Side effects and mitigation methods of Sorafenib
Sorafenib is a multi kinase inhibitor primarily used for the treatment of liver cancer, kidney cancer, and thyroid cancer. Its common side effects include skin reactions, gastrointestinal symptoms, and hypertension, most of which can be relieved through symptomatic treatment. The following provides a detailed explanation from two aspects: classification of side effects and mitigation measures.
1. Common side effects and treatment
(1) Skin reaction
Hand and foot skin reactions: manifested as redness, swelling, flaking, and pain. It is recommended to wear loose shoes and socks, use urea ointment to moisturize, and avoid prolonged friction. In severe cases, medication should be reduced or suspended.
Skin rash: mostly papules, can be treated with topical corticosteroid ointment. Avoid direct sunlight and use SPF30+sunscreen.
(2) Gastrointestinal symptoms
Diarrhea: The incidence rate is about 30%. It is recommended to have a low fiber diet and supplement electrolytes. Loperamide can be used at discretion.
Nausea and vomiting: Eat in small portions and use 5-HT3 receptor antagonists if necessary.
2. Serious side effects to be wary of
(1) Cardiovascular system
Hypertension: It is common in the early stages of medication and requires weekly monitoring of blood pressure. If the blood pressure is greater than 150/100mmHg, antihypertensive treatment should be initiated.
Myocardial ischemia: rare but severe, chest pain should be immediately discontinued and medical attention sought.
(2) Risk of bleeding
May prolong clotting time, manifested as nosebleeds and gum bleeding. Avoid using anticoagulants simultaneously, and discontinue medication if severe bleeding occurs.
(3) Abnormal liver function
About 10% of patients experience elevated transaminase levels. Monitor liver function monthly before and during treatment, and discontinue medication if ALT>5 times the normal value.
3. Precautions for special populations
(1) Elderly patients
Age 65 and above are more prone to fatigue and hypertension, and it is recommended to reduce the starting dose by half.
(2) Liver and kidney dysfunction
Child Pugh A/B grade liver cancer patients do not require dose adjustment; Reduce severe kidney damage (eGFR<30) to 200mg/day.
(3) Pregnancy and lactation
It has embryonic toxicity, and patients of childbearing age need to take dual contraceptive measures. Prohibited during lactation.
4. Drug interactions
CYP3A4 inducers (such as rifampicin) can reduce drug efficacy, while inhibitors (such as ketoconazole) may increase toxicity. INR monitoring needs to be strengthened when combined with warfarin.
Disclaimer：《Side effects and mitigation methods of Sorafenib》Edited and sorted by Seagull Pharmacy's editors. Please contact us in time if there is any infringement. In addition, the suggestions for drug usage, dosage and disease mentioned in the article are only for medical staff's reference, and can not be used as any basis for medication！