Sorafenib - Overall Recommendations
Sorafenib CAN be Co-Administered with the Following Agents, IF Administered with Caution1,2
- Irinotecan (and other agents metabolised/eliminated by the UGT1A1 pathway)
- Carboplatin and paclitaxel
- St John’s Wort
- CYP2B6 and CYP2C8 substrates
Sorafenib CANNOT be Co-Administered with the Following Agents
- Carboplatin and paclitaxel in combination in patients with squamous cell lung cancer1,2
Additional Important Information when Prescribing Sorafenib
Sorafenib has been shown to prolong the QT/QTc interval, which may lead to an increased risk for ventricular arrhythmias.2 Medical oncologists should be aware of the risk of co-administration of drugs that prolong the QTc interval in patients given sorafenib.3 If a drug is indicated which also prolongs the QTc interval, an ECG should be obtained 24-48 hours before and 1 week after initiating the concomitant therapy.
Pharmacists should also routinely check for concomitant use of such QT prolonging drugs such as 5HT3 antagonists, antibiotics, antifungals and over the counter drugs such as domperidone.3
Consider increasing the dose of sorafenib to 1,000 mg/ 24 hours if co-administering with rifampicin or neomycin.4,5
The international normalised ratio should be monitored during concomitant use of warfarin and sorafenib.
- European Medicines Agency. Sorafenib (NEXAVAR). Summary of Product Characteristics. 2015.
- Food and Drug Administration. Sorafenib (Nexavar) Prescribing information. 2015.
- van Leeuwen RW, van Gelder T, Mathijssen RH, Jansman FG. Drug-drug interactions with tyrosine-kinase inhibitors: a clinical perspective. Lancet Oncol 2014; 15: e315-326.
- Pajares B, Torres E, Trigo JM et al. Tyrosine kinase inhibitors and drug interactions: a review with practical recommendations. Clin Transl Oncol 2012; 14: 94-101.
- Teo YL, Ho HK, Chan A. Metabolism-related pharmacokinetic drug-drug interactions with tyrosine kinase inhibitors: current understanding, challenges and recommendations. Br J Clin Pharmacol 2015; 79: 241-253.