Radium 223 Dichloride
Pronunciation: (RAY-dee-um too-twenty-three dye-KLOR-ide).
- Generic name
- Radium 223 dichloride
- Brand names
- Ra223, Xofigo, Radionex
- Drug class
- Radiopharmaceutical, Antineoplastic Agent
Availability and supply rules vary by country
Trade names by country: United Kingdom
Australia: · Full directory
What Radium 223 dichloride is and how it works
Uses, formulations, monitoring, and supply rules can differ by patient, product, and country. Follow the exact local product information and professional advice.
Mechanism of action: how Radium 223 dichloride works
Radium 223 dichloride is a targeted alpha-emitting radiopharmaceutical. It mimics calcium and selectively binds to areas of increased bone turnover, such as bone metastases. The emitted alpha particles cause double-stranded DNA breaks in adjacent tumor cells, leading to cell death while minimizing damage to surrounding healthy tissue due to the short range of alpha radiation. (2) (3)
What Radium 223 dichloride is used for
Treatment of castration-resistant prostate cancer
Treatment of symptomatic bone metastases
Treatment of prostate cancer with no known visceral metastatic disease
Treatment of prostate cancer with no known visceral metastatic disease (2) (3)
Before taking Radium 223 dichloride
Do not take / not appropriate for
- Contraindicated in pregnancy, breastfeeding, and patients with known hypersensitivity to radium 223 dichloride. (Contraindication) (2)
- Not recommended for use with abiraterone and prednisone/prednisolone due to increased risk of fractures and mortality. (Contraindication) (2)
Tell your clinician about
(2) (3)How to take Radium 223 dichloride
- General Instructions: Radium 223 dichloride is administered as a slow intravenous injection by a healthcare professional, typically every 4 weeks for a total of 6 injections.. Adult Dosing: The recommended dose is 55 kBq per kg body weight, given intravenously every 4 weeks for 6 cycles.. Pediatric Dosing: Safety and efficacy in children have not been established. This medication is not recommended for pediatric use.. Administration: Administered by a trained healthcare provider in a clinical setting. Do not self-administer.. When To Stop: Treatment may be stopped if there are severe side effects, significant drop in blood counts, or as directed by your doctor.. Storage: Radium 223 dichloride is stored and handled by healthcare professionals under strict radiation safety protocols. Patients do not store this medication at home.
- This page does not provide a dose calculator. Dosing must follow the prescriber, pharmacist, or product label.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (2) (3)
Missed dose
If you miss an appointment for your injection, contact your healthcare provider as soon as possible to reschedule. Do not attempt to administer the medication yourself.
Overdose
In case of suspected overdose, seek immediate medical attention. Overdose may increase the risk of bone marrow suppression and gastrointestinal toxicity. Supportive care and monitoring of blood counts are recommended. (2) (3)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms to a healthcare professional.
Myelosuppression
Incidence: Reported in the clinician-authored database; frequency not established
Nausea
Incidence: Reported in the clinician-authored database; frequency not established
Diarrhea
Incidence: Reported in the clinician-authored database; frequency not established
Vomiting
Incidence: Reported in the clinician-authored database; frequency not established
Peripheral edema
Incidence: Reported in the clinician-authored database; frequency not established
Thrombocytopenia
Incidence: Reported in the clinician-authored database; frequency not established
Anemia
Incidence: Reported in the clinician-authored database; frequency not established
Serious warnings
May cause severe bone marrow suppression — serious
Symptoms: May cause severe bone marrow suppression. Not for use in women who are pregnant or breastfeeding. Use caution in patients with impaired bone marrow reserve. Risk of gastrointestinal side effects, including diarrhea and vomiting. Radiation safety precautions are required after administration.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2) (3)
Contraindications recorded in the clinician database — serious
Symptoms: Contraindications recorded in the clinician database: Contraindicated in pregnancy, breastfeeding, and patients with known hypersensitivity to radium 223 dichloride. Use with caution in patients with compromised bone marrow reserve, active infections, or gastrointestinal disorders. Not recommended for use with abiraterone and prednisone/prednisolone due to increased risk of fractures and mortality.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2) (3)
Fertility and contraception — serious
Symptoms: Fertility and contraception: because of possible effects on sperm production, male patients should use condoms and their female partners of reproductive potential should use effective contraception during treatment and for 6 months after completing it. Based on how the medicine works, it may impair male fertility.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2) (3)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Recorded interactions | Radium 223 dichloride may interact with other cytotoxic agents, increasing the risk of bone marrow suppression. Concurrent use with abiraterone and prednisone/prednisolone is not recommended due to increased risk of fractures and mortality. Always inform your healthcare provider about all medications and supplements you are taking. | (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
Radium 223 dichloride is only approved for use in men and its safety and efficacy have not been established in women. Based on how it works, it can cause fetal harm if a pregnant person were exposed. Because of possible effects on sperm production, male patients should use condoms and their female partners of reproductive potential should use effective contraception during treatment and for 6 months after finishing it. (2) (3)
Breastfeeding
This medicine's safety and efficacy have not been established in women. There is no data on whether radium-223 dichloride passes into human breast milk, its effects on a breastfed child, or its effects on milk production. (2) (3)
Children
Frequency: Not applicable.. Weight Based: Not recommended for pediatric use.. Max Daily Dose: Not applicable.. Max Single Dose: Not applicable.. Age Restrictions: Safety not established in children. (2) (3)
Renal_impairment
No dedicated renal- or hepatic-impairment trial has been conducted for radium-223 dichloride. Renal: based on subgroup analyses in the pivotal trial, dose adjustment is not needed for existing mild (creatinine clearance 60-89 mL/min) or moderate (30-59 mL/min) renal impairment; no dose adjustment can be recommended for severe renal impairment (below 30 mL/min) because only limited data (2 patients) are available. Hepatic: because radium-223 is neither metabolized by the liver nor eliminated via bile, hepatic impairment is unlikely to affect its pharmacokinetics; dose adjustment is not needed for mild hepatic impairment, but no dose adjustment can be recommended for moderate or severe hepatic impairment due to lack of clinical data. (2) (3)
Hepatic_impairment
No dedicated renal- or hepatic-impairment trial has been conducted for radium-223 dichloride. Renal: based on subgroup analyses in the pivotal trial, dose adjustment is not needed for existing mild (creatinine clearance 60-89 mL/min) or moderate (30-59 mL/min) renal impairment; no dose adjustment can be recommended for severe renal impairment (below 30 mL/min) because only limited data (2 patients) are available. Hepatic: because radium-223 is neither metabolized by the liver nor eliminated via bile, hepatic impairment is unlikely to affect its pharmacokinetics; dose adjustment is not needed for mild hepatic impairment, but no dose adjustment can be recommended for moderate or severe hepatic impairment due to lack of clinical data. (2) (3)
Monitoring
(2) (3)Storage
Radium 223 dichloride is stored and handled only by licensed healthcare professionals under strict radiation-safety protocols — patients do not store this medication at home. For reference: the FDA label specifies storage at room temperature, below 40°C (104°F), in the original container or equivalent radiation shielding, by persons licensed by the Nuclear Regulatory Commission or the relevant Agreement State authority, following procedures for proper handling and disposal of radioactive material.
Professional information
Clinician-facing context only. This section does not replace current product labeling.
General
Indication: Treatment of castration-resistant prostate cancer
Dose summary: The recommended dose of Radium 223 dichloride is 55 kBq/kg (1.49 mCi/kg) administered intravenously.
Renal context: No dedicated renal-impairment trial has been conducted for radium-223 dichloride. Based on subgroup analyses in the pivotal randomized trial, dose adjustment is not needed for existing mild (creatinine clearance 60-89 mL/min) or moderate (30-59 mL/min) renal impairment; no dose adjustment can be recommended for severe renal impairment (below 30 mL/min) because of the limited data available (only 2 patients studied). (2) (3)
Hepatic guidance
No dedicated hepatic-impairment trial has been conducted for radium-223 dichloride. Because radium-223 is neither metabolized by the liver nor eliminated via bile, hepatic impairment is unlikely to affect its pharmacokinetics; dose adjustment is not needed for mild hepatic impairment based on subgroup analysis, but no dose adjustment can be recommended for moderate or severe hepatic impairment due to a lack of clinical data.
Frequently asked questions
What is Radium 223 dichloride used for?
Radium 223 dichloride is used to treat adults with castration-resistant prostate cancer that has spread to bones but not to other organs.
How does Radium 223 dichloride work?
It mimics calcium and targets bone metastases, delivering localized radiation to cancer cells in the bone while minimizing damage to surrounding healthy tissue.
What are the most common side effects?
Common side effects include nausea, diarrhea, vomiting, swelling, and mild decreases in blood cell counts.
Can women take Radium 223 dichloride?
No, it is not indicated for use in women, especially those who are pregnant or breastfeeding, due to potential harm to the fetus or infant.
How is Radium 223 dichloride administered?
It is given as an intravenous injection by a healthcare professional, usually every 4 weeks for 6 cycles.
What should I do if I miss a dose?
Contact your healthcare provider to reschedule your appointment. Do not attempt to self-administer the medication.
Are there any special precautions after receiving Radium 223 dichloride?
Yes, follow radiation safety instructions provided by your healthcare team, such as proper hygiene and limiting close contact with others for a short period after treatment.
What happens if I take too much Radium 223 dichloride?
Radium 223 dichloride is administered by healthcare professionals, making overdose by self-administration unlikely. However, an overdose could lead to increased myelosuppression and other radiation-related toxicities. If you suspect an overdose or experience unusual symptoms, it is crucial to seek immediate emergency medical attention for appropriate management and supportive care.
Can I drink alcohol while taking Radium 223 dichloride?
While there are no direct contraindications regarding alcohol consumption with Radium 223 dichloride, it is generally advisable to limit or avoid alcohol. Alcohol can exacerbate common side effects like fatigue or nausea, and may also impact liver function, which is important for overall health during cancer treatment. Always consult your healthcare provider for personalized advice.
Is Radium 223 dichloride safe during pregnancy?
Radium 223 dichloride is not recommended for use during pregnancy due to its potential to cause fetal harm. It falls under a pregnancy category that advises against its use in pregnant women. Women of childbearing potential should use effective contraception during treatment and for a period afterward. Always consult your healthcare provider to discuss risks and alternatives.
What is the mechanism of action of Radium 223 dichloride?
Radium 223 dichloride is a targeted alpha-emitting radiopharmaceutical. It mimics calcium and selectively binds to areas of increased bone turnover, such as bone metastases. The emitted alpha particles cause double-stranded DNA breaks in adjacent tumor cells, leading to cell death while minimizing damage to surrounding healthy tissue due to the short range of alpha radiation. (2) (3)
What is the generic name of Radium 223 Dichloride?
The generic name is Radium 223 dichloride. It is sold under brand names including Ra223, Xofigo, Radionex.
What class of drug is Radium 223 dichloride?
Radium 223 Dichloride is classed as: Radiopharmaceutical, Antineoplastic Agent.
References
- Clinician-authored medicine record for Radium 223 dichlorideMedGuideGlobal · Global (internal) · accessed 2026-08-07 · source 1
- XOFIGO (radium Ra 223 dichloride) injection — FDA-approved prescribing informationU.S. FDA (via DailyMed) · United States · accessed 2026-08-03 · source 2
- XOFIGO (radium Ra 223 dichloride) injection — FDA-approved prescribing information (Bayer HealthCare)U.S. FDA (via DailyMed) · United States · accessed 2026-08-07 · source 3
- Radium Ra 223 Injection — patient drug information (MedlinePlus)U.S. National Library of Medicine (MedlinePlus) · US · accessed 2026-08-14 · source 4
- Radium 223 dichloride — RxNorm normalized drug concept (RXCUI 1424174)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 5
Brand names by country
Single-ingredient Radium 223 dichloride names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United Kingdom
- Xofigo 1100 kBq/mL solution for injection1100 kBq/mL · Bayer plc