rifabutin, and rifampin. Coumadin also affected the absorption of this drug.

Concurrent use of neomycin also significantly impacted the absorption of Sorafenib in patients. The affect on absorption with the use of other antibiotics has not been adequately researched.

In general, Tell your doctor or pharmacist if you are taking or planning to take any of these medications:  

  • Warfarin (Coumadin)
  • Bupropion (Wellbutrin, Zyban)
  • Carbamazepine (Equetro, Tegretol)
  • Cyclophosphamide (Cytoxan, Neosar)
  • Dexamethasone
  • Doxorubicin (Doxil, Adriamycin)
  • Efavirenz (Sustiva)
  • Ifosfamide
  • Irinotecan (Camptosar)
  • Methadone (Dolophine, Methadose)
  • Phenobarbital
  • Phenytoin (Dilantin, Phenytek)
  • Rifampin (Rifadin, Rimactane).  

Side effects: Sorafenib not only attacks cancer cells but also healthy cells, which often leads, in most patients, to the following side effects:    

  • hair loss  
  • diarrhea  
  • headache  
  • nausea and vomitting  
  • blue-green urine   
  • ulcers in the mouth and lips   
  • reduced urine volume  

If the side effects above persist for weeks, contact your oncologist. In addition, contact your doctor immediately if you experience any of these symptoms:  

  • bluish discoloration of the whites of the eyes
  • seizures
  • yellowing of eyes or skin
  • black, tarry stools
  • persistent cough
  • shortness of breath
  • abnormal or accelerated heartbeat
  • stomach pain
  • blood in urine or stool
  • fever associated with chills
  • pain in lower back or side
  • pain or difficulty when passing urine
  • swelling of feet and lower legs
  • Unusual bleeding or bruising 

 

 

 

References: 

1 - fda.gov, FDA Approves Sorafenib for Patients with Inoperable Liver Cancer  

2 - nlm.nih.gov, Sorafenib 

3 - doctissimo.fr, Sorafenib