Adult Dosing
Pain due to bone metastases
- Recommended dose: 148 MBq (4 mCi) given by slow IV injection over 1-2 minutes
- Alt: 1.5-2.2 MBq/kg (40-60 mcCi/kg) IV over 1-2 minutes
- May repeat administrations based on the patient’s response to therapy, current symptoms, and hematologic status
Notes:- Do not repeat administration within 3 months of previous dose
- Measure the patient dose immediately prior to therapy using appropriate radioactivity calibration system
- Keep the vial inside its transportation shield whenever possible
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
See Supplemental Patient Information
- Avoid use in patients with seriously compromised bone marrow due to prior therapy or disease infiltration, unless potential benefit of the therapy outweighs its risks
- Bone marrow toxicity, especially involving white blood cells and platelets, has been reported with therapy use. Monitor peripheral blood cell counts at least once every alternate week
- Platelet levels may decline to 70% of pre-treatment values; the nadir of platelet depression occurs usually between 12 and 16 wks following therapy administration, after which recovery occurs gradually, reaching pre-administration levels 6 months after treatment
- Carefully evaluate the patient’s hematologic response to initial dose, current platelet level and evidence of marrow toxicity, prior to re-administration
- Dose verification and patient identification is recommended prior to administration, as a relatively high dose of radioactivity is delivered by strontium-89
- Fetal harm may occur following administration to a pregnant woman. Advise women of childbearing age to avoid becoming pregnant during therapy
- If used during pregnancy or if the patient becomes pregnant during therapy, caution the patient regarding the potential risk to the fetus
- Therapy not intended for treatment of cancer not involving bone. Confirm presence of bone metastases prior to therapy
- Therapy should be administered by physicians who are well trained, experienced, and certified by appropriate government agency authorized to license the handling of radionuclides
- Strontium-89 must be handled with care and appropriate safety measures to reduce radiation exposure to clinical personnel
- Therapy not recommended in patients with very short life expectancy, as the onset of pain relief usually requires 7-20 days following administration
- Rapid administration (<30 second injection) may lead to a calcium-like flushing sensation
- Consider special precautions, such as urinary catheterization, following administration to incontinent patients in order to reduce the risk of radioactive contamination of clothing, bed linen and the patient's surroundings
- Use cautiously in patients with renal impairment only after careful evaluation of the possible benefits and risks of therapy
Cautions: Use cautiously in
- Renal impairment
- Platelet counts <60,000
- WBC counts <2,400
Supplemental Patient Information
- Advise women of childbearing potential to avoid becoming pregnant during therapy. Apprise female patients of the potential hazard to the fetus if used during pregnancy or if the patient becomes pregnant while receiving therapy
Pregnancy Category:D
Breastfeeding: It is unknown if this drug is excreted in human milk. However, because strontium-89 acts as a calcium analog, it is likely to be secreted in breast milk. Manufacturer recommends discontinuation of nursing during therapy.
