Radium 223 dichloride Disease Interactions

A randomized clinical trial reported that 2% of the patients receiving radium Ra 223 experienced bone marrow failure or ongoing pancytopenia, including 2 deaths due to bone marrow failure. Myelosuppression including thrombocytopenia, neutropenia, pancytopenia, and leukopenia have been reported in patients receiving this agent. Patients should have a baseline hematologic evaluation, as well as another evaluation prior to every dose. The absolute neutrophil count (ANC) prior to the first administration should be >= 1.5 x 10^9/L, the platelet count should be >= 100 x 10^9/L, and hemoglobin should be >= 10 g/dL; and before subsequent administrations, the ANC should be >= 1 x 10^9/L and the platelet count >= 50 x 10^9/L. Discontinue treatment if after the last administration there is no recovery of these values within 6 to 8 weeks, despite supporting care and in those patients experiencing life-threatening complications. Caution is advised in patients with preexisting hematologic issues.

No dedicated hepatic or renal impairment studies have been conducted for radium Ra 223. Subgroup analyses in the randomized controlled trials have concluded that no dose adjustment is needed in patients with mild to moderate renal impairment, and mild hepatic impairment. No dose adjustment can be recommended for patients with severe renal impairment or moderate to severe hepatic impairment. Caution is advised if used in these patients.