What is Xgeva Uses, warnings & interactions
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Xgeva (denosumab) is a prescription medication that is manufactured by Amgen Inc. It was approved in 2010 by the U.S. Food and Drug Administration (FDA) to treat high calcium levels due to certain types of cancer. It is also used to prevent bone fractures and other bone problems by stopping osteoclasts from breaking down bone tissue.
If your doctor has prescribed Xgeva to you, you may want to know more about what it is and how it works. Here we’ll explain what Xgeva is used for, how it works, its side effects, and more.
What is Xgeva used for?
Xgeva (denosumab) is a RANK ligand (RANKL) inhibitor that is approved by the FDA for:
- Prevention of fractures and other bone problems in patients with multiple myeloma and patients with bone metastases and solid tumors from prostate cancer, breast cancer, and lung cancer.
- Adults and skeletally mature adolescents with giant cell tumor of bone.
- Hypercalcemia due to cancer that did not respond to bisphosphonate therapy.
How does Xgeva work?
RANKL is a protein that helps regulate the breaking down and rebuilding of bone. When cancer cells attack bones, this protein can become overactive, causing an increase in the breakdown of the bone. This can lead to weak bones which are more likely to fracture or break. When bone is broken down, it can also cause calcium levels to rise.
Xgeva prevents RANKL from binding to its receptor, which slows bone breakdown, prevents the growth of giant cell tumors, and keeps calcium levels from increasing. This also helps reduce the risk of broken bones, surgery, radiation, and spinal cord compression.
What are the most commonly prescribed doses of Xgeva?
- 120 mg/1.7 mL (70 mg/mL) solution in a single-dose vial for subcutaneous injection
Before taking Xgeva
Before beginning Xgeva, tell your healthcare provider about your medical conditions, including if you:
- are taking the medication Prolia (denosumab) as they contain the same active ingredient.
- can’t take calcium or vitamin D supplements.
- had previous thyroid or parathyroid surgery.
- have osteoporosis.
- have malabsorption syndrome.
- have kidney impairment or are on dialysis.
- are taking medications that might lower your blood calcium levels.
- have scheduled dental surgery.
- are breastfeeding or plan to breastfeed.
How to take Xgeva
- Read the Full Prescribing Information including the Boxed Warning, Instructions for Use, and Medication Guide that comes with this medication.
- Xgeva is an injection given under the skin in your upper arm, thigh, or stomach area by your doctor. It should not be injected into your vein or muscle.
- You should take calcium and vitamin D supplements as needed to treat or prevent low calcium levels.
- Make sure your dentist is aware you are taking Xgeva. You may have to stop taking Xgeva before having dental procedures or surgery.
- Pay close attention to your oral hygiene while on this medication. Make sure to brush and floss your teeth regularly while on Xgeva.
You should not use Xgeva if you have low calcium levels (hypocalcemia) or have a known hypersensitivity to any ingredients in Xgeva.
- You should avoid Prolia while on Xgeva as they both contain the same active ingredient.
- Severe allergic reactions have occurred with this medication.
- Xgeva causes an increased risk of severe and sometimes fatal cases of hypocalcemia. Your calcium levels should be monitored while on this medication.
- Osteonecrosis of the jaw (ONJ) has been reported in patients taking this medication. You should have an oral exam before starting Xgeva and be monitored for symptoms such as jaw pain, tooth or gum infections, toothache, or ulcers on your gums.
- You should be monitored for high calcium levels (hypercalcemia) and multiple vertebral fractures (MVF) when stopping this medication.
- Xgeva use during pregnancy is not recommended as it can cause fetal harm. Females who may become pregnant should use an effective form of contraception.
Xgeva drug interactions
When Xgeva is taken with other medications, it may change the way they work or increase the frequency and severity of side effects. Discuss with your doctor whether any of the prescription drugs, over-the-counter medications, vitamins, and herbal supplements you take may interact with this medication, including medications that weaken your immune system.
Xgeva side effects
Some common side effects of Xgeva in clinical trials include:
- Extreme tiredness
- Back pain
- Low levels of calcium
- Upper respiratory tract infection
- Decreased appetite
- Bone, joint, or muscle pain
- Muscle spasms
Xgeva can sometimes cause more serious side effects, including:
- Severe, life-threatening allergic reactions (hives, angioedema, and shortness of breath)
- Severe jaw bone problems, including bone loss
- Low red blood cells
Contact your doctor for medical advice about any possible side effects you experience while taking Xgeva. You can report your adverse reactions to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Your healthcare professional can prescribe other medications for your condition if Xgeva is not right for you. These other treatment options will vary by different factors such as side effects and costs. Some FDA-approved alternatives to Xgeva include:
- Prolia (denosumab)
- Crysvita (burosumab)
- Evenity (romosozumab)
- Tepezza (teprotumumab)
- Zometa (zoledronic acid)
- Actonel (risedronate)
- Tymlos (abaloparatide)
Can you take Xgeva while you are pregnant or breastfeeding?
Xgeva can cause harm to your unborn baby. You should notify your doctor if you become pregnant or think you may be pregnant. Females who can become pregnant should use an effective form of birth control while taking this medication and for at least 5 months after their last dose of Xgeva. There is no data on whether Xgeva is found in breast milk or the effects it may have on the infant. You should always discuss the risks and benefits of any medication with your healthcare provider if you are pregnant, plan on becoming pregnant, or are breastfeeding.
Is Xgeva a chemotherapy drug?
No, Xgeva is not a chemotherapy drug nor is it used to treat any form of cancer. It is used to treat people with weak bones due to cancer.
How long can you be on Xgeva?
Xgeva is a medication you take long-term. Your doctor may keep you on this medication as long as it is effective and you are not experiencing serious side effects such as osteonecrosis of the jaw.
What is the cost of Xgeva?
The average cost of 1 vial of Xgeva 120 mg/1.7 mL (70 mg/mL) solution is around $3000.
Is there a generic for Xgeva?
Currently, there is a generic Xgeva available on the market. However, you can still save on brand-name drugs like Xgeva through NiceRx if eligible for assistance.