Xgeva Dosages: Your GoodRx Guide
Key takeaways:
Xgeva (denosumab) is a prescription medication that helps promote healthier bones. It’s used to prevent bone breakdown and fractures in people who have certain types of cancer. It can also help treat high calcium levels due to cancer.
The recommended Xgeva dosage for most people is 120 mg injected under the skin every 4 weeks in your upper arm, upper thigh, or stomach. A trained healthcare professional will administer each dose to you.
There are ways to save on Xgeva. If you’re eligible, a manufacturer savings card can help you get Xgeva for as little as $0 per treatment. A patient assistance program is also available.
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Table of contents
Cancer does strange things to our bodies. And it can sometimes contribute to complications in our bones, blood, and more. Dealing with problems like these can feel overwhelming, but with supportive treatments, such as Xgeva (denosumab), some of them can be easier to manage.
Xgeva is beneficial for many health conditions related to these situations, such as certain blood cancers, giant cell bone tumors, and cancer-related hypercalcemia (high calcium levels). One of the main goals of this medication is to strengthen bones weakened by cancer (or could be weakened) to prevent possible bone breaks.
Yet, in order to work at its best, it’s important to receive the right amount of Xgeva with every dose. This foundation helps ensure that the benefits of this injectable medication are as fruitful as possible.
What’s the typical Xgeva dosage for adults?
Xgeva is administered once a month by a trained healthcare professional. They’ll be in charge of determining your specific dosage.
For most people, the typical Xgeva dosage is 120 mg injected under the skin every 4 weeks in the upper arm, upper thigh, or stomach. This recommended dosage is the same for all of the health conditions that Xgeva is approved to treat.
However, depending on what you’re using the medication for, your cancer specialist may give you additional doses of Xgeva during your first month of treatment.
Calcium and vitamin D supplementation
Xgeva is designed to slow down bone breakdown. This slowing effect causes less calcium to move from your bones to your bloodstream. Normally, the daily natural breakdown of bone is part of what keeps your calcium readings at a steady level. When this process is less active due to Xgeva, your blood calcium levels may drop too low.
It’s common to add calcium and vitamin D supplements to your regimen if your blood calcium levels drop too low at any time while you’re receiving Xgeva. You may also be asked to take them — along with magnesium supplements — before starting Xgeva if your levels are already low. Magnesium supplementation is also helpful for added bone protection.
Your cancer specialist will likely tell you how much calcium and vitamin D to take — if any. But a typical calcium dosage is at least 1,000 mg daily, and a normal vitamin D dosage is at least 400 IU (international unit) daily. Vitamin D helps your body absorb calcium.
What’s the typical Xgeva dosage for children?
Certain kids are also eligible to receive Xgeva. The medication can be given to adolescents who have giant cell bone tumors. They must also be 12 years old or older, weigh 99 lbs (45 kg) or more, and have mature bones.
The recommended dose doesn’t change, though. Xgeva dosages for adolescents like these are the same as adult dosages. The typical dose is 120 mg injected every 4 weeks under the skin in the upper arm, upper thigh, or stomach.
Good to know: Xgeva’s safety and effectiveness hasn’t been studied in children younger than 12. As a result, younger kids likely won’t receive Xgeva as part of their cancer treatment plan.
Are there any Xgeva dosage adjustments for medical conditions?
In some cases, yes. Your cancer specialist may closely monitor or adjust your Xgeva dosage if you have kidney problems or experience certain side effects from the medication.
Dosages for people with kidney problems
Xgeva has no formal dosage recommendations for people with kidney conditions. But taking Xgeva may not be as safe for people with kidney problems. This is due to its effects on blood calcium levels.
Why is this the case? Some people with chronic kidney disease have a condition called secondary hyperparathyroidism. People with secondary hyperparathyroidism depend on bone breakdown for blood calcium support more than other people. Xgeva interferes with the bone breakdown process and makes low calcium levels more likely.
If you have kidney issues and receive Xgeva, your cancer specialist may keep a closer eye on your calcium and vitamin D levels. Make sure to tell them right away if you notice any symptoms of low calcium levels yourself, such as muscle spasms, tingling in the fingers, and cramping.
Dosages for people who experience Xgeva side effects
Xgeva can cause a number of side effects. In rare cases, they can be serious.
Talk to your cancer specialist if you experience symptoms of side effects like these; if so, they may ask you to you stop your Xgeva prescription:
Serious muscle or bone pain
Symptoms of a serious infection, such as fever, chills, and a rapid heartbeat
Bone breakdown in the jaw (called osteonecrosis of the jaw), including symptoms such as jaw pain, swelling, or exposed bone
What's more, call 911 or go to the nearest ER if you experience signs or symptoms of a severe allergic reaction — such as trouble breathing or swallowing — at any point.
How do Xgeva dosages compare to Prolia dosages?
Xgeva and Prolia are different brand names of the same medication, denosumab. But they come in different dosages and are used for different health conditions.
While Xgeva doses are usually given as 120 mg injected every 4 weeks under the skin, Prolia is given less often and at a lower dose. A typical Prolia dosage is 60 mg injected under the skin once every 6 months.
Prolia has more general uses than Xgeva. It’s most often used to treat osteoporosis or bone loss caused by factors such as older age, corticosteroids, or breast and prostate cancer medications. As mentioned, Xgeva is primarily used to prevent bone fractures in people who have certain types of cancer.
What happens if you miss a dose of Xgeva?
If you’re prescribed Xgeva, it's important to stay on schedule. This will help make sure your bones are protected as much as possible. This medication is typically given once every 4 weeks, but this may vary depending on your cancer specialist’s directions.
If you miss your normal Xgeva appointment, it's important to call your cancer specialist to reschedule it as soon as possible. There are many ways to help you remember and keep track of when you should receive your Xgeva doses, such as setting phone alarms or circling the date on your home calendar.
What should you do if you take too much Xgeva?
Thankfully, most people won’t end up receiving too much Xgeva. This medication is typically administered by your cancer specialist, so it’s unlikely you’ll be given too much medication. They’ll be in charge of preparing your dose and giving you the right amount of medicine every time.
There isn’t much information available about the consequences of receiving too much Xgeva. But in theory, Xgeva side effects may be more likely to happen if you do. Contact your cancer specialist right away if you’re experiencing new or worsening side effects that may be related to Xgeva.
How to save on Xgeva
There are ways to save on Xgeva, which is available as a reference (“brand-name”) medication. GoodRx can help you navigate between patient assistance programs and copay savings cards to save money on your prescription.
Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $0 for Xgeva using a savings card from the manufacturer.
Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Xgeva’s patient assistance program, which offers the medication free of charge.
The first biosimilar to Xgeva, called Wyost (denosumab-bbdz), was also approved in early March 2024. Biosimilars are highly comparable in safety and effectiveness to a reference biologic. But, at this time, Wyost’s launch date isn’t entirely clear.
The bottom line
Xgeva (denosumab) is an injectable medication given under the skin to treat and prevent bone problems from certain types of cancer. The typical Xgeva dosage for adults is 120 mg given every 4 weeks. In some cases, you may receive additional doses during your first month of treatment. Your cancer specialist will inject Xgeva under the skin in your upper arm, upper thigh, or stomach. Certain children can also receive this dose if they’re over the age of 12, weigh over 99 lbs, and have mature bones. If you have kidney problems or experience side effects related to Xgeva, your cancer specialist may adjust your dose or monitor you extra closely. Ask your cancer specialist about the best way to receive Xgeva.
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References
Amgen Inc. (2020). Xgeva [package insert]. DailyMed.
Bleizgys, A. (2021). Vitamin D dosing: Basic principles and a brief algorithm (2021 update). Nutrients.
Cavallo, F., et al. (2021). Evaluation of bone age in children: A mini-review. Frontiers in Pediatrics.
Fong, J., et al. (2012). Hypocalcemia: Updates in diagnosis and management for primary care. Canadian Family Physician.
Khazai, N., et al. (2008). Calcium and vitamin D: Skeletal and extraskeletal health. Current Rheumatology Reports.
Laskowski, L. K., et al. (2016). A RANKL wrinkle: Denosumab-induced hypocalcemia. Journal of Medical Toxicology.
National Kidney Foundation. (n.d.). Secondary hyperparathyroidism.
U.S. Food and Drug Administration. (2024). FDA approves first interchangeable biosimilars to Prolia and Xgeva to treat certain types of osteoporosis and prevent bone events in cancer.
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