Drug-Drug:

• May ↑ risk of bleeding with warfarin.
• CYP3A4 inducers, including rifampin, phenytoin, phenobarbital, carbamazepine, and dexamethasone, may ↓ levels and effectiveness.
• Irinotecan, docetaxel, and doxorubicin may ↑ levels and risk of toxicity.
• Neomycin may ↓ levels.

Drug-Natural Products:

• St. John's wort may ↓ levels and effectiveness.

(Generic available)

• Tablets: 200 mg;

• PO (Adults): 400 mg twice daily until disease progression or unacceptable toxicity.

NexAVAR

• Inhibits tumor growth by inhibiting multikinase enzyme, some of which are involved in angiogenesis.

• Decreased growth and spread of advanced renal cell carcinoma, hepatocellular carcinoma, and differentiated thyroid carcinoma.

Therapeutic Classification: antineoplastics

Pharmacologic Classification: kinase inhibitors

Absorption: 38–49% absorbed following oral administration; absorption ↓ by high-fat meals.

Distribution: Unknown.

Protein Binding: 99.5%.

Metabolism/Excretion: Primarily metabolized by the liver via the CYP3A4 isoenzyme and UGT1A9; some metabolites are pharmacologically active. Primarily excreted in feces (77%), with 51% being excreted as unchanged drug. 19% excreted in urine, primarily as metabolites.

Half-life: 25–48 hr.

(plasma concentrations)

• Instruct patient to take sorafenib as directed. If a dose is missed, skip dose and take next dose at regular time; do not double dose. Do not share medication with others; may be harmful. Advise patient to read Patient Information before starting therapy and with each Rx refill in case of changes.
• Inform patient of risk of hand-foot skin reactions, hypertension, and requirement for monitoring risk of bleeding and cardiac ischemia. Advise patient to notify health care professional promptly if bleeding or chest pain occurs.
• Advise patient to notify health care professional immediately if signs and symptoms of hepatotoxicity (yellow skin or white part of eyes, dark tea-colored urine, light-colored bowel movements, worsening nausea, worsening vomiting, abdominal pain), rash, blistering or peeling of skin or inside of mouth, shortness of breath, cough, dizziness, fainting, or fever occur.
• Advise patient to notify health care professional of therapy prior to treatment, dental procedure, or surgery. Sorafenib therapy should be interrupted in patients undergoing major surgery.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially St. John's wort.
• Discuss with patient the possibility of hair loss. Explore coping strategies.
• May cause fetal harm. Advise females of reproductive potential to use effective contraception during and for 6 mo after stopping therapy. Advise males with female partners of reproductive potential to use effective contraception during and for 3 mo after last dose. Advise female patients to avoid breastfeeding during and for 2 wk after last dose of therapy. May impair female and male fertility.

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