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General Medication Fact Sheet for Xgeva
| Field | Information |
|---|---|
| Medication Name | XGEVA |
| Generic Name | Denosumab |
| Boxed/Label Warning | Increased risk of severe hypocalcemia in patients with advanced kidney disease. Osteonecrosis of the jaw. Atypical femoral fracture. |
| Purpose | Used to prevent skeletal-related events in patients with bone metastases from solid tumors and for the treatment of giant cell tumor of bone. Also used to treat hypercalcemia of malignancy that is refractory to bisphosphonate therapy. |
| Mechanism of Action | A RANK ligand (RANKL) inhibitor. Denosumab binds to RANKL, preventing it from activating its receptor RANK on the surface of osteoclasts and their precursors. This inhibition suppresses osteoclast formation, function, and survival, thereby decreasing bone resorption. |
| Dosage Forms | Subcutaneous injection |
| Available Strengths | 120 mg/1.7 mL |
| Dosage Frequency | 120 mg every 4 weeks |
| Common Side Effects | Fatigue, weakness, nausea, diarrhea, hypophosphatemia |
| Serious Side Effects | Osteonecrosis of the jaw (ONJ), atypical femoral fractures, hypocalcemia (especially in patients with kidney problems), serious infections, dermatologic reactions |
| Drug Interactions | Calcium supplements, Vitamin D, other drugs that affect bone metabolism (Bisphosphonates) |
| Important Notes | Ensure adequate calcium and vitamin D intake. Monitor calcium levels regularly, especially in patients with kidney impairment. Report any new thigh, hip, or groin pain. Maintain good oral hygiene and undergo regular dental check-ups. |
| Storage | Store in the refrigerator (2°C to 8°C [36°F to 46°F]) in the original carton to protect from light. Do not freeze. |
| Missed Dose | Contact your healthcare provider immediately to reschedule your injection. Do not self-administer a double dose. |
| Alternatives | Zoledronic acid (Zometa), Pamidronate, Bisphosphonates |
Xgeva Alternatives
| Medication | Mechanism of Action | Notes |
|---|---|---|
| Zoledronic acid (Zometa) | Bisphosphonate that inhibits bone resorption | Administered intravenously. Used for bone metastases and hypercalcemia of malignancy. |
| Pamidronate | Bisphosphonate that inhibits bone resorption | Administered intravenously. Used for bone metastases and hypercalcemia of malignancy. |
| Bisphosphonates | Inhibit osteoclast activity, reducing bone resorption | Oral or intravenous; other Bisphosphonates include alendronate, risedronate, ibandronate. |
Xgeva Side Effects
| Common Side Effects | Serious Side Effects |
|---|---|
| Fatigue | Osteonecrosis of the jaw (ONJ) |
| Weakness | Atypical femoral fractures |
| Nausea | Hypocalcemia |
| Diarrhea | Serious infections |
| Hypophosphatemia | Dermatologic reactions (e.g., rash, dermatitis) |
| Musculoskeletal pain | Hypersensitivity reactions (e.g., anaphylaxis) |
Xgeva Dosage Guide
| Condition | Starting Dose | Maintenance Dose | Administration Notes |
|---|---|---|---|
| Prevention of Skeletal-Related Events in Bone Metastases | 120 mg | 120 mg every 4 weeks | Subcutaneous injection administered by a healthcare professional in the upper arm, upper thigh, or abdomen. |
| Giant Cell Tumor of Bone | 120 mg | 120 mg every 4 weeks with additional 120mg doses on days 8 and 15 of the first month. | Subcutaneous injection administered by a healthcare professional in the upper arm, upper thigh, or abdomen. |
| Hypercalcemia of Malignancy | 120 mg | 120 mg every 4 weeks | Administer subcutaneous injection only after IV Bisphosphonates have been tried. |
