Home Drug Guide Sorafenib Tosylate

Drug Guide

Generic Name

Sorafenib Tosylate

Brand Names Nexavar

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Multikinase inhibitor

FDA Approved Indications

  • Hepatocellular carcinoma (liver cancer)
  • Advanced renal cell carcinoma
  • Thyroid carcinoma (differentiated thyroid carcinoma after radioactive iodine failure)

Mechanism of Action

Sorafenib inhibits multiple intracellular and cell surface kinases involved in tumor cell proliferation and angiogenesis, including RAF kinases, VEGFR, PDGFR, and KIT, thereby reducing tumor growth and vascularization.

Dosage and Administration

Adult: 400 mg orally twice daily, with or without food. Dose adjustments may be necessary based on tolerance.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; consider age-related decline in organ function.

Renal Impairment: Adjust dose in severe renal impairment; no specific dose adjustment recommended for mild to moderate impairment.

Hepatic Impairment: Use with caution; no specific dose recommendation for mild impairment; contraindicated in severe impairment.

Pharmacokinetics

Absorption: Well absorbed orally, with peak concentrations in about 3 hours.

Distribution: Extensive distribution; protein binding >99.5%.

Metabolism: Primarily metabolized by hepatic CYP3A4 and UGT1A9.

Excretion: Excreted mostly in feces; minor amount in urine.

Half Life: Approximately 25 to 48 hours.

Contraindications

  • Hypersensitivity to sorafenib or any component of the formulation.

Precautions

  • Risk of bleeding, hypertension, cardiac ischemia, wound healing complications, gastrointestinal perforation, hepatic toxicity, renal failure, skin reactions. Use with caution in patients with cardiovascular disease, bleeding risk, or impaired liver function.

Adverse Reactions - Common

  • Hand-foot skin reaction (Very common)
  • Diarrhea (Common)
  • Fatigue (Common)
  • Nausea (Common)
  • Hair depigmentation or alopecia (Common)

Adverse Reactions - Serious

  • Hypertension (Uncommon)
  • Bleeding complications (hemorrhage) (Uncommon)
  • Cardiac ischemia or infarction (Rare)
  • Hepatic toxicity (Rare)
  • Gastrointestinal perforation (Rare)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) may increase sorafenib levels.
  • CYP3A4 inducers (e.g., rifampin) may decrease efficacy.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, liver function tests, complete blood counts, wound assessment, and signs of bleeding.

Diagnoses:

  • Risk for bleeding
  • Impaired skin integrity
  • Risk for hypertension

Implementation: Administer with or without food. Monitor patient for adverse effects, especially bleeding and hypertension. Adjust dose as needed based on tolerance and side effects.

Evaluation: Assess efficacy through tumor response, and safety by monitoring side effects and lab parameters.

Patient/Family Teaching

  • Report any unusual bleeding or bruising.
  • Protect skin from excessive sun and injury.
  • Avoid strenuous activity if bleeding risk exists.
  • Maintain adherence to medication regimen.
  • Monitor and report symptoms of hypertension or hepatic issues.

Special Considerations

Black Box Warnings:

  • Hepatotoxicity, hemorrhage, and developmental risk of fetal harm.

Genetic Factors: None specific.

Lab Test Interference: May alter levels of blood pressure and liver function tests.

Overdose Management

Signs/Symptoms: Severe skin reactions, bleeding, hypertension, or other serious toxicity.

Treatment: Supportive care; consider activated charcoal if ingestion is recent; hemodialysis is unlikely to be effective due to high protein binding.

Storage and Handling

Storage: Store at room temperature, away from moisture, light, and heat.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.