[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Hedgehog pathway inhibitors](https://durgical.com/en/pharmacology/classes/hedgehog-pathway-inhibitors/) › Sonidegib # Sonidegib ## Hedgehog pathway inhibitors? Hedgehog pathway inhibitors ## High alert? An error with this medicine can cause serious harm: double checks and protocols are used. ## Pregnancy: contraindicated? Contraindicated in pregnancy (EU label). Sonidegib carries a high risk of embryo-fetal death or birth defects: pregnancy tests and contraception for many months after treatment… An oral Smoothened blocker for locally advanced basal cell carcinoma, taken on an empty stomach. Muscle damage and birth defects are the key risks. Updated Nov 12, 2026 ## Quick facts **Group** [Hedgehog pathway inhibitors](https://durgical.com/en/pharmacology/classes/hedgehog-pathway-inhibitors/) **Target** Smoothened (SMO) receptor **Key effects** Muscle spasms and pain · Hair loss · Taste change **Monitor** Pregnancy test before starting · Creatine kinase **ATC** L01XJ02 No doses: the clinician sets them by the current guideline. On this page - The basics Mechanism of action - Indications - Adverse effects - Pharmacokinetics - Memory aid - Clinical What the labels mean - Safety Contraindications - Key interactions - What is monitored - Administration and safety - Pregnancy and breastfeeding - Nursing care - Study Test yourself - Connections Connections ## Mechanism of action ◎**Smoothened (SMO) receptor**Sonidegib ⓘ No structure with sonidegib was found. The figure shows vismodegib, another Smoothened inhibitor, in the same transmembrane pocket of human Smoothened. **Target in 3D:** Smoothened (SMO) receptor. PDB structure 5L7I (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/5L7I) · Drag to rotate · pinch to zoom Sonidegib binds Smoothened, the signalling protein that the Hedgehog pathway uses. When PTCH1 is lost, as in most basal cell carcinomas, Smoothened drives GLI transcription factors continuously; sonidegib shuts this down and the tumour stops growing. - Sonidegib binds Smoothened (SMO) - GLI transcription factors switch off - Basal cell carcinoma stops growing ## Indications - Locally advanced basal cell carcinoma that recurred after surgery or radiation, or that cannot be treated with them. [Basal cell carcinoma →](https://durgical.com/en/conditions/basal-cell-carcinoma/) ## Adverse effects ### Common - Muscle spasms and pain - Hair loss - Taste change, decreased appetite, weight loss - Nausea, diarrhoea, abdominal pain - Fatigue, itching, missed periods ### Serious (rare, important) - Embryo-fetal death or severe birth defects (boxed warning) - Muscle damage with high CK, possibly rhabdomyolysis (dark urine, less urine) - Premature closure of growth plates in children ## Contraindications - Hypersensitivity to sonidegib - Pregnancy (EU label) ## Key interactions **St John's wort** Can lower sonidegib levels; avoided. **Grapefruit and its juice** Can raise sonidegib levels; discussed with the treating team. ## What is monitored - Pregnancy test before starting - Creatine kinase (CK) at baseline and during treatment, and kidney function - Muscle pain, weakness or dark urine ## Administration and safety - Oral capsules on an empty stomach, at the same time each day. - No blood donation during treatment and for many months after; men do not donate semen. ## Pregnancy and breastfeeding Contraindicated in pregnancy (EU label). Sonidegib carries a high risk of embryo-fetal death or birth defects: pregnancy tests and contraception for many months after treatment are required, men use condoms, and blood donation is avoided. ## Nursing care - Confirm a negative pregnancy test and reliable contraception; men use condoms even after vasectomy. - Teach to report unexplained muscle pain, tenderness, weakness or dark urine. - Check CK as ordered. - Teach about taste and hair changes; support nutrition. ## Pharmacokinetics **Absorption** Oral capsules once a day on an empty stomach (before or well after a meal). ## Memory aid «Sonidegib, sore muscles»: of the Smoothened blockers, sonidegib is the one remembered for CK rises and rhabdomyolysis. ## Test yourself Think of the answer, then tap the question to see it. ## How is sonidegib taken relative to food? On an empty stomach. ## Which laboratory test watches its muscle toxicity? Creatine kinase (CK). ## Which cancer is sonidegib used for? Locally advanced basal cell carcinoma. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/sonidegib/) [More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology) ## What the labels mean **High alert** An error with this medicine can cause serious harm: double checks and protocols are used. **Pregnancy: contraindicated** Contraindicated in pregnancy (EU label). Sonidegib carries a high risk of embryo-fetal death or birth defects: pregnancy tests and contraception for many months after treatment… ## Connections ## Related drugs 2 - [Vismodegib](https://durgical.com/en/pharmacology/vismodegib/) - [Glasdegib](https://durgical.com/en/pharmacology/glasdegib/) ## Related conditions 1 - [Basal cell carcinoma](https://durgical.com/en/conditions/basal-cell-carcinoma/) [← Back to the class: Hedgehog pathway inhibitors](https://durgical.com/en/pharmacology/classes/hedgehog-pathway-inhibitors/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [Sonidegib: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a615034.html) (MedlinePlus (U.S. National Library of Medicine), 2019); [Sonidegib - NCI](https://www.cancer.gov/about-cancer/treatment/drugs/sonidegib) (National Cancer Institute, 2020); [EMA: product information for sonidegib](https://www.ema.europa.eu/en/documents/product-information/odomzo-epar-product-information_en.pdf) (European Medicines Agency, 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01XJ02) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/sonidegib/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/sonidegib/