Nexavar (Sorafenib) belongs to a group of medications called multikinase inhibitors. Nexavar (Sorafenib) is an anticancer medication that interferes with cell communication, causing a slowing in the growth of cancer cells as well as delaying the growth of new blood vessels leading to the cancer cells. Nexavar (Sorafenib) is used to treat liver cancer (hepatocellular carcinoma) that cannot be removed by surgery. It is used to treat kidney cancer (renal clear cell carcinoma) that is advanced or has spread to other areas of the body for adults who have not responded to or can't be treated with other therapies. It is also used to treat advanced Thyroid cancer or thyroid cancer that has spread when radioactive iodine has not been effective.

Nexavar (Sorafenib) may be available under multiple brand names and/or in several different forms. Any specific brand name of Nexavar (Sorafenib) may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of Nexavar (Sorafenib) may not be used for all of the conditions discussed here.

Your doctor may have suggested Nexavar (Sorafenib) for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking Nexavar (Sorafenib), speak to your doctor. Do not stop taking Nexavar (Sorafenib) without consulting your doctor.

Do not give Nexavar (Sorafenib) to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take Nexavar (Sorafenib) if their doctor has not prescribed it.

The recommended adult dose is 400 mg taken by mouth twice daily, with a large glass of water. Take Nexavar (Sorafenib) without food or with a meal that is low-to-moderate in fat content. If you experience certain side effects, your doctor may suggest a lower dose of 400 mg once daily for 28 days or indefinitely.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take Nexavar (Sorafenib) exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Nexavar (Sorafenib) at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Nexavar (Sorafenib). If you are concerned about side effects, discuss the risks and benefits of Nexavar (Sorafenib) with your doctor.

The following side effects have been reported by at least 1% of people taking Nexavar (Sorafenib). Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal pain
• Acne
• bone pain
• changed sense of taste
• Constipation
• Diarrhea
• difficulty swallowing
• Dry Mouth
• dry skin
• Eczema (e.g., inflamed, dry, or scaly skin that peels)
• fatigue
• flu-like symptoms
• flushing
• hair loss
• hoarseness of voice
• impotence (e.g., erection problems)
• indigestion or heartburn
• inflammation or sores of the mouth and tongue
• joint pain
• loss of appetite
• muscle pain
• muscle spasms
• nausea
• rash or itchiness
• persistent runny nose
• skin inflammation at site of radiation treatment
• tingling sensation in hands or feet
• vomiting
• weakness
• weight loss

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• dehydration
• difficulty breathing or breathlessness
• Fever
• increase in blood pressure
• inflammation of small blood vessels (e.g., rash, skin redness, small blood spots under skin)
• lung inflammation (e.g., shortness of breath, cough)
• new or irregular growths on the skin
• symptoms of an abnormal heart rhythm (e.g.: dizziness, fainting, pounding or irregular heartbeat, seizures)
• signs of Anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• signs of Depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• signs of heart failure (e.g., fast, irregular heartbeat or pulse, chest pain, sudden weight gain, difficulty breathing, leg swelling)
• signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, listlessness)
• signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of low blood calcium levels (e.g., muscle spasms, tingling or numbness of the fingers and mouth, twitching, memory loss)
• signs of low potassium levels in the blood (e.g., weakness, fatigue, muscle cramps, irregular heartbeat)
• signs of muscle damage (e.g., unexplained muscle pain, tenderness or weakness, or brown or discoloured urine)
• signs of skin reaction in the hands or feet (e.g., redness, pain, swelling or blistering of palms of hands or soles of feet)
• symptoms of low sodium in the blood (e.g., tiredness, weakness, confusion, achy, stiff or uncoordinated muscles)
• symptoms of decreased thyroid activity (e.g., fatigue, weight gain, feeling cold, constipation)
• symptoms of increased thyroid activity (e.g., anxiety, fast heartbeat, nervousness, sweating)
• weight loss

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a serious allergic reaction (e.g., difficulty breathing or wheezing, Hives, swelling of face or throat)
• signs of bleeding in the stomach (e.g., bloody, black, or tarry stools; spitting up of blood; vomiting blood or material that looks like coffee grounds)
• signs of a severe skin reaction (e.g., blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, a rash combined with fever or discomfort)
• symptoms of an artery dissection (e.g., sudden, severe abdominal, back, or chest pain)
• symptoms of an artery Aneurysm (e.g., a bulge in the wall of an artery – strong pain in the neck or back, cough, coughing up blood, unusual pulsing in the chest or abdomen, hoarseness)
• symptoms of a Heart Attack (e.g., cold sweat, severe chest pain, shortness of breath)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Nexavar (Sorafenib).

Each red, round, film-coated tablet, with the Bayer cross logo stamped on one side and "200" on the other, contains 200 mg of Nexavar (Sorafenib). Nonmedicinal ingredients: croscarmellose sodium, microcrystalline cellulose, hydroxypropyl methylcellulose, sodium lauryl sulfate, magnesium stearate, macrogol, titanium dioxide, and ferric oxide red.

Do not take Nexavar (Sorafenib) if you are allergic to Nexavar (Sorafenib) or any ingredients of the medication.

There may be an interaction between Nexavar (Sorafenib) and any of the following:

• Acetaminophen
• antiarrhythmics (e.g., amiodarone, disopyramide, Dronedarone, procainamide, quinidine, sotalol)
• anticancer mediations (e.g., Carboplatin, Docetaxel, Doxorubicin, Irinotecan, Paclitaxel)
• Apalutamide
• "azole" antifungals (e.g., itraconazole, ketoconazole, Voriconazole)
• Baricitinib
• BCG
• bisphosphonates (e.g., Alendronate, etidronate)
• Chlorpromazine
• Clozapine
• Cobicistat
• conivaptan
• Deferiprone
• echinacea
• Enzalutamide
• Fingolimod
• Glyburide
• haloperidol
• Hepatitis C antivirals (e.g., dasabuvir, ombitasvir, paritaprevir)
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• Leflunomide
• lumacaftor and Ivacaftor
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• Mesalamine
• methadone
• mifepristone
• Mitotane
• neomycin
• Ocrelizumab
• Pimecrolimus
• other protein kinase inhibitors (e.g., Ceritinib, Lapatinib, Pazopanib, Sunitinib, Tofacitinib)
• proton pump inhibitors (e.g., Esomeprazole, Lansoprazole, Omeprazole)
• rifampin
• Roflumilast
• St. John's wort
• seizure medications (e.g., Carbamazepine, Phenobarbital, Phenytoin, primidone)
• Tacrolimus
• tofacitinib
• upadacitinib
• vaccines
• warfarin
• Ziprasidone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Nexavar (Sorafenib). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take Nexavar (Sorafenib).

Bleeding problems: Nexavar (Sorafenib) may increase your risk of bleeding. This risk may be greater if you are taking medications such as Warfarin or if you have bleeding problems. If you develop unexplained bruising, nosebleeds, dark or tarry stools, or start coughing up blood, contact your doctor immediately or seek immediate medical attention.

Blood pressure: Nexavar (Sorafenib) may increase blood pressure. The increase in blood pressure is usually mild-to-moderate and can be treated with blood pressure lowering medications. You and your doctor should monitor your blood pressure regularly while you are taking Nexavar (Sorafenib).

Electrolyte imbalances: If you have electrolyte imbalances (e.g., low potassium, magnesium, or calcium), an eating disorder, or vomiting or diarrhea, you should discuss with your doctor how Nexavar (Sorafenib) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Nexavar (Sorafenib), and whether any special monitoring is needed.

Gastrointestinal problems: On rare occasions, Nexavar (Sorafenib) can cause perforation of the stomach or intestines. If you experience severe abdominal pain, fever, vomiting, or nausea, contact your doctor immediately.

Hand-foot skin reaction: A rash on the palms of your hands as well as the soles of your feet may occur, usually within the first 12 weeks of using Nexavar (Sorafenib). It can vary in redness and itchiness, but it is possible that blistering and pain can develop. Speak to your doctor immediately if you develop a rash, pain, or blistering on your hands or feet.

Heart problems: Nexavar (Sorafenib) may affect your heart function and cause heart problems such as heart attack, decreased oxygen supply to the heart, heart failure, and a slow heart rate. Get immediate medical attention if you experience shortness of breath, sudden chest pain, or an extremely slow heart rate. If you have a history of heart problems discuss with your doctor how Nexavar (Sorafenib) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Nexavar (Sorafenib), and whether any special monitoring is needed.

Infection: Nexavar (Sorafenib) can reduce the number of cells that fight infection in the body (white blood cells). If possible, avoid contact with people who have contagious infections. Tell your doctor immediately if you notice signs of an infection, such as fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness. Your doctor will do blood tests regularly to monitor the number of specific types of blood cells in your blood.

Liver problems: Liver disease or reduced liver function may cause Nexavar (Sorafenib) to build up in the body, causing side effects. Nexavar (Sorafenib) has not been studied for use by people who have severe liver problems and may itself cause liver problems. Nexavar (Sorafenib) may reduce liver function and can cause liver failure. If you have liver problems, discuss with your doctor how Nexavar (Sorafenib) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Nexavar (Sorafenib), and whether any special monitoring is needed.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Lung inflammation: Lung inflammation (interstitial lung disease) causing difficulty breathing has occurred on rare occasions for some people taking Nexavar (Sorafenib). This complication can be serious and sometimes fatal. If you experience new or worsening shortness of breath or cough (with or without fever) at any time while you are taking Nexavar (Sorafenib), contact your doctor immediately.

QT prolongation: Nexavar (Sorafenib) can affect the electrical activity of the heart causing QT prolongation. You are more at risk for QT prolongation and its complications (e.g., abnormal heartbeat, fainting, or death) if you:

• are female
• are older than 65 years of age
• are taking other medications that prolong the QT interval (e.g., quinidine, Sotalol, Amiodarone, Disopyramide, Haloperidol, Amitriptyline, Methadone, clarithromycin, erythromycin, moxifloxacin, fluconazole)
• have a family history of sudden death related to heart problems
• have a history of heart disease or abnormal heart rhythms
• have a slow heart rate
• have congenital prolongation of the QT interval
• have Diabetes
• have had a Stroke
• have low potassium, magnesium, or calcium levels
• have nutritional deficiencies
• have reduced liver function

If you have any of these risk factors you should discuss with your doctor how Nexavar (Sorafenib) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Nexavar (Sorafenib), and whether any special monitoring is needed. If you experience dizziness, fainting, a seizure, or a rapid and pounding or irregular heartbeat, get immediate medication attention.

Wound healing: Nexavar (Sorafenib) may affect the way wounds heal. If you are having surgery, a dental procedure, or have recently had surgery, let your doctor know. You may need to temporarily stop taking Nexavar (Sorafenib). Your doctor will suggest when you can restart the medication.

Pregnancy: Nexavar (Sorafenib) should not be used during pregnancy unless the benefits outweigh the risks. Nexavar (Sorafenib) may reduce fertility in men and women. Effective contraception must be used while taking Nexavar (Sorafenib) and for at least 2 weeks after stopping Nexavar (Sorafenib).

Breast-feeding: It is not known if Nexavar (Sorafenib) passes into breast milk. If you are a breast-feeding mother and are taking Nexavar (Sorafenib), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Nexavar (Sorafenib) have not been established for children.