Radium Ra 223 dichloride (Xofigo®)

Radium Ra 223 dichloride (Xofigo®) is an alpha-emitting radiopharmaceutical medication. The alpha particles target cancer cells in the bones, delivering radiation directly to the tumor. The radiation damages the DNA of the tumor cells, causing them to die or stop growing. Because the radiation is given directly to the tumor, the damage to surrounding tissues is minimized.

Possible Side Effects of Radium Ra 223 dichloride (Xofigo®)

There are a number of things you can do to manage the side effects of Radium Ra 223 dichloride (Xofigo®).  Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your oncology care team know if you experience any shortness of breath, difficulty breathing, or pain in your chest. If the count gets too low, you may receive a blood transfusion.

Infection and Low White Blood Cell Count (Lymphocytopenia, Leukopenia, or Neutropenia)

This medication can cause life-threatening infections, with or without a decrease in white blood cell counts.

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (i.e.: those who have a cold, fever, or cough or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bathe daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your oncology care team before scheduling dental appointments or procedures.
• Ask your oncology care team before you, or someone you live with has any vaccinations.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your oncology care team know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.

• Do not use a razor (an electric razor is fine).
• Avoid contact sports and activities that can result in injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), etc. as these can all increase the risk of bleeding. Please consult with your healthcare team regarding the use of these agents and all over-the-counter medications/supplements while on therapy.
• Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Nausea/Vomiting

Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy, or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. 

Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Diarrhea

Your oncology care team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration. For medications with serious diarrhea complications: Diarrhea can be a serious side effect that can lead to dehydration. Notify your healthcare provider if you develop diarrhea.

Important but less common side effects

• Secondary Cancers: A secondary cancer develops as a result of cancer treatment for another cancer. This is rare, but you should be aware of the risk. This medication may increase the risk of osteosarcoma or other secondary malignant neoplasms. This can occur years after treatment. Your provider will monitor your labs closely. Consider having a complete blood count with differential checked annually by your healthcare provider if you received high-risk therapies.
• Peripheral Edema: This medication can cause edema, which is swelling due to an accumulation of fluid. This typically occurs in the lower extremities (feet, legs, and ankles) or hands. Report any swelling you experience to your healthcare provider.

Reproductive Concerns

 Exposure of an unborn child to this medication could cause birth defects, so you should not father a child or become pregnant while on this medication. Effective birth control is necessary during treatment and for at least 6 months after treatment. Even if you believe you are not producing sperm or not menstruating, you could still be fertile and conceive.

This medication can affect fertility. Talk with your healthcare provider about fertility preservation options.