Sorafenib (patient information)

# Why is this medication prescribed
Sorafenib is used to treat advanced renal cell carcinoma (a type of cancer that begins in the kidneys). Sorafenib is in a class of medications called multikinase inhibitors. It works by slowing the spread of cancer cells.

# How should this medicine be used
Sorafenib comes as a tablet to take by mouth. It is usually taken twice a day. Sorafenib is taken without food, one hour before or 2 hours after a meal. Take sorafenib at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take sorafenib exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Swallow the tablets whole with water. Do not split, chew, or crush them.
Your doctor may decrease your dose of sorafenib during your treatment, or may tell you to stop taking sorafenib for a period of time if you experience side effects. Be sure to tell your doctor how you are feeling during your treatment with sorafenib.
Continue to take sorafenib even if you feel well. Do not stop taking sorafenib without talking to your doctor.
Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# What special precautions should I follow
Before taking sorafenib:
- tell your doctor and pharmacist if you are allergic to sorafenib or any other medications.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: anticoagulants (blood thinners) such as 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), or rifampin (Rifadin, Rimactane). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor what herbal products you are taking, especially St. John's wort.
- tell your doctor if you have or have ever had high blood pressure, bleeding problems, chest pain, a heart attack, kidney disease other than kidney cancer, or heart or liver disease.
- you should know that sorafenib may decrease fertility in men and women. However, you should not assume that you or your partner cannot become pregnant. If you are pregnant or breastfeeding, you should tell your doctor before you begin taking this drug. Use a reliable method of birth control during your treatment and for 2 weeks after you stop taking sorafenib. Talk to your doctor about birth control methods that will work for you. Sorafenib may harm the fetus.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking sorafenib.

# What special dietary instructions should I follow
Unless your doctor tells you otherwise, continue your normal diet.

# What should I do if I forget a dose
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

# Side effects

## Mild side effects
Sorafenib may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- tiredness
- weakness
- rash
- skin redness
- hair loss
- itching
- dry skin
- nausea
- vomiting
- loss of appetite
- constipation
- diarrhea
- stomach pain
- dry mouth
- mouth sores
- weight loss
- joint pain
- numbness, pain or tingling in hands or feet
- headache

## Severe side effects
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
- unusual bruising or bleeding
- black and/or tarry stools
- red blood in stools
- bloody vomit
- vomiting material that looks like coffee grounds
- severe abdominal pain
- chest pain
- shortness of breath
- sudden severe headache
- confusion
- changes in vision
- seizures
- redness, pain, swelling or blisters on the palms of the hands or soles of the feet
Sorafenib may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

# What storage conditions are needed for this medicine
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- diarrhea
- rash or other skin problems

# What other information should I know
Keep all appointments with your doctor. Your doctor will check your blood pressure every week during the first six weeks of your treatment and then from time to time as needed.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Nexavar