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 cancer chemotherapy                                                             

 

Sorafenib ( Nexavar)

 

Brand name:  Nexavar 

 

Generic name: Sorafenib 

Therapeutic Class:  multikinase inhibitor (tyrosine kinase inhibitor, angiogenesis inhibitor, VEGF inhibitor)   

Manufacturer/Distributor:  Bayer Pharma   

FDA Approval: Sorafenib was approved by the US Food and Drug Administration (FDA) in 2005 for the treatment of renal cell carcinoma, a form of kidney cancer. 

Availability:   Sorafenib is available by prescription only  

 

Indications:  Sorafenib is indicated for the treatment of these two cancers:  

  • hepatocellular carcinoma (also called malignant hepatoma), a form of liver cancer   
  • Advanced renal cell cancer after failure of prior treatment with interferon alfa or interleukin-2 (IL-2), or in patients for whom these treatments are considered inadequate.    

Sorafenib can be prescribed to treat other medical conditions not listed in this article; contact your doctor or pharmacist for more information. 

Dosage form: Sorafenib comes as a tablet to be taken by mouth 

Dosage:  to prescribe you an effective dosage of Sorafenib, your oncologist will consider the type and severity of the cancer, whether or not you are taking other medications, your health status, and your body surface area (BSA). 

 Usually, the recommended dosage for adults is 400 mg, taken by mouth 2 times a day with water. Take the medication without food, one hour before or 2 hours after a meal. If you take Sorafenib with a meal, make sure its fat content is low. Take Sorafenib at around the same times every day. Swallow the tablets whole with a full glass of water; do not chew or crush them.  

In some cases, your doctor may recommend a different dosage; it is important that you do not change the dosage or stop the treatment without first consulting your doctor. Taking Sorafenib more or less may cause serious health problems, or lower its curative effect.  

Overdose: as with any drug, 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.  

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.    

Missing dose: do your best to take Sorafenib 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.   

Contraindication:  Sorafenib is contraindicated in the following conditions: 

  • pregnancy   
  • breastfeeding  
  • allergy to Sorafenib  or any of the constituents  
  • before taking Sorafenib, tell your doctor if you experience any of the 6 following conditions; the drug may aggravate these conditions:    

a)  chest pain  

b) liver disease  

c) high blood pressure 

d) bleeding problems 

e) heart attack or heart disease 

f) Non cancerous kidney disease.   

 

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:  talk you to your doctor before taking aspirin,  vitamins, nutritional supplements, or St. John's wort. Certain medication can interact with Sorafenib. Tell your doctor or pharmacist if you are taking 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 attack cancer cells but also healthy cells, which often leads, in most patients, to the following side effects:    

  • pregnancy   
  • breastfeeding  
  • 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