Ra-223 Dichloride

What it is and how it works

Radium-223 is a calcium mimetic that forms complexes with hydroxyapatite in areas of increased bone turnover such as bone metastases. Its high-energy, short-range alpha particles cause double-strand DNA breaks in adjacent tumour cells with limited damage to surrounding marrow.

Indications

Metastatic castration-resistant prostate cancer with symptomatic bone metastases and no known visceral metastases, under licence-specific conditions (e.g. after prior lines of therapy).

Dosage and administration (summary)

Dosing is individualised according to protocol by nuclear medicine specialists; the licensed regimen is based on body weight (kBq/kg) by slow intravenous injection every 4 weeks for six injections.

Contraindications

Not for use in women; contraindicated in combination with abiraterone and prednisone/prednisolone.

Warnings and precautions

Bone marrow suppression (thrombocytopenia, neutropenia) may occur; check blood counts before each dose. Increased fractures and deaths were reported when combined with abiraterone, so bone health should be assessed; men should use effective contraception, and radiation-protection measures are required.

Pregnancy

Not indicated in women.

Storage and supply

Store according to radiopharmaceutical regulations in the original lead-shielded container; no special temperature requirements stated beyond the manufacturer’s instructions.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.