Nexavar (Sorafenib)

Sorafenib, the active ingredient in Nexavar, is a multikinase inhibitor presented as a tablet for oral use. It is indicated for advanced renal cell carcinoma, unresectable hepatocellular carcinoma, and radioiodine‑refractory differentiated thyroid carcinoma in adult patients.

GNH USA supplies Nexavar as a licensed, GDP‑compliant international pharmaceutical supplier serving hospitals, oncology centres, pharmacies and clinics worldwide.

Sorafenib is indicated for several advanced solid tumours that rely on kinase‑driven growth and angiogenesis.

- Advanced renal cell carcinoma: prolongs progression‑free survival in adults with metastatic disease. - Unresectable hepatocellular carcinoma: improves overall survival in patients not amenable to curative therapy. - Radioiodine‑refractory differentiated thyroid carcinoma: delays disease progression in patients with progressive disease.

Sorafenib is associated with a range of adverse reactions that vary in frequency and severity.

Common Side Effects: - Diarrhoea: frequent loose stools, may require supportive care. - Fatigue: persistent tiredness affecting daily activities. - Hand‑foot skin reaction: redness, swelling or pain on palms and soles. - Hypertension: elevated blood pressure, often requiring antihypertensive therapy. - Nausea and vomiting: gastrointestinal upset common during treatment. - Rash: skin eruptions of varying intensity.

Serious or Rare Side Effects: - Severe hypertension or hypertensive crisis. - Cardiac ischaemia or myocardial infarction. - Hepatic failure or marked transaminase elevation. - Gastrointestinal perforation or bleeding. - Severe skin reactions such as Stevens‑Johnson syndrome. - Arterial thromboembolic events including stroke.

Before initiating Sorafenib, clinicians should assess several safety parameters and counsel patients on potential risks.

- Monitor blood pressure: check regularly and treat hypertension promptly. - Assess liver function: perform baseline and periodic hepatic enzyme tests. - Evaluate cardiac status: consider ECG and cardiac history, especially in patients with risk factors. - Counsel on hand‑foot skin reaction: advise patients to report early signs and use moisturisers. - Avoid use in pregnancy: drug is contraindicated due to fetal risk. - Store at room temperature: keep in the original pack, protect from moisture and light.

Sorafenib may interact with other medicines, altering its effectiveness or increasing toxicity.

Major Interactions (Avoid): - Strong CYP3A4 inducers (e.g., rifampin, carbamazepine, St. John's wort): markedly reduce sorafenib exposure. - Concomitant use with anticoagulants (e.g., warfarin) or antiplatelet agents: heightened risk of bleeding. - QT‑prolonging drugs (e.g., sotalol, quinidine): may increase the risk of cardiac arrhythmias.

Moderate Interactions (Monitor Closely): - Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): increase sorafenib plasma levels. - Antihypertensive agents: sorafenib‑induced hypertension may require dose adjustment. - Drugs affecting gastric pH (e.g., proton‑pump inhibitors): may modestly affect absorption. - Herbal supplements with cardiovascular activity: monitor for additive effects on blood pressure.