Denosumab (Xgeva®, Prolia®)

You will have denosumab at the hospital as an outpatient. You have denosumab as an injection under the skin (subcutaneously). You have the injection in the thigh, stomach or upper arm. 

• XGEVA is usually given once every 4 weeks.
• Prolia is given once every 6 months.

Your doctor or nurse will take a blood test before each treatment to check the amount of calcium in your blood. 

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

A low level of calcium may cause muscle spasms, twitching, cramps, or tingling around your mouth or in your fingers and toes. Tell your doctor straight away if you get any of these signs. Your doctor will take regular blood tests to check your calcium levels. If they are low, they will prescribe calcium and vitamin D supplements for you. 

Occasionally, if calcium levels become very low, you may feel drowsy or confused. Let your doctor know if you, or other people, notice this.

Denosumab can cause pain in the bones and joints. This may be more common in your hands and feet. It can also cause some pain in the muscles. Tell your doctor if this happens. They can give you painkillers to help.

Osteonecrosis of the jaw is when healthy bone tissue becomes damaged and dies. Gum disease, problems with dentures, and some dental treatments can increase the risk of osteonecrosis.

Your doctor, nurse or pharmacist will advise you to have a full dental check-up before starting denosumab. If you have any mouth ulcers or sores, you should not start treatment until they have healed.

It is very important to look after your teeth during and after treatment with denosumab. Brush them regularly and have regular dental check-ups. It is important to tell your doctor or nurse if you are having any dental treatment. Let your dentist know you are having denosumab.

Some of the symptoms of osteonecrosis can include: 

• pain and swelling in your jaw
• redness of the gums or gum infections
• loosening of teeth. 

Tell your cancer specialist and dentist straight away if you have any of these symptoms. Rarely, osteonecrosis can also affect the bones around the ears. If you have any ear pain, infection, or fluid leaking (discharge) from your ear, tell your doctor straight away.

Denosumab (Prolia) can cause skin rashes. It is important to tell your doctor if this happens. They can give you medicine to help with this.

Occasionally this treatment can cause a skin infection. If you notice an area of skin becomes red, swollen and warm to touch, tell your doctor straight away.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

• try to drink at least 2 litres (3½ pints) of fluids each day
• avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
• contact the hospital for advice.

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

This treatment may cause flu-like symptoms such as:

• feeling hot or cold or shivery
• a headache 
• muscle or body aches. 

Tell your doctor if these symptoms affect you. It may help to take mild painkillers.

Denosumab (Prolia) can cause back pain and sciatica. Tell your doctor if this happens. They can give you painkillers to help. It is important to let your doctor know if you have any numbness or tingling in your lower back or legs. This may be caused by pressure on nerves in or around the spine.

Tell your doctor straight away if you have any weakness, loss of bladder or bowel control, or you feel any loss of sensation in your legs.

Denosumab (Prolia) can cause clouding of the eye’s lens (cataracts). Tell your doctor if you notice any changes in your vision. Do not drive if your vision has been affected.

Some people may find that they sweat more than usual while having this treatment. Try to drink plenty of fluids if this happens. You can talk to your doctor if you have any concerns.

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

• medicines you have been prescribed
• medicines you buy in a shop or chemist
• vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.

Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus (covid) vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations. 

If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.

Your doctor or nurse can give you more information.

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.