Denosumab (Generic Name)

Other Names: Xgeva®, Prolia®

About this drug

This drug used to prevent and treat bone problems and fractures due to bone metastasis from a solid tumor. It is also used to prevent and treat osteoporosis. The drug is given by injection under the skin (subcutaneously).

Possible Side Effects (More Common)

  • Rash
  • Skin irritation
  • Pain in your arms or legs
  • Fatigue

Possible Side Effects (Less Common)

  • Edema-which is swelling-usually in your ankles, feet, arms and hands.  Steroids are often given to lessen this side effect.
  • Bone pain
  • Muscle pain
  • Upper respiratory infection
  • Increase in cholesterol. Your doctor will monitor your cholesterol.
  • Decrease in calcium.  Your doctor will monitor your calcium.  You may experience numbness or tingling around your mouth or in your hands or feet.  Other symptoms of low calcium in your blood are muscle stiffness, twitching, spasms, or cramps.

These side effects are rare:

  • Cataracts
  • Cough
  • Constipation
  • Diarrhea
  • Osteonecrosis (oss-tee-oh-ne-KRO-sis) of the jaw. This is a breakdown of the jaw bone. It is a serious but rare condition.  Possible symptoms include:
        • Pain, swelling, or infection of the gums
        • Loosening of the teeth
        • Poor healing of the gums
        • Numbness or the feeling of heaviness in the jaw

Reproduction Concerns

  • Pregnancy warning: It is not known if this drug may have harmful effects on the unborn child. For this reason, be sure to speak with your doctor if you are pregnant or planning to become pregnant while receiving this drug.  If you have been exposed to this drug during pregnancy, genetic counseling is available to you to discuss the potential risks of problems in the fetus.
  • Breast feeding warning: It is not known if this drug is safe for breast feeding. Speak with your doctor if you are considering breast feeding while you are on this drug.

Treating Side Effects

  • Low calcium- You should take at least 1000mg of calcium and 400 IU of Vitamin D pills daily. There are 2 types of calcium pills: calcium carbonate and calcium citrate.  Ask your doctor  which type and what dosage you should take daily.

                  Type and dosage of daily calcium and Vitamin D:



  • Dental problems- Tell your oncologist if you have dental problems before you start this drug. It is important that your dentist knows that you are on this drug. Provide your dentist and your oncologist with each other’s name and telephone number for consultation.
        • Keep your teeth and mouth very clean. Brush your teeth and tongue with a soft toothbrush after every meal and at bedtime.
        • Use a mirror to check your teeth and gums daily for any changes, such as sores or bleeding gums. If you notice a change, report it to your oncologist immediately.
  • Rash-  Do not put anything on your rash or skin irritation unless your doctor or nurse says you may. Keep the area around the rash or irritation clean and dry. Ask your doctor for medication if your rash or irritation is bothersome.
  • Vision-  Tell your eye doctor that you are receiving denosumab.  See your eye doctor if you have vision changes.
  • Other side effects-  Ask your doctor or nurse about medication that is available to help prevent or lessen constipation, diarrhea, muscle pain, or cough.

Food and Drug Interactions

  • Denosumab may enhance the toxic effects of other drugs that lower your immunity that you are taking at the same time.  This may increase your risk of infection.
  • Avoid drinking alcohol since it may increase your risk of developing osteoporosis.
  • There are no known interactions of denosumab with food. This drug may interact with other medication. Tell your doctor and pharmacist about all the medication and dietary supplements (vitamins, minerals, herbs and others) that you are currently taking. The safety and effectiveness of dietary supplements and alternative diets are often unknown. Using these might unexpectedly affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's advice.

When to Call the Doctor

Call your doctor or nurse immediately if you have any of the following symptoms:

  • Fever of 100.5 F (38 C) or above
  • Chills 
  • Rash or skin irritation
  • Numbness or tingling around your mouth or in your hands or feet.
  • Muscle stiffness, twitching, spasms, or cramps
  • Diarrhea of four stools a day or diarrhea with weakness or lightheadedness
  • Jaw pain, numbness, swelling, or fluid draining from your jaw, mouth, or teeth. You may experience persistent pain or slow healing of the mouth or jaw after dental procedures

Call your doctor or nurse as soon as possible if any of the following symptoms occur:

  • Swelling in your ankles, feet, arms and hands
  • Cough
  • Changes in your vision

Revised December 2011

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