Xofigo is a brand-name prescription medication. It’s FDA-approved to treat prostate cancer that’s metastasized (spread) to your bones. Xofigo is used to treat this type of cancer when:

  • the bone metastases are causing symptoms such as bone pain
  • the cancer hasn’t spread to other parts of your body, such as your liver or lungs
  • treatments to lower your testosterone levels, such as surgery or medications, are no longer working

Drug details

Xofigo is a type of drug called a radiopharmaceutical. It contains the active drug radium-223. This is a form of radium that gives off small amounts of radiation. Xofigo is absorbed into your bones, and the radiation kills the cancer cells there.

Xofigo comes as a liquid solution in single-dose vials. Your healthcare provider will administer this medication by injection into your vein. This takes about 1 minute. You’ll likely have one dose every 4 weeks, with up to six doses.

Effectiveness

For information about the effectiveness of Xofigo, see the “Xofigo uses” section below.

Xofigo is available only as a brand-name medication. It contains radium Ra 223 dichloride. Xofigo isn’t currently available in generic form.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics usually cost less than brand-name drugs.

Xofigo can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Xofigo. These lists do not include all possible side effects.

For more information about the possible side effects of Xofigo, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Xofigo, you can do so through MedWatch.

Mild side effects

Mild side effects* of Xofigo can include:

  • nausea and vomiting †
  • diarrhea†
  • peripheral edema (swelling of your arms, hands, legs, or feet)†
  • pain, swelling, or redness at the site where Xofigo is injected

Most of these side effects may go away within a few days or a couple of weeks. If they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Xofigo. To learn about other mild side effects, talk with your doctor or pharmacist, or view Xofigo’s patient brochure.
† For more information about this side effects, see “Side effect details” below.

Serious side effects

Serious side effects from Xofigo aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening, or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

  • Dehydration.* Be sure to drink plenty of fluids while you take Xofigo. Symptoms of dehydration can include:
    • dry mouth
    • feeling thirsty
    • urinating less, or less often, than usual
    • dark yellow, orange, or brown urine
    • headache
    • dizziness
    • lethargy
  • Reduced kidney function or kidney failure. Symptoms can include:
    • swollen feet or ankles
    • trouble urinating
    • producing little or no urine
    • muscle cramps
    • itching
    • loss of appetite
    • nausea and vomiting
  • Low blood cell levels.*
  • Allergic reaction.*

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

Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here’s some detail on certain side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Xofigo. It’s not known how often this may have occurred in clinical studies of Xofigo. Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth, swelling, or redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have an allergic reaction to Xofigo, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening, or if you think you’re having a medical emergency.

Low blood cell levels

Xofigo can cause blood cell levels to drop. That’s because the radiation it produces can damage your bone marrow. Your bone marrow is a spongy material inside your bones that makes blood cells. If your bone marrow is damaged, it produces fewer blood cells. This is called bone marrow suppression. Xofigo can cause your bone marrow to produce fewer red blood cells, white blood cells, and platelets.

In clinical studies:

About blood cells

Red blood cells carry oxygen through the body. If you have low levels of red blood cells, this can make you feel tired and weak.

White blood cells such as neutrophils and lymphocytes are part of your immune system. They help your body fight infection. If you have low levels of white blood cells, this weakens your immune system. This can raise your risk for developing infections. Some infections can be serious or life threatening.

Platelets help your blood to form clots. If you have low levels of platelets, this can lead to easy bruising or bleeding.

You’ll likely have a blood test to check your blood cells before you start treatment with Xofigo. You’ll also have a blood test before you have each dose of Xofigo. If your blood cell levels are too low, your doctor may delay your dose until your blood cells have recovered.

Tell your doctor right away if you develop any symptoms of low blood cell levels while you’re taking Xofigo. You’ll need to have a blood test to check your blood cells.

Symptoms of low blood cell levels

Symptoms of low blood cell levels can include:

  • signs of infection, such as:
    • fever
    • chills
    • sore throat
    • cough
    • skin sores
    • wounds that won’t heal
    • burning sensation when you urinate
  • bruising easily or with no apparent cause
  • bleeding more easily than usual, for example nosebleeds or bleeding gums
  • taking a long time to stop bleeding if you have an injury
  • fatigue (lack of energy)
  • shortness of breath

If your blood cell levels are very low, you might need treatment. A blood transfusion may help increase your levels. If your blood cell levels remain low, you may need to stop taking Xofigo.

Gastrointestinal issues

Xofigo commonly causes gastrointestinal (digestive) issues, such as nausea, vomiting, and diarrhea.

In clinical studies, these symptoms occurred as follows:

NauseaVomitingDiarrhea
People taking Xofigo36%19%25%
People taking placebo*35%14%15%

Vomiting and diarrhea can cause you to lose too much fluid from your body. This can sometimes lead to dehydration, which is a low level of fluid in your body. This is a serious side effect of Xofigo. Signs of dehydration include a dry mouth, fatigue, and headache.

Your doctor may prescribe medication to help prevent nausea and vomiting while you take Xofigo. If you have nausea or vomiting despite taking antinausea medication, be sure to tell your doctor. They may be able to prescribe a different antinausea medication that works better for you.

* a treatment containing no active drug

Managing diarrhea and vomiting

If you have diarrhea with Xofigo, ask your doctor how to manage this. They may prescribe medication to treat your diarrhea.

If you have vomiting or diarrhea with Xofigo, be sure to drink plenty of fluids. This will help you avoid getting dehydrated. It can be helpful to sip on fluids throughout the day. Your doctor may also recommend drinking rehydration drinks. These contain electrolytes, such as sodium and potassium, that your body can lose through vomiting and diarrhea.

Bodily fluids such as vomit and diarrhea may give off small amounts of radiation. This can happen for about a week after you have a dose of Xofigo. To help protect household members and caregivers, you should use a toilet, rather than a bedpan, whenever possible. Flush it several times after each use and wash your hands thoroughly.

Caregivers who handle bodily fluids should wear gloves and wash their hands afterwards. Soiled clothing, linen, or towels should be washed right away, separately from other items.

Peripheral edema

Xofigo can sometimes cause peripheral edema (swelling of the arms, hands, legs, or feet).

In clinical studies, peripheral edema occurred in:

  • 13% of people who took Xofigo
  • 10% of people who took a placebo (a treatment containing no active drug)

If you have peripheral edema, tell your doctor. This side effect can sometimes be a symptom of kidney failure, which is a serious side effect of Xofigo. Your doctor may want to check your kidney function to make sure your kidneys are working properly.

Fatigue (not a side effect)

Fatigue (lack of energy) wasn’t reported as a specific side effect of Xofigo in clinical studies. However, cancer, which this drug treats, often causes fatigue. Fatigue can also be a symptom of low blood cell counts, which Xofigo can cause. Low blood cell counts that can lead to fatigue include:

If you have fatigue while taking Xofigo, taking short naps may help. Be sure to take time to rest if you’ve been physically active. Talk with your doctor if you have trouble managing fatigue.

As with all medications, the cost of Xofigo can vary.The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Xofigo, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Xofigo, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Xofigo, or if you need help understanding your insurance coverage, help is available.

Bayer, the manufacturer of Xofigo, offers a program called Access Services that may provide ways to lower the cost of this drug. For more information and to find out if you’re eligible for support, call 855-6XOFIGO (855-696-3446) or visit the program website.

Generic version

Xofigo is not available in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

The Xofigo dosage your doctor prescribes will depend on your body weight.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Xofigo comes as a liquid solution in single-dose vials. Each vial contains 1,100 kilobecquerel (kBq) of radioactivity per milliliter (mL) of solution at the reference date.*

Your healthcare provider will administer Xofigo by injection into a vein. This takes about 1 minute.

* kBq is a measurement unit of radioactivity. The reference date refers to the date and time this measurement was taken. The radioactivity of Xofigo decreases over time. Your doctor will take this into account when calculating your dose.

Dosage for prostate cancer

The recommended dosage of Xofigo for prostate cancer that’s spread to the bones is 55 kBq per kilogram of body weight. This is typically given once every 4 weeks, with up to six doses.

Dosage questions

Below are answers to some questions you may have about taking Xofigo.

What if I miss a dose?

It’s important to keep your appointments for your dose of Xofigo. If you miss an appointment, call your doctor’s office right away to reschedule.

To help make sure you don’t miss a dose, try setting a reminder on your phone for your appointments.

Will I need to use this drug long term?

No, Xofigo is not meant to be used as a long-term treatment. It’s not known if it’s safe or effective to have more than six doses of Xofigo.

Xofigo is used to treat prostate cancer that’s spread to your bones. When cancer spreads to your bones, the affected areas are called bone metastases. They can cause symptoms such as bone pain. Xofigo is a form of radiation therapy that specifically targets the cancer cells in your bones.

Xofigo mechanism of action

A drug’s mechanism of action is how it works to cause an effect in the body. Xofigo is a type of drug called a radiopharmaceutical. It contains the active drug radium-223. Radium is a chemical element that’s related to calcium. Radium-223 is a form of radium that gives off small amounts of radiation. Your bones absorb radium-223 because of its similarity to calcium.

Xofigo is absorbed into areas of bone where there’s a lot of breakdown and rebuilding of bone tissue, which occurs with bone metastases. Once Xofigo is in your bones, the radiation it gives off kills the cancer cells in the bones. Xofigo helps to shrink bone metastases and relieve symptoms such as bone pain.

Xofigo gives off a weak form of radiation called alpha particles. Alpha particles can travel only a very small distance, through less than 10 cells. This means the radiation affects only the cancer cells in your bones. It doesn’t affect those in other parts of your body.

That said, Xofigo can have some side effects* in other parts of your body. For example, the radiation can affect your bone marrow, which is where your blood cells are made. And because the drug is expelled through your intestines, it can cause digestive problems, such as nausea, vomiting, and diarrhea.

The amount of radiation Xofigo gives off decreases gradually over a few weeks. Xofigo has a half-life of 11.4 days. This is the length of time it takes for the amount of radioactivity from your dose to decrease by half.

* For more information on side effects, see the “Xofigo side effects” section above.

How long does it take to work?

After you have an injection of Xofigo, the drug is quickly absorbed from your bloodstream into your bones. It starts working in your bones within the first 10–15 minutes after you have an injection. However, you’re unlikely to notice it working right away.

You’ll likely have a dose every 4 weeks, with up to six doses. If you have symptoms such as bone pain, these may start to improve a few weeks after you start this course of treatment.

The Food and Drug Administration (FDA) approves prescription drugs such as Xofigo to treat certain conditions. Xofigo may also be used off-label for other conditions. Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.

Xofigo for prostate cancer

Xofigo is FDA-approved to treat prostate cancer that has spread to your bones. Cancers that have spread to your bones are called bone metastases. Xofigo is used to treat this type of cancer when:

  • the bone metastases are causing symptoms such as bone pain
  • the cancer hasn’t spread to other parts of your body, such as your liver or lungs
  • the cancer is castration resistant (treatments to lower your testosterone levels, such as surgery or medications, are no longer working)

Prostate cancer affects the prostate gland, a small gland located between the penis and the bladder. It’s part of the male* reproductive system. Growth of prostate cancer is usually stimulated by the hormone testosterone.

Prostate cancer treatment typically involves lowering your testosterone levels. This is called castration. It slows down the growth of the cancer. Castration can be done with medications called hormone therapies. It can also be done with surgery to remove your testicles, since they produce most of the testosterone in your body. If the cancer continues to grow or spread even with these treatments, doctors refer to the cancer as castration resistant.

Castration-resistant prostate cancer often spreads to other parts of your body, in particular your bones. This is called advanced or metastatic prostate cancer.

If prostate cancer spreads to your bones, the bone metastases can cause symptoms such as:

  • pain in your bones, typically in your back, hips, or pelvis
  • stiffness in your neck or back
  • weak bones that may fracture more easily
  • numbness or weakness (if metastases in your spine press on your spinal cord)
  • hypercalcemia (a high level of calcium in the blood)

* Use of the terms “male” or “female” within this article refers to a person’s sex assigned at birth.

Radium-223

Xofigo is a type of drug called a radiopharmaceutical. It contains the active drug radium-223. This is a form of radium that gives off small amounts of radiation. Xofigo is absorbed into your bones, and the radiation kills the cancer cells there.

Xofigo helps shrink the bone metastases and reduce their symptoms. It helps people with this type of cancer live longer.

Effectiveness for prostate cancer

A clinical study found Xofigo to be effective for improving overall survival in people with prostate cancer that has spread to the bone.

In this study:

  • those treated with Xofigo were 30% less likely to die than those treated with a placebo (a treatment containing no active drug)
  • at least 50% of those treated with Xofigo lived for 14.9 months
  • at least 50% of those treated with a placebo lived for 11.3 months

Off-label use for Xofigo

In addition to the use listed above, Xofigo may also be used off-label for other conditions. Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA. Below is an example of an off-label use for Xofigo.

Xofigo for breast cancer

Xofigo is not FDA-approved to treat breast cancer. However, it may be used off-label to treat bone metastases in people with breast cancer. Bone metastasis is cancer that has spread to your bones.

Xofigo is currently under investigation for this use.

For example, one small study used Xofigo with hormone therapy and denosumab (Prolia) in people with breast cancer and bone metastases. Hormone therapy for breast cancer is treatment that lowers levels of estrogen (female hormone). Denosumab is a medication that helps prevent weakened bones. In this study, the combination of Xofigo with these treatments helped people to live without their cancer spreading or getting worse. However, this study didn’t compare Xofigo with any other treatments.

Another ongoing study is looking at the effect of using Xofigo with capecitabine (Xeloda) in people with breast cancer and bone metastases. Capecitabine is a chemotherapy drug. Chemotherapy drugs help kill cancer cells.

If you’re interested in taking Xofigo for breast cancer that’s spread to your bones, talk with your doctor about whether this treatment is right for you.

Xofigo and children

Xofigo is not used in children. It hasn’t been studied for any uses in children.

Other drugs are available that can treat prostate cancer that has spread to your bones. Some may be a better fit for you than others. If you’re interested in finding an alternative to Xofigo, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.

Examples of other drugs that may be used to treat prostate cancer that’s spread to your bones include:

You may wonder how Xofigo compares with other medications that are prescribed for similar uses. Here we look at how Xofigo and Xtandi are alike and different.

Ingredients

Xofigo contains radium-223. It’s a radiopharmaceutical, which is a form of radiation therapy.

Xtandi contains enzalutamide. Xtandi is a hormone therapy that blocks the action of testosterone.

Uses

Here is a list of conditions that the Food and Drug Administration (FDA) has approved Xofigo and Xtandi to treat.

  • Xofigo is FDA-approved to treat:
  • Xtandi is FDA-approved to treat:
    • castration-resistant* prostate cancer
    • castration-sensitive* prostate cancer that’s spread to other parts of the body

* Castration is treatment that lowers testosterone levels, such as medications or surgery. Castration resistant means the cancer is no longer improving with these treatments. Castration sensitive means the cancer is still improving with these treatments.

Drug forms and administration

Xofigo is given by injection into a vein by a healthcare provider. You’ll likely receive it once every 4 weeks, with up to six doses.

Xtandi comes as a tablet and a capsule. It’s typically taken by mouth once per day.

Side effects and risks

Xofigo and Xtandi contain different types of drugs. These medications can cause some similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with either Xofigo or Xtandi, as well as mild side effects that both drugs may share.

Serious side effects

These lists contain examples of serious side effects that can occur with either Xofigo or Xtandi, as well as serious side effects that both drugs may share.

Effectiveness

Xofigo and Xtandi have different FDA-approved uses, but they can both be used to treat prostate cancer that’s spread to your bones.

These drugs haven’t been directly compared in clinical studies, but studies have found both Xofigo and Xtandi to be effective for treating this form of prostate cancer.

Costs

The costs of Xofigo and Xtandi may vary depending on your treatment plan. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Xofigo and Xtandi are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

You may wonder how Xofigo compares with other medications that are prescribed for similar uses. Here we look at how Xofigo and Zytiga are alike and different.

Ingredients

Xofigo contain radium-223. It’s a radiopharmaceutical, which is a form of radiation therapy.

Zytiga contains abiraterone. Zytiga is a hormone therapy that lowers testosterone levels.

Uses

Here is a list of conditions that the Food and Drug Administration (FDA) has approved Xofigo and Zytiga to treat.

  • Xofigo is FDA-approved to treat:
  • Zytiga is FDA-approved for use with prednisone to treat prostate cancer that’s spread to other parts of the body and is:
    • castration resistant* or
    • castration sensitive* and high risk for getting worse

* Castration is treatment, such as medications or surgery, that lowers testosterone levels. Castration resistant means the cancer is no longer improving with these treatments. Castration sensitive means the cancer is still improving with these treatments.

Drug forms and administration

Xofigo is given by injection into a vein by a healthcare provider. It’s typically given once every 4 weeks, with up to six doses.

Zytiga comes as tablets that are taken by mouth once daily.

Side effects and risks

Xofigo and Zytiga contain different types of drugs. These medications can cause some similar side effects but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with either Xofigo or Zytiga, as well as mild side effects that both drugs may share.

Serious side effects

These lists contain examples of serious side effects that can occur with either Xofigo or Zytiga, as well as serious side effects that both drugs may share.

Effectiveness

Xofigo and Zytiga have different FDA-approved uses, but they’re both used to treat prostate cancer that’s spread to your bones.

These drugs haven’t been directly compared in clinical studies, but studies have found both Xofigo and Zytiga to be effective for treating this form of prostate cancer.

Costs

The costs of Xofigo and Zytiga may vary depending on your treatment plan. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Xofigo and Zytiga are both brand-name drugs. There’s currently no generic form of Xofigo. Zytiga is available in generic form. Brand-name medications usually cost more than generics.

You should receive Xofigo according to your doctor’s or healthcare provider’s instructions.

You may have Xofigo as an inpatient in a hospital or nursing facility. Or you may have it as an outpatient in a clinic. Your healthcare provider will administer Xofigo by injection into a vein. This usually takes about 1 minute.

When it’s administered

You’ll likely receive Xofigo once every 4 weeks, with a total of six doses.

It’s important to keep your appointments to have your dose of Xofigo. If you miss an appointment, call your doctor’s office right away to reschedule.

To help make sure you don’t miss a dose, try setting a reminder on your phone for your appointments.

There’s no known interaction between alcohol and Xofigo. But drinking alcohol with this treatment might increase gastrointestinal (digestive) side effects,* such as diarrhea or nausea.

If you drink alcohol, talk with your doctor about how much is safe for you to drink with Xofigo.

*For more information on these side effects, see “Side effect details” in the “Xofigo side effects” section above.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Xofigo and other medications

Xofigo isn’t expected to interact with other medications, but this hasn’t been specifically studied.

However, Xofigo shouldn’t be used with abiraterone (Zytiga) and prednisone/prednisolone. In a clinical study, people who took this combination of treatments had an increased risk of bone fractures and death.

In addition, Xofigo shouldn’t usually be used with chemotherapy or with other forms of radiation therapy. Using Xofigo with these treatments could make your blood cell counts fall too low.

For more information about these two potential interactions, see the “Common questions about Xofigo” section below.

Before taking Xofigo, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Xofigo and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Xofigo. However, you should still check with your doctor or pharmacist before using any of these products while taking Xofigo.

Xofigo and foods

There aren’t any foods that have been specifically reported to interact with Xofigo. If you have any questions about eating certain foods with Xofigo, talk with your doctor.

Xofigo and vaccines

In most cases, you shouldn’t get vaccines, especially live vaccines, while you’re receiving Xofigo treatment.

Live vaccines contain live but weakened forms of bacteria or viruses. These vaccines don’t cause infections in people with healthy immune systems. However, if Xofigo damages your bone marrow and reduces your white blood cell count, this can weaken your immune system. If you receive a live vaccine while your immune system is weakened, it could cause infection.

Examples of live vaccines that you shouldn’t get while you’re having treatment with Xofigo include:

If you have an inactive (not live) vaccine while your immune system is weakened, this can’t cause infection. But the vaccine might be less effective than usual. Examples of inactive vaccines include the flu shot and the pneumonia vaccine.

Talk with your doctor about getting your vaccines up to date before you start treatment with Xofigo.

Here are answers to some frequently asked questions about Xofigo.

Is Xofigo a chemotherapy drug?

No, Xofigo isn’t a chemotherapy drug. It’s a type of drug called a radiopharmaceutical. This is a form of radiation therapy. Xofigo is absorbed into your bones like calcium. The drug gives off a small amount of radiation that kills the cancer cells in your bones.

Talk with your doctor or pharmacist if you have questions about this type of therapy.

Does Medicare cover Xofigo?

Yes, it usually does. The cost of Xofigo will usually be covered by Medicare if other treatments for your condition haven’t been effective. It may also be covered if your doctor considers Xofigo your best option for effective treatment.

If you have Xofigo as an inpatient in a hospital or nursing facility, the cost of the drug is usually covered by Medicare Part A (hospital insurance). If you have Xofigo as an outpatient, it’s usually covered by Medicare Part B (medical insurance).

Talk with your doctor to find out if Medicare will cover Xofigo treatment in your particular circumstances.

Will I need to have lab tests while I’m taking Xofigo?

Yes, you will. Xofigo can cause low blood cell counts. You’ll need blood tests to check your blood cell levels before you have each dose of Xofigo. If your blood cell counts are too low, your doctor may need to postpone your dose. Or you may need to stop taking Xofigo.

Is it OK to be around other people after receiving a dose of Xofigo?

Yes, it’s safe to be around other people after having a dose of Xofigo. Although Xofigo is a form of radiation therapy, this drug only gives off a weak form of radiation. The radiation can only travel a very small distance, through less than 10 cells. So it can’t affect people with whom you have close personal contact.

However, after you have Xofigo, your bodily fluids (such as feces, urine, and vomit) may emit small amounts of radiation. This could last for at least a week. To protect your household members and caregivers, you should use a toilet, rather than a bedpan, whenever possible. After using the toilet, flush it several times and wash your hands thoroughly.

Caregivers who handle bodily fluids should wear gloves and wash their hands afterwards. Soiled clothing, linen, or towels should be washed right away, separately from other items.

Can I take Xofigo with other prostate cancer treatments?

Yes, in some cases you can. For example, you might take Xofigo with drugs that help protect your bones. These include zoledronic acid (Zometa) and denosumab (Xgeva). You might also take it with certain hormone therapies. These include luteinizing hormone-releasing hormone (LHRH) agonists, such as leuprolide (Lupron), or antiandrogens, such as enzalutamide (Xtandi).

However, Xofigo shouldn’t be used with abiraterone (Zytiga) and prednisone/prednisolone. In a clinical study, people who took this combination of treatments had an increased risk of bone fractures and death.

In addition, Xofigo shouldn’t usually be used with chemotherapy or with other forms of radiation therapy. Using Xofigo with these treatments could make your blood cell counts fall too low.

Talk with your doctor about taking Xofigo with other treatments for prostate cancer.

Xofigo shouldn’t be taken during pregnancy because it could harm the fetus. Although Xofigo isn’t approved by the Food and Drug Administration (FDA) for use in females,* it’s sometimes used off-label to treat bone metastases in people with breast cancer. (Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.)

Also, Xofigo can cause changes in your sperm that could be harmful to a fetus. You and your partner shouldn’t conceive a child while you’re taking Xofigo, or for 6 months after you stop treatment.

* Use of the terms “male” or “female” within this article refers to a person’s sex assigned at birth.

Xofigo and fertility

Xofigo may make you infertile (unable to have a biological child). Infertility was not seen in clinical trials, but it’s thought that infertility could occur based on how the drug works. It’s not known if this would be a temporary or permanent effect.

If you want to have biological children in the future, discuss this issue with your doctor before starting Xofigo treatment.

Xofigo should not be taken during pregnancy* because it could harm the fetus.

Also, Xofigo can cause changes in your sperm that could be harmful to a fetus. You and your partner shouldn’t conceive a child while you’re taking Xofigo and for 6 months after you stop taking it. If you’re sexually active and you or your partner can become pregnant, talk with your doctor. They can suggest effective birth control options.

For more information about taking Xofigo during pregnancy, see the “Xofigo and pregnancy” section above.

For males

If your partner could become pregnant, you need to use condoms to avoid pregnancy. You’ll need to use condoms while you’re taking Xofigo and for 6 months after you stop treatment.

For females

It’s important to follow these guidelines regarding birth control:

* Although Xofigo isn’t approved by the Food and Drug Administration (FDA) for use in females, it is sometimes used off-label to treat bone metastases in people with breast cancer.

It’s not known if Xofigo is safe to take while breastfeeding. It hasn’t been studied in females who are breastfeeding. Although Xofigo isn’t approved by the Food and Drug Administration (FDA) for use in females, it is sometimes used off-label to treat bone metastases in people with breast cancer. (Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.)

If you’re taking Xofigo and considering breastfeeding, talk with your doctor about whether that would be safe for your child.

Before taking Xofigo, talk with your doctor about your health history. Xofigo may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Allergic reaction. If you’ve had an allergic reaction to Xofigo or any of its ingredients, you shouldn’t take Xofigo. Ask your doctor what other medications are better options for you.
  • Bone marrow problems. Xofigo can damage your bone marrow and cause low blood cell counts. If you already have bone marrow problems, Xofigo could make them worse. Your doctor will likely order blood tests to check your blood cells before and during treatment with Xofigo. If your blood cell counts are too low, you may not be able to have Xofigo.
  • Kidney problems. Xofigo can cause reduced kidney function and kidney failure. If you have any kidney problems, Xofigo could make them worse. Talk with your doctor about whether Xofigo is right for you.
  • Pregnancy. Xofigo should not be taken during pregnancy* because it could harm the fetus. Xofigo can also cause changes in sperm that could be harmful to a fetus. So you shouldn’t conceive a child with your partner while taking it. For more information, see the “Xofigo and pregnancy” and “Xofigo and birth control” sections above.
  • Breastfeeding. It’s not known if Xofigo is safe to take while breastfeeding. It hasn’t been studied in females* who are breastfeeding. For more information, see the “Xofigo and breastfeeding” section above.

* Although Xofigo isn’t approved by the Food and Drug Administration (FDA) for use in females, it is sometimes used off-label to treat bone metastases in people with breast cancer.

Note: For more information about the potential negative effects of Xofigo, see the “Xofigo side effects” section above.

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 other 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.