Tyrosine Kinase Inhibitors (TKIs) are targeted therapies used commonly in the treatment of metastatic renal cell carcinoma (mRCC). These drugs target vital intracellular tumour cell signaling pathways particularly in angiogenesis-driven clear cell RCC. Despite the introduction of newer anti-cancer agents in this setting, they remain an important first line drug for those with favourable risk factors, and as combination therapy in intermediate and poor risk groups. Taken orally, TKIs are on the whole, well tolerated. However close monitoring of liver function, full blood count and blood pressure is vital due to their wide-ranging effects.