Sorafenib

Sorafenib is a type of targeted cancer drug. You pronounce it as sor-a-feh-nib.

It is a possible treatment for:

  • a type of liver cancer called hepatocellular carcinoma
  • some types of thyroid cancer when radioactive iodine treatment has not worked
  • advanced kidney cancer

How does sorafenib work?

Sorafenib is a type of targeted cancer drug called a cancer growth blocker. It works in two ways. It stops:

  • signals that tell cancer cells to grow
  • cancer cells forming new blood vessels, which they need to be able to grow

How do you take sorafenib?

You have sorafenib as tablets. You usually take them twice a day, with a glass of water.

You should take the tablets either without food or with a meal that contains low amounts of fat. A high fat meal may make sorafenib work less well.

If you are going to have a high fat meal, take the tablets at least 1 hour before or 2 hours afterwards.

You must take tablets according to the instructions your doctor or pharmacist gives you.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

How often do you have sorafenib?

You continue taking sorafenib for as long as the treatment is working and you are not experiencing too many side effects. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV Open a glossary item. This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system Open a glossary item and can cause the virus to become active again (reactivation). 

What are the side effects of sorafenib?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects

  • your side effects aren’t getting any better

  • your side effects are getting worse

  • the side effects are affecting your daily life

Early treatment can help manage side effects better. 

Contact your advice line immediately if you have signs of infection, including a:

  • temperature of 37.5C or above
  • temperature below 36C
  • severe skin reaction

Signs of a severe skin reaction include peeling or blistering of the skin.

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Soreness, redness and peeling on palms and soles of feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Weakness and fatigue

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

High temperature, fever or chills

High temperature (fever, shivering or chills) can happen with this drug. This is because it can affect your body’s ability to control temperature. Having a fever with this drug doesn’t always mean you have an infection. But you should call your advice line, as an infection can be serious if not treated quickly.

High blood pressure

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. You have your blood pressure checked regularly.

Bleeding

There is a risk of bleeding with sorafenib. Let your doctor or nurse know straight away if you have dizziness, fainting, loss of control of any part of the body, darker poo or if you have nose bleeds or cough up blood.

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Skin changes

You might notice skin changes, such as dryness, itching, rashes similar to acne or darker skin. More rarely, you might have thickening or peeling of your skin.

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

Very rarely, you might have a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening.

Hair thinning

Your hair may thin or you might lose hair in certain areas (patches). You're unlikely to lose all your hair. It usually grows back when you finish treatment. 

Other areas of hair that might be affected include your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. 

Pain

You might get pain in your joints, bones, mouth, tummy (abdomen) and at the site of the tumour. Tell your doctor or nurse if you have pain so they can give you painkillers and advice on what to do to help. 

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Low phosphate levels

Blood tests may show you have low phosphate levels. Your doctor can give you supplements to correct this.

Tell your doctor if you have any muscle weakness or confusion.

High levels of pancreatic enzymes in your blood

You might have high levels of substances (enzymes) called amylase and lipase in your blood. This doesn't usually cause symptoms. Changes in the enzyme levels usually return to normal when you stop the drug.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). . You might have one or more of them. They include:

  • breathlessness and looking pale due to a drop in red blood cells

  • low platelets which means you may bruise and bleed easily

  • lower levels of hormones made by your thyroid gland - you might feel tired, cold, sad or depressed

  • low levels of calcium, sodium and potassium in your blood - you have regular blood tests during treatment

  • low blood sugar levels

  • depression - let your doctor or nurse know if you have a change in mood

  • numbness or tingling in your fingers and toes

  • taste changes

  • ringing in your ears (tinnitus)

  • heart problems such as heart failure or heart attack. More rarely you might have a sudden increase in your blood pressure. Call 999 if you have chest pain

  • redness in your face and other areas of the skin (flushing)

  • runny nose

  • changes in voice

  • mouth problems such as sore or dry mouth, inflammation, mouth ulcers or a burning feeling on your tongue

  • heartburn and indigestion

  • difficulty swallowing

  • a type of skin cancer called squamous cell cancer - tell your doctor if you notice any skin changes

  • muscle pain or cramps

  • high levels of protein in your wee

  • your kidneys not working well (kidney failure)

  • erection problems

  • flu-like symptoms such as feeling hot or cold, shivery or aching - tell your doctor or nurse if you feel unwell

  • swollen or infected hair follicles (folliculitis)

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

  • an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness

  • higher levels of hormones made by your thyroid gland which can cause irregular or fast heart rate (palpitations), weight loss, anxiety and mood swings

  • lack of fluid in your body (dehydration)

  • changes in the brain that are usually reversible, causing a sudden onset of symptoms including headaches, dizziness, confusion, fits (seizures) and changes to vision (reversible posterior leukoencephalopathy syndrome)

  • lung problems such as inflammation

  • inflammation of your pancreas, gallbladder, bile duct or stomach. Or a hole may develop in your stomach or bowel (perforation)

  • changes in your liver that can make your skin and eyes look yellow, and have dark wee and pale coloured poo (stools)

  • swollen breasts that may feel tender or painful

  • • blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know ?

Other medicines, food and drink 

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for a few months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunistions

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having.

Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, and yellow fever.

You can usually have:

  • other vaccines, but they might not give you as much protection as usual
  • the flu vaccine (as an injection)
  • the coronavirus (COVID-19) vaccine

Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your immune system Open a glossary item is weakened.

Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.

More information about this treatment

For further information about this treatment go to the Medicines Health and Regulatory Authority (MHRA).

You can report any side effect you have to the MHRA as part of their Yellow Card Scheme.

  • Electronic Medicines Compendium

    Accessed June 2025

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • Sorafenib (Nexavar) 1055/15
    Scottish Medicines Consortium (SMC), 2015

  • Sorafenib (Nexavar) 482/08
    Scottish Medicines Consortium (SMC), 2016

  • Lenvatinib and sorafenib for treating differentiated thyroid cancer after radioactive iodine
    National Institute for Health and Care Excellence (NICE), 2018

  • Sorafenib for treating advanced hepatocellular carcinoma
    National Institute for Health and Care Excellence (NICE), 2017

Last reviewed: 
31 Jul 2025
Next review due: 
31 Jul 2028

Related links