Drug General Information (ID: DDIYV67I2P)
  Drug Name Sorafenib Drug Info Anisindione Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antineoplastics Anticoagulants
  Structure

 Mechanism of Sorafenib-Anisindione Interaction (Severity Level: Moderate)
     Increased risk of bleeding Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Sorafenib Anisindione
      Mechanism Risk of bleeding Risk of bleeding
Anticoagulant 
      Key Mechanism Factor 1
Factor Name Bleeding
Factor Description Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
      Mechanism Description
  • Increased risk of bleeding by the combination of Sorafenib and Anisindione 

Recommended Action
      Management Caution is advised if oral anticoagulants are prescribed with sorafenib. The INR should be checked frequently and anticoagulant dosage adjusted accordingly, particularly following initiation, discontinuation or change of dosage of sorafenib in patients who are stabilized on their anticoagulant regimen. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References
1 Laber DA, Mushtaq M "Compassionate use of sorafenib in patients with advanced renal cell cancer." Clin Genitourin Cancer 7 (2009): 34-8. [PMID: 19213666]
2 Moretti LV, Montalvo RO "Elevated International Normalized Ratio associated with concurrent use of sorafenib and warfarin." Am J Health Syst Pharm 66 (2009): 2123-2125. [PMID: 19923313]
3 Product Information. Nexavar (sorafenib). Bayer Pharmaceutical Inc, West Haven, CT.