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
Written by
Finlay66
To view profiles and participate in discussions please or .
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.
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?
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?
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.
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.
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.
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.
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.
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. "
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?
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
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.
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.
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.
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.......
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Radium 223 instead of enzalutamide 
Radium 223 Xofigo Treatment
Xofigo Radium 223 Dichloride 
Radium 223 success/advice?
