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Strontium-89

Medically reviewed by Drugs.com. Last updated on May 9, 2023.

Pronunciation

(STRON shee um atey nine)

Index Terms

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intravenous, as chloride:

Generic: 1 mCi/mL (1 ea)

Solution, Intravenous, as chloride [preservative free]:

Metastron: 1 mCi/mL (4 mL [DSC]) [pyrogen free]

Brand Names: U.S.

Pharmacologic Category

Pharmacology

Strontium-89 selectively localizes in metastatic bone lesions emitting beta radiation to reduce pain.

Distribution

Selectively localizes in bone mineral (preferentially to metastatic bone lesions)

Excretion

In patients with bone metastases: Urine (67%); feces (33%)

Onset of Action

Pain relief: 7 to 20 days

Use: Labeled Indications

Skeletal metastases (bone pain): Relief of bone pain in patients with skeletal metastases.

Limitation of use: Confirm the presence of bone metastases prior to therapy.

Contraindications

There are no contraindications listed in the manufacturer’s labeling.

Dosing: Adult

Skeletal metastases (bone pain): IV: 148 megabecquerel (MBq; 4 millicurie [mCi]) or 1.5 to 2.2 MBq (40 to 60 microCi)/kg; repeat doses should be based on individual response, symptoms, and blood counts and are generally not recommended at intervals <90 days. Measure dose by a suitable radioactivity calibration system immediately prior to administration.

Dosing: Geriatric

Refer to adult dosing.

Administration

IV: Administer intravenously slowly over 1 to 2 minutes. Radiopharmaceutical; use appropriate precautions for handling and disposal.

Storage

Store vial (and contents) at 15°C to 25°C (59°F to 77°F); store in transportation shield container.

Drug Interactions

There are no known significant interactions.

Strontium-89 chloride drug interactions (more detail)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

Cardiovascular: Flushing (after rapid injection)

Hematologic & oncologic: Leukopenia, thrombocytopenia (nadir: 12 to 16 weeks; recovery: 6 months)

Neuromuscular & skeletal: Ostealgia (transient increase; duration: 36 to 72 hours)

<1%, postmarketing, and/or case reports: Chills, fever, hot flash, septicemia

Strontium-89 chloride side effects (more detail)

Warnings/Precautions

Concerns related to adverse effects:

• Bone marrow suppression: Bone marrow toxicity (thrombocytopenia and leukopenia) is likely to occur. Use is not recommended in patients with seriously compromised bone marrow function from prior therapies or from disease infiltration (unless potential benefit outweighs risks). Monitor CBC at least every other week. The platelet nadir typically occurs between 12 and 16 weeks following administration; platelets and WBC recovery occur slowly, generally reaching baseline levels 6 months after treatment in the absence of other therapy interventions or disease progression. Use with caution in patients with platelets <60,000/mm3 or WBCs <2,400/mm3. Carefully evaluate bone marrow status and toxicity of initial dose if considering repeat administration.

• Bone pain: A small number of patients have experienced a transient increase in bone pain at 36 to 72 hours after administration; this is generally mild and self-limiting.

• Flushing: A flushing sensation has been reported following rapid (<30 seconds) injection.

Disease-related concerns:

• Incontinence: Incontinent patients may require urinary catheterization (to minimize radioactive contamination of clothing, bedding, and/or environment).

• Renal impairment: Primarily eliminated renally; possible risk versus benefit should be evaluated in patients with renal impairment.

Special handling:

• Radiopharmaceutical: Use appropriate precautions for handling, disposal, and minimizing exposure to patients and healthcare personnel. Use only under supervision of individuals with experience/training in the handling of radioactive materials approved by the applicable regulatory authority. Patients should take the following precautions to minimize exposure (Silberstein 2003): Avoid soiling underclothing or areas around toilet bowls for 2 weeks after injection. Wash any underclothing separately if significantly stained with urine. Where a normal toilet is available, sit to urinate in preference to a urinal. Flush toilet twice after use. Wash hands thoroughly after urination.

Other warnings/precautions:

• Appropriate use: Strontium-89 is not indicated for use in patients with cancer not involving bone. Due to delayed onset of pain relief (7 to 20 days following administration), also not indicated for use in patients with a short life expectancy.

Monitoring Parameters

CBC with differential (at least every other week)

Reproductive Considerations

Women of childbearing potential should avoid becoming pregnant.

Pregnancy Risk Factor

D

Pregnancy Considerations

May cause fetal harm if administered during pregnancy.

Patient Education

What is this drug used for?

• It is used to treat bone pain caused by cancer.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Flushing

• Bone pain

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Infection

• Bleeding like vomiting blood or vomit that looks like coffee grounds, coughing up blood, blood in the urine, black, red, or tarry stools, bleeding from the gums, abnormal vaginal bleeding, bruises without a reason or that get bigger, or any bleeding that is very bad or that will not stop.

• Severe loss of strength and energy

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer