Xofigo Dosage: Form, Strength, How It's Given, and More

If you’ve been diagnosed with advanced prostate cancer that has spread to the bones, your oncologist may recommend Xofigo as part of your treatment plan. Understanding the medication’s dosage, how it’s given, safety precautions, and what to expect can help you feel more confident and prepared for the journey ahead.

In this guide, we’ll cover everything about Xofigo — from dosage calculations and treatment schedules to side effect management and important safety tips.

What is Xofigo?

Xofigo (generic name: radium Ra 223 dichloride) is a radiopharmaceutical — a unique type of cancer medicine that contains radioactive material designed to target bone metastases.

Unlike chemotherapy, which travels through the entire body, or hormone therapy, which affects testosterone-driven cancer growth, Xofigo delivers radiation directly to bone cancer cells. It mimics calcium, allowing it to settle into areas of high bone activity — which is exactly where metastatic prostate cancer cells tend to grow.

Who Is Xofigo For?

The U.S. FDA has approved Xofigo for:

Men with castration-resistant prostate cancer (CRPC)
Cancer that has spread to bones but not to other organs
Cases where the disease continues to progress despite hormone-lowering treatments

Forms and Strength of Xofigo

Unlike oral medications or home injections, Xofigo is not self-administered.

Form: Clear, colorless liquid solution
Strength: 1,100 kilobecquerels (kBq) per milliliter (mL) at the reference date
Measurement unit: kBq measures radioactivity — the dose must be carefully calculated for safety and effectiveness.

Because radioactive substances naturally decay over time, your healthcare team will adjust the volume you receive based on when the vial was prepared.

How Xofigo Is Given

Where: Only in specialized facilities (hospital oncology units, cancer centers, or nuclear medicine departments)
By whom: Trained professionals licensed to handle radioactive drugs
Method: Given intravenously (IV) over about one minute
Safety: Staff use shielding, protective gear, and strict handling protocols

Xofigo Dosage Calculation

The standard dose is:

55 kBq per kilogram (kg) of body weight

Since 1 kg ≈ 2.2 lbs, your exact dose is determined at each visit based on your current weight.

Example:
If you weigh 80 kg (176 lbs) → 80 × 55 kBq = 4,400 kBq per treatment.

Typical Treatment Schedule

Frequency: Once every 4 weeks
Total injections: 6 doses (about 24 weeks of treatment)
Adjustments: May be delayed if blood counts drop too low

Your doctor will check your blood work before each session to ensure it’s safe to proceed.

What to Do If You Miss a Dose

Missing a scheduled Xofigo injection isn’t ideal, but it’s also not a reason to panic.

If you cannot make your appointment:

Call your oncology clinic immediately – Don’t wait until your next scheduled dose.
Reschedule as soon as possible – Your care team will adjust the remaining treatment schedule to maintain the proper spacing between doses.
Expect possible extra tests – If your treatment gap is long, your doctor may repeat blood tests to check your bone marrow health before giving the next dose.

💡 Tip:
To reduce the risk of missing appointments:

Book all six sessions in advance at the start of treatment.
Use phone alarms or a calendar app to set reminders.
Ask a family member or friend to help track your schedule.

Side Effects of Xofigo

Like all cancer treatments, Xofigo can cause side effects — some are mild and manageable, while others require immediate medical attention.

Common Side Effects

These may appear after your injection and tend to improve with time:

Digestive symptoms: Nausea, diarrhea, vomiting
Swelling: Particularly in the ankles, feet, or legs
Fatigue: Low energy levels can persist for days or weeks
Decreased appetite and weight loss
Dehydration (especially if digestive side effects are prolonged)

Xofigo can lower blood cell counts:

Low white blood cells (neutropenia) → Higher infection risk
Low red blood cells (anemia) → Fatigue, dizziness, shortness of breath
Low platelets (thrombocytopenia) → Easy bruising, nosebleeds, or prolonged bleeding

This is why blood work before each dose is mandatory.

Managing Side Effects Effectively

For digestive symptoms:

Eat smaller, more frequent meals
Avoid greasy, spicy, or high-fiber foods during flare-ups
Stay hydrated with water, electrolyte drinks, or clear broths

For swelling:

Elevate your legs when sitting
Wear compression socks if recommended by your doctor
Reduce excess salt in your diet

For fatigue:

Schedule rest periods throughout the day
Light exercise like walking can improve energy over time
Avoid overexertion on treatment days

For low blood counts:

Wash hands frequently and avoid crowds during flu season
Report fevers above 100.4°F (38°C) immediately
Use a soft toothbrush and electric razor to prevent bleeding

Serious Side Effects – When to Call the Doctor

Seek urgent medical attention if you notice:

Persistent vomiting or diarrhea leading to dehydration
Signs of infection (fever, chills, persistent cough)
Unusual bruising or bleeding
Dizziness, confusion, or extreme fatigue
Reduced urine output or severe dehydration symptoms

Radiation Safety at Home After Xofigo

Because Xofigo contains radioactive material, small amounts of radiation will leave your body through urine and stool for several days after each injection.

Precautions:

Use the toilet sitting down (to avoid splashes) for at least 7 days post-treatment
Flush twice after each use
Wash hands thoroughly with soap and water
If urine or stool comes into contact with clothing, wash separately from other laundry
Pregnant women and young children should avoid close contact for several days after each dose

These steps protect your loved ones from unnecessary exposure.

Precautions and Contraindications

Xofigo may not be suitable for:

Men with severely compromised bone marrow function
Patients whose cancer has spread to organs beyond bone and lymph nodes
Individuals with active inflammatory bowel disease (due to higher GI side effect risk)

Women who are pregnant or breastfeeding should never handle Xofigo or body fluids from treated patients.

Drug Interactions with Xofigo

Compared to chemotherapy, Xofigo has fewer known drug interactions, but there are still important considerations.

Potential Interactions

Blood thinners (warfarin, apixaban, etc.) – Low platelet counts from Xofigo can increase bleeding risk. Your doctor may monitor your INR (for warfarin users) or adjust dosing for other anticoagulants.
Immunosuppressants – These may compound the risk of infection when Xofigo lowers white blood cell counts.
Certain antibiotics – Some antibiotics, particularly those affecting kidney function, may interfere with how your body clears Xofigo.
Other bone-targeting agents – Medications like zoledronic acid or denosumab can be used alongside Xofigo, but timing and monitoring are essential to reduce risk of overlapping side effects like hypocalcemia (low calcium levels).

💡 Tip: Always give your healthcare team a complete list of:

Prescription medications
Over-the-counter drugs
Vitamins and herbal supplements

Even “natural” products like St. John’s Wort or high-dose antioxidants can potentially interfere with treatment.

Post-Treatment Monitoring

Even after your last Xofigo injection, follow-up is crucial to track both cancer control and side effects.

Typical monitoring includes:

Blood tests – Check for recovery of red cells, white cells, and platelets.
Imaging scans – Evaluate whether bone metastases have shrunk, stabilized, or progressed.
Symptom review – Discuss bone pain, fatigue, mobility changes, and overall quality of life.
Long-term safety checks – While rare, secondary cancers can develop years later, so your oncologist may keep you under extended observation.

Lifestyle Adjustments During Xofigo Treatment

Treatment with Xofigo isn’t just about getting injections — small changes to your daily routine can improve comfort and outcomes.

Nutrition:

Focus on protein-rich foods to support bone health and healing.
Stay hydrated to help your body clear the radioactive material.
Limit alcohol, which can worsen dehydration and interfere with recovery.

Activity:

Gentle weight-bearing exercise (walking, light resistance bands) helps maintain bone strength.
Avoid high-impact activities that increase fracture risk.

Infection prevention:

Practice good hygiene, especially during low white blood cell periods.
Avoid raw or undercooked meat and unwashed produce during treatment.

Patient Experience Tips

Bring a friend or family member to your first appointment for emotional support and to help remember instructions.
Track your side effects in a journal — this helps your oncologist adjust treatment or recommend supportive care.
Plan lighter schedules around injection days to allow for rest.
Communicate openly — if pain worsens or you notice new symptoms, speak up right away.

Is Xofigo the Right Choice for You?

When deciding on Xofigo, you and your oncologist will weigh several factors:

Cancer location – Best for cases where prostate cancer has spread only to bones, not other organs.
Overall health – Bone marrow strength, kidney function, and other medical conditions matter.
Previous treatments – Xofigo is usually given after hormone therapy stops working.
Treatment goals – Some patients prioritize pain relief and mobility; others aim to slow progression as much as possible.

Remember — starting Xofigo doesn’t mean you can’t change course. If it’s not providing benefits or side effects are too severe, your team can pivot to another therapy.

Key Takeaways

Xofigo offers targeted treatment for bone metastases in prostate cancer with a structured 6-dose schedule.
Side effects are manageable with proactive care, but regular blood monitoring is essential.
Radiation safety measures at home protect loved ones.
Clear communication with your healthcare team ensures safer, more effective treatment.

Cost of Xofigo in 2025

Without insurance, Xofigo can exceed $12,000 per dose. With six doses, total treatment costs can surpass $70,000.

Ways to Save:

Manufacturer assistance programs
Medicare Part B coverage (often covers most costs)
Hospital charity care programs
Nonprofit patient aid organizations

Frequently Asked Questions

Q: Can Xofigo cure prostate cancer?
No. Xofigo is a palliative therapy — it manages symptoms and slows bone disease but is not a cure.

Q: Will I lose my hair with Xofigo?
Hair loss is not typical since radiation is targeted to the bones.

Q: How soon will I feel pain relief?
Some patients notice improvement within a few weeks, while others may take multiple doses.

Q: Can I be around my grandchildren after Xofigo?
Yes, but follow radiation precautions for a few days after each treatment.

Bottom Line

Xofigo is a highly targeted, bone-specific treatment for advanced prostate cancer that can relieve pain and delay complications. By understanding its dosage, schedule, safety measures, and costs, you can work with your oncology team to maximize benefits while minimizing risks.

With careful monitoring and support, many men find that Xofigo improves both comfort and quality of life during a difficult stage of their cancer journey.

Xofigo Dosage: Form, Strength, How It’s Given, and More