Managing side effects

If you know what to expect, you can tell your doctor about it early. Watch out for signs of side effects and tell your doctor about any changes in how you feel. Your healthcare team has different ways to help manage some of the side effects of NEXAVAR. One approach your healthcare professional may take is to change your dose or stop your treatment temporarily. This is a common way to help manage certain side effects, and is generally not a cause for concern. Be sure to discuss any questions that you have with your doctor. Your doctor may need to permanently stop your treatment with NEXAVAR due to side effects.

Tell your doctor if you have any side effects that bother you or do not go away.

Tips for managing some of the most common side effects

    HFSR is a skin problem that causes redness, pain, swelling, or blisters on the palms of your hands and soles of your feet. Most of the time it happens in the first 6 weeks of treatment.

    Some of the common signs of HFSR include:

    Numb feeling

    A numb feeling 
    or "pins-and-needles"

    Sensitivity to warm

    Sensitivity to warm 
    or hot objects (like 
    a coffee mug)

    Hfsr tenderness

    or soreness

    Burning feeling

    Burning feeling






    Hard skin

    Buildup of 
    hard skin

    Cracked skin or blisters

    Dry and/or 
    cracked skin 
    or blisters

    Peeling and/or flaking skin

    Peeling and/or 
    flaking skin


    These things may happen all at once, one at a time, or not at all.

    If you see signs of HFSR, tell your doctor right away. Your doctor will tell you what to do about HFSR, if you get it. If your HFSR is very bad, your doctor may have you take less NEXAVAR or tell you to stop taking NEXAVAR for a while. Many people who take NEXAVAR have their dose lowered. It is not unusual for your doctor to do this. In serious cases, your doctor will have you stop taking NEXAVAR permanently.

    Your doctor may also give you another medicine to treat the skin problems, or send you to a skin doctor, called a dermatologist (der-ma-tol-ogist), who can help you with these skin problems.

    What HFSR looks like:

    Illustrations of common side effects of NEXAVAR® (sorafenib), plus charts on dealing with side effects

    Grade 1: Mild

    Illustrations of common side effects of NEXAVAR® (sorafenib), plus charts on dealing with side effects

    Grade 2: Moderate

    Illustrations of common side effects of NEXAVAR® (sorafenib), plus charts on dealing with side effects

    Grade 3: Severe

  • Photos courtesy of Elizabeth Manchen, RN, MS, OCN. Reproduced with patients’ permission. Return to content
  • There are ways to manage HFSR, if you get it.

    Things that you CAN do (make sure you ask your doctor first):

    • Use creams and/or lotions on your hands and/or feet. Use a lot of cream and/or lotion daily or leave it on overnight while you sleep. Cover with gloves or socks to make sure it stays on

    • See a skin or foot doctor about calluses or other problems with your feet

    • Use cotton socks, shoe pads, or soft shoes

    • Soak skin in an Epsom salt bath with warm water

    • Wear loose clothes and shoes

    Things you should NOT do:

    • Do not do things that rub your feet, like jogging, aerobics, or long walks

    • Do not use anything that rubs your hands, like tools that need pressure to work

    • Do not rub your skin with a towel after a shower or bath. It can make your skin problems worse

    • Do not stand for a long time

    • Do not keep your hands or feet in hot water for a long time, for example, while washing dishes or bathing

    • Do not touch strong cleaners (soaps) that you might use around the house

    • Do not sit in a hot place or in the sun

    Following these ideas and talking to your doctor are important ways to help you manage HFSR.

    This is a common side effect when you take NEXAVAR and it usually happens soon after your treatment.

    • Your blood pressure should be checked every week during the first 6 weeks of taking NEXAVAR and then regularly after that

    • If your blood pressure is high, it should be treated. High blood pressure can only be treated with medicine from a doctor's prescription

    • If the high blood pressure does not get better, even with the medicine, you might have to stop taking NEXAVAR, but this is something your doctor will tell you

    Loose bowel movements may not sound serious, but they can lead to a loss of water in your body (dehydration [de-hi-dra-tion]) and weight loss. Your doctor can give you medicine for diarrhea, but you must first tell your doctor about the problem. Below are some tips that can help you with loose bowel movements.

    Things you CAN do (make sure you ask your doctor first):

    • Eat a number of small meals a day and ask your doctor about foods that are good for you

    • Drink a lot of water or clear liquids, but not anything very hot or cold, and drink at least 1 glass after each loose bowel movement

    • Take whatever medicine your doctor prescribes to help with diarrhea

    Things you should NOT do:

    • Do not eat dairy products like milk and ice cream, high-fat foods like red meat and cheese, and high-fiber foods like broccoli and fiber cereals

    • Do not eat spicy foods or foods that give you gas, like beans

    • Do not drink alcohol, coffee, tea, or sodas with caffeine (like colas)

    • Do not drink prune juice or orange juice

    • Do not chew sugar-free gum or candy (made with sorbitol)

    Rashes that are different from HFSR can show up on the body or face when taking NEXAVAR. Below are some tips that can help you manage rashes.

    Things you CAN do (make sure you ask your doctor first):

    • Use a moisturizer with no perfume or added ingredients after you take a shower or bath

    • Use anti-itch products

    • Use a mild soap

    • If you have to be outside, use a sunblock with at least 30 SPF

    • Wear loose clothes

    • Wear a hat with a brim to block the sun

    Things you should NOT do:

    • Do not use hot water or take hot showers

    • Do not sit in the sun

    Using NEXAVAR can make you feel more tired than normal. This tired feeling will not always go away, even with a lot of rest and sleep.

    Tell your doctor about feeling tired. Your doctor will try to figure out what is making you tired. It could be NEXAVAR. It could be the cancer. It could be what you are eating. It could be not getting enough sleep. Below are some tips that can help you if you are feeling tired.

    Things you CAN do (make sure you ask your doctor first):

    • Do things that need more energy in the morning, or at times when you feel you have more energy

    • Keep busy with things that relax you, like games, music, reading, or visiting friends

    • Keep moving during the day

    • Exercise as much as you can, but ask your doctor if it is okay and what kind of exercise you should try

    Things you should NOT do:

    • Do not try to do everything. Decide what is most important