Radium 223 and (AdcalD3) calcium supplements

[Finlay66]

Hi

I was hoping for some clarity here as I've been getting different advice in the UK.

I think the advice is to keep off the calcium supplements 7 days before a Ra 223 injection and then return to the tablets a few days after. Similarly my Zometa (Zoledronic Acid )injection should be timed so it is no closer than 7 days before or after the Radium injection.

Also are there any views on keeping on Dexamethasone to control inflammation?

I'd be grateful for wisdom here as to what works best particularly with regard to the Adcal and Zometa timing?

Thanks

[GP24]

Your overall survival will not change if you omit these drugs for seven days. Therefore I would follow the recommendation by your doctor. You can continue with Dexamethasone.

[Tall_Allen]

Yes, bad idea to take calcium supplements with Xofigo. Why are you supplementing calcium?Is your serum calcium low?

Start with NSAIDs for inflammation.

[Finlay66 in reply to Tall_Allen]

Thank you Tall Allen. I'll discuss again with my Oncologist. Are you saying I should stay off a calcium supplement altogether or just for the 7 days prior to the injection?

[Tall_Allen in reply to Finlay66]

Definitely before and after the injection. IDK why you are supplementing calcium - you didn't answer my question.

[Finlay66 in reply to Tall_Allen]

I've been told to take Adcal D3 ever since starting Enzalutamide and although I'm now castration resistant and have finished 10 cycles Docetaxel, they insisted I take it alongside Zometa to maintain stable calcium levels. I have a blood test on Monday so it will be useful to see how things are going with ALP and my overall bone profile.

I think what I'm trying to understand is how to ensure that Xofigo is as effective as possible whilst managing my bone profile?

[Benkaymel in reply to Finlay66]

I was prescribed Natecal (calcium+D3) by my MO when I started Xtandi last year but since my serum calcium was normal I didn't actually take it. Also my GP questioned why I was given it without evidence of needing it via a DEXA scan (I've never had one) or a deficiency. I have a blood test every month so after the last one I decided to start taking the Natecal to see what effect it has on my serum calcium level at the next blood test.

[mypk]

Radium behaves in the body like calcium - an important building block of bone - and therefore accumulates where a lot of bone remodeling is taking place. This includes bone metastases.

Therefore, the intake of calcium, phosphate or vitamin D should be paused a few days before until the day after the therapy.

The instruction from my nuclear medicine doctor was to not take calcium/vitamin D tablets 3 days before a Xofigo infusion and 1 day after. My XGEVA (denosumab) injections, which involve taking 600 mg of calcium daily in the form of tablets or effervescent tablets with vitamin D, continued during the radium-223 therapy - only with the 4-day break for each radium-223 infusion.

[Finlay66 in reply to mypk]

Thank you.

[Tall_Allen in reply to mypk]

Intake of extra calcium may be risky, but if your serum levels are low, you may need it. I'm trying to discern why you needed it. It sounds like you were just taking it routinely.

[Hidden in reply to Tall_Allen]

Because its concurrent with XGEVA treatments.

[Tall_Allen in reply to Hidden]

Only required if serum calcium is low

[Hidden in reply to Tall_Allen]

On Prednisone, my monthly calcium blood is constantly 9.2, while on calcium supplements.

Thats towards the low end.

The trick is keeping your Potassium up to prevent kidney stones.

I won't quote the studies, search, its good reading!!

[Tall_Allen in reply to Hidden]

There are no studies to search. Your experience is probably that you would have low serum calcium if you didn't supplement, which again proves my point - test your serum calcium first.

[mypk in reply to Tall_Allen]

"Only required if serum calcium is low"

Are you sure? Amgen's product information for XGEVA (Denosumab) says

------------

4..4 Supplementation of at least 500 mg calcium and 400 IU vitamin D daily is required in all patients, unless hypercalcaemia is present (see section 4.4).

4.4 Special warnings and precautions for use Calcium and Vitamin D supplementation Supplementation with calcium and vitamin D is required in all patients unless hypercalcaemia is present (see section 4.2).

------------

And hypercalcaemia is when your serum calcium is too high.

Link:

ema.europa.eu/en/documents/...

[Tall_Allen in reply to mypk]

Yes, I'm sure. I'm aware of the prescription info. The problem is that the Xgeva and Zometa trials were done with supplementation. As these authors found:

"Studies seeking to show whether these supplements do increase the efficacy of osteoporotic treatment or decrease adverse events (that is, hypocalcaemia) are lacking. "

ncbi.nlm.nih.gov/pmc/articl...

Many men will have low calcium and require supplementation with calcium and Vitamin D when taking Zometa and Xgeva, but checking serum calcium is always part of blood tests anyway, so why not do it? One may have too much or too little - isn't it better to get the dose right?

[Hidden in reply to Tall_Allen]

Another reason is weight lifting while taking Prednisone, you need to increase Calcium and D to supplement bone rebuilding. Prednisone decreases the absorption of calcium within the body

[Tall_Allen in reply to Hidden]

There is no proof that calcium supplementation is required while "weight lifting while taking Prednisone, you need to increase Calcium and D to supplement bone rebuilding."

It is very simple - if serum calcium is low for any reason, supplementation along with Vitamin D is required, otherwise it may do more harm than good.

[Hidden in reply to Tall_Allen]

Read my response above.

[Finlay66 in reply to Tall_Allen]

My calcium levels have been stable and normal over the past year with Adcal D3 supplements. I think what I'm trying to establish is how things should change after my first cycle of Xofigo. At present I'm inclined to stop the supplements one week before the injection and then seek advice based on the blood test and the advice of the Oncologist on when to resume the tablets to keep things stable.

When you say "risky" what exactly are the risks?

Many thanks for your advice to date.

[Tall_Allen in reply to Finlay66]

Excess calcium can cause heart and kidney disease, and has been implicated in encouraging PCa progression. Take it if you need it.

[FionaElbourne]

my husband took both of these drugs the whole way through his Radium treatment. He is currently on dexamethosone after his Lutetium treatment but only for 12 days gradually reducing after 4 days. He takes cocodamol for pain for a few days after the steroid finishes as he still has pain. He had no pain with the radium treatment, we are in Scotland.

[Finlay66 in reply to FionaElbourne]

Thank you. Did he stop the Adcal D3 before each injection?

[FionaElbourne in reply to Finlay66]

no he took it throughout the treatment.

[j-o-h-n]

How ya gonna keep 'em down on the farm after they've seen H.U.

Hey MooMoo, Yes Homogenized , I just read in the Daily Dairy Utter that humans say that our calcium is bad for them.......MooMoo, holy cow, do I have a bone to pick with them.......

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 04/23/2023 2:42 PM DST