Xgeva (denosumab) is a prescription, brand-name medication. It’s approved by the Food and Drug Administration (FDA), in certain situations, to:

Here are some fast facts about Xgeva:

  • Active ingredient: denosumab, which is a biologic
  • Drug class: RANK ligand (RANKL) inhibitor
  • Drug form: solution in a vial, given as a subcutaneous injection by a healthcare professional

If Xgeva works for you, your doctor will likely recommend that you receive it long term.

Like other drugs, Xgeva can cause side effects. Read on to learn about potential common, mild, and serious side effects. For a general overview of Xgeva, including details about its uses, see this article.

These are just a few of the more common side effects reported by people who received Xgeva in clinical trials. These side effects can vary, depending on the condition that the drug is being used to treat.

More common side effects in people with multiple myeloma who received Xgeva to help prevent broken bones included:

More common side effects in people who received Xgeva to help prevent broken bones due to bone cancer with solid tumors included:

More common side effects in people who received Xgeva for hypercalcemia due to advanced cancer included:

More common side effects in people who received Xgeva for giant cell bone tumors included:

* For more information about this side effect, see “Side effect specifics” below.

Mild side effects can occur with Xgeva use. This list doesn’t include all the possible mild side effects of the drug. For more information, you can refer to Xgeva’s prescribing information.

These are just a few of the more common side effects reported by people who received Xgeva in clinical trials. These side effects can vary, depending on which condition the drug is being used to treat.

Mild side effects that have been reported in people who received Xgeva to help prevent broken bones from multiple myeloma included:

Mild side effects that have been reported in people who received Xgeva to help prevent broken bones due to bone cancer from solid tumors included:

  • fatigue
  • weakness
  • nausea*

Mild side effects that have been reported in people who received Xgeva for hypercalcemia due to advanced cancer included:

  • headache
  • difficulty breathing
  • decreased appetite
  • diarrhea
  • vomiting
  • constipation
  • nausea*
  • swelling of the hands, legs, arms, or feet*

Mild side effects that have been reported in people who received Xgeva for giant cell bone tumors included:

* For more information about this side effect, see “Side effect specifics” below.

These side effects may be temporary, lasting a few days to weeks. But if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while using Xgeva and want to tell the FDA about it, visit MedWatch.

Xgeva may cause serious side effects. The list below may not include all the possible serious side effects of the drug. For more information, you can refer to Xgeva’s prescribing information.

If you develop serious side effects while receiving Xgeva, talk with your doctor right away. If a side effect seems life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects that have been reported and their symptoms include:

* For more information about this side effect, see “Side effect specifics” below.

Learn more about some of the side effects that Xgeva may cause.

Dental or jaw problems

It’s possible to develop dental or jaw problems during Xgeva treatment. Specifically, this medication may increase your risk of developing a condition called osteonecrosis of the jaw (ONJ). This condition can occur if your jawbone cells begin to die.

Symptoms of ONJ may include:

Some factors may increase your risk of developing dental or jaw problems, including ONJ. These include recently having had a dental procedure and not regularly brushing and flossing your teeth.

What you can do

Before you start Xgeva treatment, your doctor will recommend that you have an oral examination. Your dentist can determine if you need any dental work. It’s advised that you have this work completed before receiving Xgeva. This may help decrease the risk of dental- or jaw-related side effects. Keep in mind that’s it’s also important to have good oral hygiene throughout your treatment with Xgeva.

If you need to have a dental procedure during your treatment, be sure to tell your doctor. They may recommend pausing Xgeva use during the procedure and afterward while you heal.

If you notice any symptoms of ONJ while receiving Xgeva, see your doctor right away. And if you have other dental- or jaw-related side effects, be sure to tell them.

Bone pain

Bone pain may occur with Xgeva use. Bone pain, including joint pain, occurred in people who received Xgeva in clinical trials for giant cell bone tumors. However, this side effect wasn’t commonly reported in people who received the medication for other uses.

What you can do

If you experience bone pain during your Xgeva treatment, talk with your doctor. The drug can increase your risk of certain bone fractures. Due to this risk, your doctor may order testing (such as an X-ray) to see if your pain is from a broken bone.

Your doctor may recommend ways to help ease bone pain while you receive Xgeva. This may include taking over-the-counter pain relievers, such as Tylenol (acetaminophen).

Nausea

Nausea may occur with Xgeva treatment. This was one of the most common side effects that people reported in clinical trials.

What you can do

If you experience nausea while receiving Xgeva, talk with your doctor. They can help determine if the medication is the cause and suggest the best ways to treat the nausea.

Swelling of the arms, legs, hands, or feet

During your treatment with Xgeva, swelling in the arms, legs, hands, or feet may occur. This was a common reported side effect in people who:

What you can do

If you experience swelling of your arms, legs, hands, or feet during your treatment with Xgeva, talk with your doctor. They may order an X-ray if you also have bone pain. The results can show if you have any broken bones. (Xgeva can increase your risk of certain bone fractures.)

If you don’t have a broken bone, your doctor may recommend other medications or ways to help reduce your swelling.

Allergic reaction

Like most drugs, Xgeva can cause an allergic reaction in some people.

Symptoms can be mild or serious and can include:

  • skin rash
  • itching
  • flushing
  • swelling under your skin, typically in your lips, eyelids, feet, or hands
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, talk with your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep receiving Xgeva. But if your symptoms are serious, and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Xgeva may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

How long do Xgeva side effects last?

It depends on what side effects you experience. Some side effects, such as nausea or diarrhea, may occur when you first start receiving Xgeva. As your body adjusts to the medication, you may notice that these side effects ease or go away completely.

However, other side effects may last throughout your treatment with Xgeva. These can include dental or jaw side effects, and anemia (a low level of red blood cells). In some cases, these side effects may continue after you stop Xgeva treatment.

If you develop side effects from Xgeva, talk with your doctor. They may be able to recommend ways to reduce how long the effects last.

How can I help prevent Xgeva side effects from occurring?

Taking certain steps may help prevent Xgeva side effects. For example, your doctor may recommend that you take calcium and vitamin D supplements throughout your treatment. This may help decrease your risk of developing hypocalcemia, which refers to low levels of calcium in your blood. (Vitamin D helps your body absorb calcium.)

Other steps may help prevent jaw and dental side effects. These can include brushing and flossing your teeth as your dentist recommends. And if you need any dental work, your doctor will likely advise you to have it before you start Xgeva treatment.

Talk with your doctor about other ways to help prevent Xgeva side effects.

Be sure to talk with your doctor about your health history before you receive Xgeva. This drug may not be right for you if you have certain medical conditions or other factors that affect your health. Conditions and factors to consider include:

Stopping treatment. Before you stop Xgeva treatment, it’s important to talk with your doctor. If you stop receiving the drug, it’s possible to develop hypercalcemia or bone fractures. To decrease your risk of these problems, your doctor may monitor your blood levels. (Too much calcium in your blood could harm your bones.) Or, your doctor may switch you to a different treatment.

Allergic reaction. If you’ve had an allergic reaction to Xgeva or any of its ingredients, your doctor will likely not prescribe Xgeva. Ask them what other medications may be better options for you.

Low calcium levels in your blood. Before you start receiving Xgeva, your doctor will order a blood test to check your calcium levels. This is because the drug may cause hypocalcemia. Due to this risk, your doctor will likely recommend that you do not use Xgeva if you have low levels of calcium in your blood.

Instead, they’ll usually treat low calcium levels before you start receiving the drug and monitor these levels throughout your treatment. Your doctor will also likely recommend that you take calcium and vitamin D supplements while you receive Xgeva. (Vitamin D helps your body absorb calcium.)

Dental procedures. If you need to have any dental work, be sure to tell your dentist that you use Xgeva. This medication may increase your risk of dental or jaw problems. In some cases, your doctor may recommend that you pause Xgeva use while you have a dental procedure and afterward while you heal.

Alcohol use with Xgeva

There are no known interactions between Xgeva and alcohol.

Talk with your doctor about what’s a safe amount of alcohol for you to drink while you receive Xgeva.

Pregnancy and breastfeeding while using Xgeva

Here’s some information about pregnancy, breastfeeding, and Xgeva.

Pregnancy. Your doctor will likely recommend that you do not use Xgeva while you’re pregnant. This is because animal trials show that Xgeva may cause unusual bone growth in a fetus and increase the risk of pregnancy loss.

Before you receive Xgeva, your doctor may test you for pregnancy. If you can become pregnant, they’ll likely recommend that you use an effective form of birth control throughout your treatment. They’ll probably also recommend using the birth control for at least 5 months after your last dose.

Breastfeeding. It’s not known if Xgeva is safe to use while breastfeeding. It’s unknown if the drug passes into breast milk or what effects it may have on a child who is breastfed. In animal trials, Xgeva was present in breast milk for up to 1 month after the medication was given. However, animal trials don’t always indicate what may happen in humans. Talk with your doctor about using Xgeva if you’re breastfeeding.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Side effects of Xgeva are usually mild, but serious side effects can occur. If you’d like to learn more about Xgeva, talk with your doctor or pharmacist. They can help answer any questions you have about side effects of the drug.

Besides talking with your doctor, you can do some more research on your own. These articles might help:

  • More information about Xgeva. For details about other aspects of Xgeva, refer to this article.
  • Dosage specifics. To learn about Xgeva’s dosage, see this article.
  • A look at your condition. If you have cancer, our cancer hub may be helpful. For more information about bone health, see this list of articles.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.