radium-223 dichloride at a glance
Medicine class
Bone-targeting alpha-emitting radiopharmaceutical
Administration
Slow intravenous injection given by authorised nuclear-medicine staff
Key checks
Blood counts and bone health require assessment and monitoring
After treatment
Follow the nuclear-medicine team's hygiene precautions for radioactive body fluids
What is radium-223 dichloride used for?
The selected product is licensed for:
Adults with metastatic castration-resistant prostate cancer progressing after at least two previous systemic treatment lines other than LHRH analogues, or who cannot receive an available systemic treatment. Bone metastases must be symptomatic and there must be no known visceral metastases. It may be used alone or with an LHRH analogue.
How does radium-223 dichloride work?
Radium-223 behaves similarly to calcium and binds to bone mineral at areas of increased bone turnover, including bone metastases. It emits alpha particles over a very short distance, damaging DNA in nearby tumour cells while limiting radiation exposure to more distant tissue.
How to take radium-223 dichloride
Radium-223 dichloride is given in a specialist nuclear-medicine setting and is not taken or stored at home.
It is given slowly into a vein through a cannula.
Food and drink can usually be taken normally; maintain hydration as directed by the treatment team.
Tell the team about bowel or bladder-control problems, catheters or stomas.
Follow written hygiene instructions for urine, faeces, vomit, contaminated laundry and spillages after administration.
radium-223 dichloride side effects
Common or expected effects
- Diarrhoea
- Nausea or vomiting
- Reduced platelet count
- Bone fracture
- Reduced white-cell or neutrophil count
- Redness, pain or swelling at the injection site
Get urgent medical advice
- Fever or recurrent infections
- Unusual bruising or bleeding
- Severe or persistent gastrointestinal symptoms causing dehydration
- New severe bone pain or loss of function suggesting a fracture
- Jaw pain, swelling, numbness or a loose tooth, particularly with bone-protective treatment
radium-223 dichloride in pregnancy
Radium-223 dichloride is not indicated for women and must not be used during pregnancy. Men with a partner who could become pregnant should use effective contraception during treatment and for six months afterwards.
radium-223 dichloride while breastfeeding
Radium-223 dichloride is not indicated for women and must not be used while breastfeeding.
radium-223 dichloride interactions
Clinical interaction studies are limited. The specialist team should review all prescribed, non-prescription and complementary products.
Abiraterone acetate with prednisone or prednisolone
This combination is contraindicated because fracture risk increased and a trend towards increased mortality was observed.
Other systemic anticancer treatments
Combination is not recommended, except with an LHRH analogue, because safety is unestablished and fracture or mortality risk may increase.
Cytotoxic chemotherapy
Concurrent use may add to bone-marrow suppression and has not been adequately established as safe or effective.
Common questions about radium-223 dichloride
Answers are fully visible for fast scanning and source review.
Is radium-223 dichloride chemotherapy or radiotherapy?
It is a therapeutic radiopharmaceutical: a radioactive substance given into a vein that delivers short-range alpha radiation mainly at active bone metastases.
Why does radium-223 dichloride target cancer in bone?
It behaves similarly to calcium and binds to bone mineral where turnover is increased, including sites of osteoblastic metastases.
Can radium-223 dichloride be used if prostate cancer has spread to internal organs?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.