Sorafenib, as a multi kinase inhibitor, has clear contraindications, dietary restrictions, and medication constraints when used. This article will systematically explain the high-risk populations, taboo food combinations, and special restrictions that need to be avoided in the clinical application of this drug to ensure medication safety.

1. Taboo population

(1) Pregnant women: Animal experiments have shown embryonic toxicity, which may cause fetal malformation or death. Strict contraception is required until at least 2 weeks after discontinuation of medication.

(2) Severe liver dysfunction: Child Pugh Class C patients are contraindicated as significant inhibition of drug metabolism may exacerbate liver damage.

(3) Active bleeding patients: including gastrointestinal bleeding, intracranial bleeding, etc. The anti angiogenic effect of drugs can exacerbate the risk of bleeding.

2. Forbidden foods

(1) Grapefruit/grapefruit: Contains strong CYP3A4 inhibitors, which can increase the blood concentration of sorafenib by more than twice, increasing the risk of toxicity.

(2) High fat diet: High fat meals during medication can reduce bioavailability by 28%, and should be taken on an empty stomach or on a low-fat diet.

(3) St. John's wort: As a CYP3A4 inducer, this herb significantly reduces drug efficacy and should be completely avoided.

3. Restrictive conditions

(1) Surgical restrictions: Medication must be discontinued for at least 2 weeks before elective surgery, and can only be resumed after evaluation for at least 4 weeks after major surgery.

(2) Combination therapy: It is prohibited to use it in combination with strong inducers of CYP3A4 (such as rifampicin), as it can lead to a 37% decrease in blood drug concentration.

(3) Monitoring requirements: During the treatment period, blood pressure should be monitored weekly, liver function should be checked every 2 weeks, and medication should be immediately suspended if grade 3 toxicity occurs.