What issues should nurses be aware of when administering denosumab to patients?

Denosumab (Prolia, Xgeva) is a monoclonal antibody that inactivates RANKL, a protein that enhances osteoclast activity and survival. By inhibiting RANKL, denosumab prevents skeletal-related events in patients with bone metastasis from solid tumors. Denosumab is not indicated for patients with multiple myeloma. Studies that compared denosumab to zolendronic acid (Reclast, Zometa) found that the time to a skeletal-related event was longer in patients who received denosumab than the time to a skeletal-related event in patients who received zolendronic acid. However, overall survival was not improved.

Patients receiving denosumab should have normal calcium levels when treatment is started and receive supplemental calcium and vitamin D as necessary. The most common adverse effects experienced by patients receiving denosumab are fatigue, asthenia, nausea, and low phosphate and calcium levels. Patients receiving denosumab should also have electrolyte monitoring and should be made aware of the risk for osteonecrosis. Denosumab has not been studied in patients on dialysis or with a creatinine clearance of less than 30 mL per minute.

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Denosumab is administered subcutaneously in the upper arm, thigh, or abdomen. The recommended dose is 120 mg subcutaneously every 4 weeks, and the drug is available in a 120 mg/1.7 mL single-use vial (Xgeva). Denosumab should be stored in a refrigerator, then warmed to room temperature in the original container for approximately 15 to 30 minutes before administration. Do not use any other methods to warm the product. ONA

Lisa Thompson is assistant professor, Department of Clinical Pharmacy, University of Colorado Denver School of Pharmacy, Aurora, Colorado.